Rheumatoid Arthritis

Many people with rheumatoid arthritis (RA) have concomitant hand osteoarthritis (OA). This Swiss cohort study by Lechtenboehmer et al¹ using a longitudinal registry of RA patients examined characteristics of RA patients who had progression of radiographic hand OA. Of over 1,300 patients who had radiographic distal interphalangeal (DIP) OA at baseline, a substantial fraction had progression of OA with osteophyte formation, joint space narrowing, and subchondral sclerosis. In subgroup analysis, biologic disease-modifying antirheumatic drug (bDMARD) use was associated with osteophyte formation, while of nearly 900 patients without radiographic OA at baseline, bDMARD use was not associated with development of DIP OA. While the authors postulate that this may be due to osteoanabolic effects of bDMARDs, in this real-world analysis the association does not imply a causative role for bDMARDs as additional confounders may exist and the onset/timing of progression is unknown. Still, the association deserves attention in controlled and long-term studies.

Another condition known to affect older adults is sarcopenia; in addition to aging, poor nutrition, lack of exercise, and autoimmune disease are thought to contribute to sarcopenia. RA is associated with an increased risk of sarcopenia. A cross-sectional study of cohort of Japanese women by Minamino et al.² of RA examines the potential relationship between 25-OH vitamin D levels and sarcopenia. Participants were over the age of 60 and not taking vitamin D supplements. Low vitamin D levels, as well as age, 28-Joint RA Disease Activity Score (DAS-28), and health assessment questionnaire disability index (HAQ), were associated with the prevalence of severe sarcopenia, including the separate components of muscle mass, physical performance, and strength. Although this does not prove causation, the known decrease in vitamin D receptors in muscle nuclei with aging lends pathophysiologic support to vitamin D’s role in sarcopenia. Whether this plays a larger role in RA-related sarcopenia also remains to be seen.

Several recent studies have expanded our awareness of respiratory illness and exposure outside of cigarette smoking as potentially associated with RA risk. This single-center case control study by Kronzer et al³ looked at respiratory disease diagnosis (based on ICD10 code) at least two years prior to RA diagnosis. Acute and chronic sinusitis, as well as pharyngitis, were associated with increased risk of RA, even adjusting for the known risk of smoking, raising the possibility of a role for the upper respiratory mucosa in RA pathogenesis. Whether this association is a sign of immune dysregulation instead or a result of other respiratory exposures is a question that should be further investigated given this growing body of evidence of respiratory involvement in RA pathogenesis.

In terms of other factors that influence the development of autoimmune disease, there is evidence of the involvement of the gut microbiome in RA pathogenesis, as well as public interest in the possibility of an optimal diet, such as the “Mediterranean diet” for control of arthritis symptoms. The recent Swedish crossover Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA) study by Turesson Wadell et al⁴ examined effects of a “typical” and “anti-inflammatory” diet with whole grains, fruits, nuts, legumes, fatty fish, and probiotics in patients with RA. Prior work suggested that the anti-inflammatory diet was associated with lower RA disease activity and inflammatory markers. Only 44 patients completed the 10 week study, perhaps contributing to the lack of differences seen in functional measures, pain, fatigue, and morning stiffness at the end of the intervention. Changes in medications may have masked dietary effects in this small study and a longer study period may be necessary to assess effects. Given the lack of evidence in this area, further research is of course needed, but this study represents an initial attempt at rigorous examination and could be suggested to interested and motivated patients as generally safe.

References

1. Lechtenboehmer CA et al. Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis. Arthritis Res Ther. 2021;23:267 (Oct 26).
2. Minamino H et al. Serum vitamin D status inversely associates with a prevalence of severe sarcopenia among female patients with rheumatoid arthritis. Sci Rep. 2021;11:20485 (Oct 14).
3. Kronzer VL et al. Association of sinusitis and upper respiratory tract diseases with incident rheumatoid arthritis: A case-control study. J Rheumatol 2021(Oct 15).
4. Turesson Wadell A et al. Effects on health-related quality of life in the randomized, controlled crossover trial ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis). PLoS One. 2021(Oct 14).

Many people with rheumatoid arthritis (RA) have concomitant hand osteoarthritis (OA). This Swiss cohort study by Lechtenboehmer et al¹ using a longitudinal registry of RA patients examined characteristics of RA patients who had progression of radiographic hand OA. Of over 1,300 patients who had radiographic distal interphalangeal (DIP) OA at baseline, a substantial fraction had progression of OA with osteophyte formation, joint space narrowing, and subchondral sclerosis. In subgroup analysis, biologic disease-modifying antirheumatic drug (bDMARD) use was associated with osteophyte formation, while of nearly 900 patients without radiographic OA at baseline, bDMARD use was not associated with development of DIP OA. While the authors postulate that this may be due to osteoanabolic effects of bDMARDs, in this real-world analysis the association does not imply a causative role for bDMARDs as additional confounders may exist and the onset/timing of progression is unknown. Still, the association deserves attention in controlled and long-term studies.

Another condition known to affect older adults is sarcopenia; in addition to aging, poor nutrition, lack of exercise, and autoimmune disease are thought to contribute to sarcopenia. RA is associated with an increased risk of sarcopenia. A cross-sectional study of cohort of Japanese women by Minamino et al.² of RA examines the potential relationship between 25-OH vitamin D levels and sarcopenia. Participants were over the age of 60 and not taking vitamin D supplements. Low vitamin D levels, as well as age, 28-Joint RA Disease Activity Score (DAS-28), and health assessment questionnaire disability index (HAQ), were associated with the prevalence of severe sarcopenia, including the separate components of muscle mass, physical performance, and strength. Although this does not prove causation, the known decrease in vitamin D receptors in muscle nuclei with aging lends pathophysiologic support to vitamin D’s role in sarcopenia. Whether this plays a larger role in RA-related sarcopenia also remains to be seen.

Several recent studies have expanded our awareness of respiratory illness and exposure outside of cigarette smoking as potentially associated with RA risk. This single-center case control study by Kronzer et al³ looked at respiratory disease diagnosis (based on ICD10 code) at least two years prior to RA diagnosis. Acute and chronic sinusitis, as well as pharyngitis, were associated with increased risk of RA, even adjusting for the known risk of smoking, raising the possibility of a role for the upper respiratory mucosa in RA pathogenesis. Whether this association is a sign of immune dysregulation instead or a result of other respiratory exposures is a question that should be further investigated given this growing body of evidence of respiratory involvement in RA pathogenesis.

In terms of other factors that influence the development of autoimmune disease, there is evidence of the involvement of the gut microbiome in RA pathogenesis, as well as public interest in the possibility of an optimal diet, such as the “Mediterranean diet” for control of arthritis symptoms. The recent Swedish crossover Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA) study by Turesson Wadell et al⁴ examined effects of a “typical” and “anti-inflammatory” diet with whole grains, fruits, nuts, legumes, fatty fish, and probiotics in patients with RA. Prior work suggested that the anti-inflammatory diet was associated with lower RA disease activity and inflammatory markers. Only 44 patients completed the 10 week study, perhaps contributing to the lack of differences seen in functional measures, pain, fatigue, and morning stiffness at the end of the intervention. Changes in medications may have masked dietary effects in this small study and a longer study period may be necessary to assess effects. Given the lack of evidence in this area, further research is of course needed, but this study represents an initial attempt at rigorous examination and could be suggested to interested and motivated patients as generally safe.

References

1. Lechtenboehmer CA et al. Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis. Arthritis Res Ther. 2021;23:267 (Oct 26).
2. Minamino H et al. Serum vitamin D status inversely associates with a prevalence of severe sarcopenia among female patients with rheumatoid arthritis. Sci Rep. 2021;11:20485 (Oct 14).
3. Kronzer VL et al. Association of sinusitis and upper respiratory tract diseases with incident rheumatoid arthritis: A case-control study. J Rheumatol 2021(Oct 15).
4. Turesson Wadell A et al. Effects on health-related quality of life in the randomized, controlled crossover trial ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis). PLoS One. 2021(Oct 14).

Many people with rheumatoid arthritis (RA) have concomitant hand osteoarthritis (OA). This Swiss cohort study by Lechtenboehmer et al¹ using a longitudinal registry of RA patients examined characteristics of RA patients who had progression of radiographic hand OA. Of over 1,300 patients who had radiographic distal interphalangeal (DIP) OA at baseline, a substantial fraction had progression of OA with osteophyte formation, joint space narrowing, and subchondral sclerosis. In subgroup analysis, biologic disease-modifying antirheumatic drug (bDMARD) use was associated with osteophyte formation, while of nearly 900 patients without radiographic OA at baseline, bDMARD use was not associated with development of DIP OA. While the authors postulate that this may be due to osteoanabolic effects of bDMARDs, in this real-world analysis the association does not imply a causative role for bDMARDs as additional confounders may exist and the onset/timing of progression is unknown. Still, the association deserves attention in controlled and long-term studies.

Another condition known to affect older adults is sarcopenia; in addition to aging, poor nutrition, lack of exercise, and autoimmune disease are thought to contribute to sarcopenia. RA is associated with an increased risk of sarcopenia. A cross-sectional study of cohort of Japanese women by Minamino et al.² of RA examines the potential relationship between 25-OH vitamin D levels and sarcopenia. Participants were over the age of 60 and not taking vitamin D supplements. Low vitamin D levels, as well as age, 28-Joint RA Disease Activity Score (DAS-28), and health assessment questionnaire disability index (HAQ), were associated with the prevalence of severe sarcopenia, including the separate components of muscle mass, physical performance, and strength. Although this does not prove causation, the known decrease in vitamin D receptors in muscle nuclei with aging lends pathophysiologic support to vitamin D’s role in sarcopenia. Whether this plays a larger role in RA-related sarcopenia also remains to be seen.

Several recent studies have expanded our awareness of respiratory illness and exposure outside of cigarette smoking as potentially associated with RA risk. This single-center case control study by Kronzer et al³ looked at respiratory disease diagnosis (based on ICD10 code) at least two years prior to RA diagnosis. Acute and chronic sinusitis, as well as pharyngitis, were associated with increased risk of RA, even adjusting for the known risk of smoking, raising the possibility of a role for the upper respiratory mucosa in RA pathogenesis. Whether this association is a sign of immune dysregulation instead or a result of other respiratory exposures is a question that should be further investigated given this growing body of evidence of respiratory involvement in RA pathogenesis.

In terms of other factors that influence the development of autoimmune disease, there is evidence of the involvement of the gut microbiome in RA pathogenesis, as well as public interest in the possibility of an optimal diet, such as the “Mediterranean diet” for control of arthritis symptoms. The recent Swedish crossover Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA) study by Turesson Wadell et al⁴ examined effects of a “typical” and “anti-inflammatory” diet with whole grains, fruits, nuts, legumes, fatty fish, and probiotics in patients with RA. Prior work suggested that the anti-inflammatory diet was associated with lower RA disease activity and inflammatory markers. Only 44 patients completed the 10 week study, perhaps contributing to the lack of differences seen in functional measures, pain, fatigue, and morning stiffness at the end of the intervention. Changes in medications may have masked dietary effects in this small study and a longer study period may be necessary to assess effects. Given the lack of evidence in this area, further research is of course needed, but this study represents an initial attempt at rigorous examination and could be suggested to interested and motivated patients as generally safe.

References

1. Lechtenboehmer CA et al. Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis. Arthritis Res Ther. 2021;23:267 (Oct 26).
2. Minamino H et al. Serum vitamin D status inversely associates with a prevalence of severe sarcopenia among female patients with rheumatoid arthritis. Sci Rep. 2021;11:20485 (Oct 14).
3. Kronzer VL et al. Association of sinusitis and upper respiratory tract diseases with incident rheumatoid arthritis: A case-control study. J Rheumatol 2021(Oct 15).
4. Turesson Wadell A et al. Effects on health-related quality of life in the randomized, controlled crossover trial ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis). PLoS One. 2021(Oct 14).

Key clinical point: Vitamin D status was inversely associated with severe sarcopenia, impaired physical performance, and decreased skeletal muscle mass in females with rheumatoid arthritis (RA), highlighting the need to investigate vitamin D supplementation as a therapeutic strategy for sarcopenic patients with RA.

Major finding: Low 25-hydroxyvitamin D (25[OH])D status (16.0 ng/mL or lower) was significantly associated with a high prevalence of severe sarcopenia (adjusted odds ratio [aOR], 6.00; P = .0006) in females with RA. Low physical performance (aOR, 2.65; P = .0043) and skeletal muscle mass (aOR, 2.54; P = .027) were the major components of sarcopenia linked with a low serum 25(OH)D level.

Study details: This was a cross-sectional study involving 156 female outpatients with RA.

Disclosures: This study was funded by AMED and Daiichi Sankyo Co. Ltd. Several authors reported receiving research grants and speaker’s fees from various sources including Daiichi Sankyo. Some of the authors including the lead author declared no conflict of interests.

Source: Minamino H et al. Sci Rep. 2021 Oct 14. doi: 10.1038/s41598-021-99894-6.

Key clinical point: Vitamin D status was inversely associated with severe sarcopenia, impaired physical performance, and decreased skeletal muscle mass in females with rheumatoid arthritis (RA), highlighting the need to investigate vitamin D supplementation as a therapeutic strategy for sarcopenic patients with RA.

Major finding: Low 25-hydroxyvitamin D (25[OH])D status (16.0 ng/mL or lower) was significantly associated with a high prevalence of severe sarcopenia (adjusted odds ratio [aOR], 6.00; P = .0006) in females with RA. Low physical performance (aOR, 2.65; P = .0043) and skeletal muscle mass (aOR, 2.54; P = .027) were the major components of sarcopenia linked with a low serum 25(OH)D level.

Study details: This was a cross-sectional study involving 156 female outpatients with RA.

Disclosures: This study was funded by AMED and Daiichi Sankyo Co. Ltd. Several authors reported receiving research grants and speaker’s fees from various sources including Daiichi Sankyo. Some of the authors including the lead author declared no conflict of interests.

Source: Minamino H et al. Sci Rep. 2021 Oct 14. doi: 10.1038/s41598-021-99894-6.

Key clinical point: Vitamin D status was inversely associated with severe sarcopenia, impaired physical performance, and decreased skeletal muscle mass in females with rheumatoid arthritis (RA), highlighting the need to investigate vitamin D supplementation as a therapeutic strategy for sarcopenic patients with RA.

Major finding: Low 25-hydroxyvitamin D (25[OH])D status (16.0 ng/mL or lower) was significantly associated with a high prevalence of severe sarcopenia (adjusted odds ratio [aOR], 6.00; P = .0006) in females with RA. Low physical performance (aOR, 2.65; P = .0043) and skeletal muscle mass (aOR, 2.54; P = .027) were the major components of sarcopenia linked with a low serum 25(OH)D level.

Study details: This was a cross-sectional study involving 156 female outpatients with RA.

Disclosures: This study was funded by AMED and Daiichi Sankyo Co. Ltd. Several authors reported receiving research grants and speaker’s fees from various sources including Daiichi Sankyo. Some of the authors including the lead author declared no conflict of interests.

Source: Minamino H et al. Sci Rep. 2021 Oct 14. doi: 10.1038/s41598-021-99894-6.

Key clinical point: The anti-inflammatory diet did not enhance health-related quality of life in patients with rheumatoid arthritis (RA) compared with a control diet. However, physical functioning improved significantly, particularly in patients who did not alter antirheumatic medication.

Major finding: The Health Assessment Questionnaire was not significantly different between the intervention and control diet periods (P = .503); however, the physical functioning improved significantly during intervention diet vs. control diet period (mean, 5.791; 95% CI, 1.576-10.005), particularly in patients without pharmacological treatment changes (mean, 7.898; P = .036).

Study details: Findings are from the ADIRA trial, a controlled crossover trial including 50 patients with RA who were randomly assigned to either an intervention diet including foods with suggested anti-inflammatory properties and promising effects on RA symptoms (n=24) or control diet (usual Swedish diet; n=26) for 10 weeks before switching to the other diet.

Disclosures: This study received grants from the Swedish government, Swedish Research Council for Health, Working Life and Welfare, and others. No conflict of interests was reported.

Source: Turesson Wadell A et al. PLoS One. 2021 Oct 14. doi: 10.1371/journal.pone.0258716.

Key clinical point: The anti-inflammatory diet did not enhance health-related quality of life in patients with rheumatoid arthritis (RA) compared with a control diet. However, physical functioning improved significantly, particularly in patients who did not alter antirheumatic medication.

Major finding: The Health Assessment Questionnaire was not significantly different between the intervention and control diet periods (P = .503); however, the physical functioning improved significantly during intervention diet vs. control diet period (mean, 5.791; 95% CI, 1.576-10.005), particularly in patients without pharmacological treatment changes (mean, 7.898; P = .036).

Study details: Findings are from the ADIRA trial, a controlled crossover trial including 50 patients with RA who were randomly assigned to either an intervention diet including foods with suggested anti-inflammatory properties and promising effects on RA symptoms (n=24) or control diet (usual Swedish diet; n=26) for 10 weeks before switching to the other diet.

Disclosures: This study received grants from the Swedish government, Swedish Research Council for Health, Working Life and Welfare, and others. No conflict of interests was reported.

Source: Turesson Wadell A et al. PLoS One. 2021 Oct 14. doi: 10.1371/journal.pone.0258716.

Key clinical point: The anti-inflammatory diet did not enhance health-related quality of life in patients with rheumatoid arthritis (RA) compared with a control diet. However, physical functioning improved significantly, particularly in patients who did not alter antirheumatic medication.

Major finding: The Health Assessment Questionnaire was not significantly different between the intervention and control diet periods (P = .503); however, the physical functioning improved significantly during intervention diet vs. control diet period (mean, 5.791; 95% CI, 1.576-10.005), particularly in patients without pharmacological treatment changes (mean, 7.898; P = .036).

Study details: Findings are from the ADIRA trial, a controlled crossover trial including 50 patients with RA who were randomly assigned to either an intervention diet including foods with suggested anti-inflammatory properties and promising effects on RA symptoms (n=24) or control diet (usual Swedish diet; n=26) for 10 weeks before switching to the other diet.

Disclosures: This study received grants from the Swedish government, Swedish Research Council for Health, Working Life and Welfare, and others. No conflict of interests was reported.

Source: Turesson Wadell A et al. PLoS One. 2021 Oct 14. doi: 10.1371/journal.pone.0258716.

Key clinical point: Sinusitis, pharyngitis, and acute respiratory burden all raised the likelihood of developing rheumatoid arthritis (RA).

Major finding: Acute sinusitis (odds ratio [OR], 1.61; 95% CI, 1.05-2.45), chronic sinusitis (OR, 2.16; 95% CI, 1.39-3.35), asthma (OR, 1.39; 95% CI, 1.03-1.87), and burden of acute respiratory tract disease during the preindex exposure period (OR, 1.30 per 10 codes; 95% CI, 1.08-1.55) were associated with an elevated risk for RA. Acute pharyngitis was associated with seronegative RA (OR, 1.68; 95% CI, 1.02-2.74), whereas chronic rhinitis/pharyngitis was associated with seropositive RA (OR, 2.46; 95% CI, 1.01-5.99).

Study details: This was a case-control study involving 741 patients with RA matched with 2,223 healthy controls.

Disclosures: The National Institute of Arthritis and Musculoskeletal and Skin Diseases and Rheumatology Research Foundation funded this research. No conflict of interests was reported.

Source: Kronzer VL et al. J Rheumatol. 2021 Oct 15. doi: 10.3899/jrheum.210580.

Key clinical point: Sinusitis, pharyngitis, and acute respiratory burden all raised the likelihood of developing rheumatoid arthritis (RA).

Major finding: Acute sinusitis (odds ratio [OR], 1.61; 95% CI, 1.05-2.45), chronic sinusitis (OR, 2.16; 95% CI, 1.39-3.35), asthma (OR, 1.39; 95% CI, 1.03-1.87), and burden of acute respiratory tract disease during the preindex exposure period (OR, 1.30 per 10 codes; 95% CI, 1.08-1.55) were associated with an elevated risk for RA. Acute pharyngitis was associated with seronegative RA (OR, 1.68; 95% CI, 1.02-2.74), whereas chronic rhinitis/pharyngitis was associated with seropositive RA (OR, 2.46; 95% CI, 1.01-5.99).

Study details: This was a case-control study involving 741 patients with RA matched with 2,223 healthy controls.

Disclosures: The National Institute of Arthritis and Musculoskeletal and Skin Diseases and Rheumatology Research Foundation funded this research. No conflict of interests was reported.

Source: Kronzer VL et al. J Rheumatol. 2021 Oct 15. doi: 10.3899/jrheum.210580.

Key clinical point: Sinusitis, pharyngitis, and acute respiratory burden all raised the likelihood of developing rheumatoid arthritis (RA).

Major finding: Acute sinusitis (odds ratio [OR], 1.61; 95% CI, 1.05-2.45), chronic sinusitis (OR, 2.16; 95% CI, 1.39-3.35), asthma (OR, 1.39; 95% CI, 1.03-1.87), and burden of acute respiratory tract disease during the preindex exposure period (OR, 1.30 per 10 codes; 95% CI, 1.08-1.55) were associated with an elevated risk for RA. Acute pharyngitis was associated with seronegative RA (OR, 1.68; 95% CI, 1.02-2.74), whereas chronic rhinitis/pharyngitis was associated with seropositive RA (OR, 2.46; 95% CI, 1.01-5.99).

Study details: This was a case-control study involving 741 patients with RA matched with 2,223 healthy controls.

Disclosures: The National Institute of Arthritis and Musculoskeletal and Skin Diseases and Rheumatology Research Foundation funded this research. No conflict of interests was reported.

Source: Kronzer VL et al. J Rheumatol. 2021 Oct 15. doi: 10.3899/jrheum.210580.

Key clinical point: Filgotinib 200 mg (FIL200) and 100 mg (FIL100) showed similar safety/tolerability in patients with moderate-to-severe rheumatoid arthritis (RA) with over a median of 1.6 years and maximum of 5.6 years of exposure, with FIL200 showing a lower infection rate in the long term.

Major finding: Treatment-emergent adverse events (TEAEs) were similar between FIL200 (exposure-adjusted incidence rate [EAIR], 195.4 per 100 patient-years of exposure [100 PYE]), FIL100 (176.3 per 100 PYE), and placebo (175.9 per 100 PYE) during the 12-week period. During long-term exposure, EAIR for grade ≥3 TEAEs were 6.4 and 7.6 per 100 PYE for FIL200 and FIL100, respectively, but serious infectious AEs were lower with FIL200 vs. FIL100 (EAIR, 1.6 vs. 3.1 per 100 PYE).

Study details: Data come from integrated analysis of 7 clinical trials including patients with moderate-to-severe RA who received ≥1 dose of FIL200, FIL100, or placebo.

Disclosures: This study was funded by Gilead Sciences, Inc. Some investigators including the lead author reported receiving grants, honoraria, consultancy/speaker’s fees, and being an employee of or shareholder of various sources including Gilead Sciences.

Source: Winthrop KL et al. Ann Rheum Dis. 2021 Nov 5. doi: 10.1136/annrheumdis-2021-221051.

Key clinical point: Filgotinib 200 mg (FIL200) and 100 mg (FIL100) showed similar safety/tolerability in patients with moderate-to-severe rheumatoid arthritis (RA) with over a median of 1.6 years and maximum of 5.6 years of exposure, with FIL200 showing a lower infection rate in the long term.

Major finding: Treatment-emergent adverse events (TEAEs) were similar between FIL200 (exposure-adjusted incidence rate [EAIR], 195.4 per 100 patient-years of exposure [100 PYE]), FIL100 (176.3 per 100 PYE), and placebo (175.9 per 100 PYE) during the 12-week period. During long-term exposure, EAIR for grade ≥3 TEAEs were 6.4 and 7.6 per 100 PYE for FIL200 and FIL100, respectively, but serious infectious AEs were lower with FIL200 vs. FIL100 (EAIR, 1.6 vs. 3.1 per 100 PYE).

Study details: Data come from integrated analysis of 7 clinical trials including patients with moderate-to-severe RA who received ≥1 dose of FIL200, FIL100, or placebo.

Disclosures: This study was funded by Gilead Sciences, Inc. Some investigators including the lead author reported receiving grants, honoraria, consultancy/speaker’s fees, and being an employee of or shareholder of various sources including Gilead Sciences.

Source: Winthrop KL et al. Ann Rheum Dis. 2021 Nov 5. doi: 10.1136/annrheumdis-2021-221051.

Key clinical point: Filgotinib 200 mg (FIL200) and 100 mg (FIL100) showed similar safety/tolerability in patients with moderate-to-severe rheumatoid arthritis (RA) with over a median of 1.6 years and maximum of 5.6 years of exposure, with FIL200 showing a lower infection rate in the long term.

Major finding: Treatment-emergent adverse events (TEAEs) were similar between FIL200 (exposure-adjusted incidence rate [EAIR], 195.4 per 100 patient-years of exposure [100 PYE]), FIL100 (176.3 per 100 PYE), and placebo (175.9 per 100 PYE) during the 12-week period. During long-term exposure, EAIR for grade ≥3 TEAEs were 6.4 and 7.6 per 100 PYE for FIL200 and FIL100, respectively, but serious infectious AEs were lower with FIL200 vs. FIL100 (EAIR, 1.6 vs. 3.1 per 100 PYE).

Study details: Data come from integrated analysis of 7 clinical trials including patients with moderate-to-severe RA who received ≥1 dose of FIL200, FIL100, or placebo.

Disclosures: This study was funded by Gilead Sciences, Inc. Some investigators including the lead author reported receiving grants, honoraria, consultancy/speaker’s fees, and being an employee of or shareholder of various sources including Gilead Sciences.

Source: Winthrop KL et al. Ann Rheum Dis. 2021 Nov 5. doi: 10.1136/annrheumdis-2021-221051.

Key clinical point: Obesity, anxiety, depression, and illness perception at baseline were associated with treatment outcomes, pain, and fatigue in patients with rheumatoid arthritis (RA).

Major finding: At 12 months, obesity vs. normal weight was associated with a lower likelihood of remission (adjusted odds ratio [aOR], 0.33; P=.005). Obesity and illness perception were significantly associated with pain (aOR, 8.16; P = .002 and aOR, 0.62; P < .001, respectively) and fatigue (aOR, 5.66; P = .049 and aOR, 0.51; P = .001, respectively) with patients with severe vs. no anxiety having higher pain (aOR, 9.60; P = .010) and those with severe (aOR, 17.07; P < .001) and moderate (aOR, 10.13; P = .001) depression having higher fatigue.

Study details: This secondary analysis of the TITRATE trial included 335 patients with RA treated with intensive management (n=168) or standard care (n=167).

Disclosures: This study was funded by the National Institute for Health Research. E Nikiphorou received speaker fees and served on advisory boards for various sources. Other authors declared no competing interest.

Source: Lee SY et al. Arthritis Res Ther. 2021 Nov 4. doi: 10.1186/s13075-021-02653-1.

Key clinical point: Obesity, anxiety, depression, and illness perception at baseline were associated with treatment outcomes, pain, and fatigue in patients with rheumatoid arthritis (RA).

Major finding: At 12 months, obesity vs. normal weight was associated with a lower likelihood of remission (adjusted odds ratio [aOR], 0.33; P=.005). Obesity and illness perception were significantly associated with pain (aOR, 8.16; P = .002 and aOR, 0.62; P < .001, respectively) and fatigue (aOR, 5.66; P = .049 and aOR, 0.51; P = .001, respectively) with patients with severe vs. no anxiety having higher pain (aOR, 9.60; P = .010) and those with severe (aOR, 17.07; P < .001) and moderate (aOR, 10.13; P = .001) depression having higher fatigue.

Study details: This secondary analysis of the TITRATE trial included 335 patients with RA treated with intensive management (n=168) or standard care (n=167).

Disclosures: This study was funded by the National Institute for Health Research. E Nikiphorou received speaker fees and served on advisory boards for various sources. Other authors declared no competing interest.

Source: Lee SY et al. Arthritis Res Ther. 2021 Nov 4. doi: 10.1186/s13075-021-02653-1.

Key clinical point: Obesity, anxiety, depression, and illness perception at baseline were associated with treatment outcomes, pain, and fatigue in patients with rheumatoid arthritis (RA).

Major finding: At 12 months, obesity vs. normal weight was associated with a lower likelihood of remission (adjusted odds ratio [aOR], 0.33; P=.005). Obesity and illness perception were significantly associated with pain (aOR, 8.16; P = .002 and aOR, 0.62; P < .001, respectively) and fatigue (aOR, 5.66; P = .049 and aOR, 0.51; P = .001, respectively) with patients with severe vs. no anxiety having higher pain (aOR, 9.60; P = .010) and those with severe (aOR, 17.07; P < .001) and moderate (aOR, 10.13; P = .001) depression having higher fatigue.

Study details: This secondary analysis of the TITRATE trial included 335 patients with RA treated with intensive management (n=168) or standard care (n=167).

Disclosures: This study was funded by the National Institute for Health Research. E Nikiphorou received speaker fees and served on advisory boards for various sources. Other authors declared no competing interest.

Source: Lee SY et al. Arthritis Res Ther. 2021 Nov 4. doi: 10.1186/s13075-021-02653-1.

Key clinical point: Certolizumab (CTZ) monotherapy seemed as effective as combination therapy with methotrexate (MTX) or leflunomide (LFN) or MTX+LFN in patients with rheumatoid arthritis (RA) who failed previous conventional synthetic disease-modifying antirheumatic drugs (csDMARD) therapy.

Major finding: Overall, 63% of patients were in remission or showed low disease activity (LDA) within 3 months of follow-up, with no difference between groups (P = .080). Most patients maintained response at 12 months, with remission or LDA achieved by 94.4%, 81.8%, 80.5%, and 51.4% of patients receiving CTZ monotherapy, CTZ+MTX, CTZ+LFN, and MTX+LFN, respectively (P = .001).

Study details: This was a retrospective cohort study of 181 patients with RA who were treated for a minimum of 3 months with certolizumab as monotherapy (n=24) or in combination with MTX (n=62), LFN (n=47) or MTX+LFN (n=48).

Disclosures: No information on funding was provided. P Santos-Moreno and A Rojas-Villarrage received fees for conferences, counseling, advisory boards, or travel expenses and research grants from various sources.

Source: Santos-Moreno P et al. Biologics. 2021 Oct 22. doi: 10.2147/BTT.S322860.

Key clinical point: Certolizumab (CTZ) monotherapy seemed as effective as combination therapy with methotrexate (MTX) or leflunomide (LFN) or MTX+LFN in patients with rheumatoid arthritis (RA) who failed previous conventional synthetic disease-modifying antirheumatic drugs (csDMARD) therapy.

Major finding: Overall, 63% of patients were in remission or showed low disease activity (LDA) within 3 months of follow-up, with no difference between groups (P = .080). Most patients maintained response at 12 months, with remission or LDA achieved by 94.4%, 81.8%, 80.5%, and 51.4% of patients receiving CTZ monotherapy, CTZ+MTX, CTZ+LFN, and MTX+LFN, respectively (P = .001).

Study details: This was a retrospective cohort study of 181 patients with RA who were treated for a minimum of 3 months with certolizumab as monotherapy (n=24) or in combination with MTX (n=62), LFN (n=47) or MTX+LFN (n=48).

Disclosures: No information on funding was provided. P Santos-Moreno and A Rojas-Villarrage received fees for conferences, counseling, advisory boards, or travel expenses and research grants from various sources.

Source: Santos-Moreno P et al. Biologics. 2021 Oct 22. doi: 10.2147/BTT.S322860.

Key clinical point: Certolizumab (CTZ) monotherapy seemed as effective as combination therapy with methotrexate (MTX) or leflunomide (LFN) or MTX+LFN in patients with rheumatoid arthritis (RA) who failed previous conventional synthetic disease-modifying antirheumatic drugs (csDMARD) therapy.

Major finding: Overall, 63% of patients were in remission or showed low disease activity (LDA) within 3 months of follow-up, with no difference between groups (P = .080). Most patients maintained response at 12 months, with remission or LDA achieved by 94.4%, 81.8%, 80.5%, and 51.4% of patients receiving CTZ monotherapy, CTZ+MTX, CTZ+LFN, and MTX+LFN, respectively (P = .001).

Study details: This was a retrospective cohort study of 181 patients with RA who were treated for a minimum of 3 months with certolizumab as monotherapy (n=24) or in combination with MTX (n=62), LFN (n=47) or MTX+LFN (n=48).

Disclosures: No information on funding was provided. P Santos-Moreno and A Rojas-Villarrage received fees for conferences, counseling, advisory boards, or travel expenses and research grants from various sources.

Source: Santos-Moreno P et al. Biologics. 2021 Oct 22. doi: 10.2147/BTT.S322860.

Key clinical point: Elevated T helper (Th)1, Th17, or Th1/T-regulatory (Treg) cell frequencies in the peripheral blood were significantly associated with the development of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA).

Major finding: The percentage of Th1 cells (adjusted odds ratio [aOR], 1.05; P = .0027], absolute number of Th17 cells (aOR, 1.11; P = .0046), and ratio of Th1/Treg (aOR, 1.08; P = .0374) were significantly associated with AF development in RA.

Study details: This was a retrospective case-control study of 40 patients with RA and AF who were propensity matched (1:3) with 120 control patients with RA.

Disclosures: This work was supported by the National Natural Science Foundation of China and the Excellent Youth Foundation of Shanxi Province. No conflict of interests was reported.

Source: Wang X et al. Front Immunol. 2021 Oct 15. doi: 10.3389/fimmu.2021.744254.

Key clinical point: Elevated T helper (Th)1, Th17, or Th1/T-regulatory (Treg) cell frequencies in the peripheral blood were significantly associated with the development of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA).

Major finding: The percentage of Th1 cells (adjusted odds ratio [aOR], 1.05; P = .0027], absolute number of Th17 cells (aOR, 1.11; P = .0046), and ratio of Th1/Treg (aOR, 1.08; P = .0374) were significantly associated with AF development in RA.

Study details: This was a retrospective case-control study of 40 patients with RA and AF who were propensity matched (1:3) with 120 control patients with RA.

Disclosures: This work was supported by the National Natural Science Foundation of China and the Excellent Youth Foundation of Shanxi Province. No conflict of interests was reported.

Source: Wang X et al. Front Immunol. 2021 Oct 15. doi: 10.3389/fimmu.2021.744254.

Key clinical point: Elevated T helper (Th)1, Th17, or Th1/T-regulatory (Treg) cell frequencies in the peripheral blood were significantly associated with the development of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA).

Major finding: The percentage of Th1 cells (adjusted odds ratio [aOR], 1.05; P = .0027], absolute number of Th17 cells (aOR, 1.11; P = .0046), and ratio of Th1/Treg (aOR, 1.08; P = .0374) were significantly associated with AF development in RA.

Study details: This was a retrospective case-control study of 40 patients with RA and AF who were propensity matched (1:3) with 120 control patients with RA.

Disclosures: This work was supported by the National Natural Science Foundation of China and the Excellent Youth Foundation of Shanxi Province. No conflict of interests was reported.

Source: Wang X et al. Front Immunol. 2021 Oct 15. doi: 10.3389/fimmu.2021.744254.

Key clinical point: Baricitinib maintained a stable safety profile with no new safety signals even with long-term exposure of up to 9.3 years in patients with active rheumatoid arthritis (RA).

Major finding: Incidence rates (IRs) per 100 patient-years at risk for serious infections (incidence ratio [IR], 2.6; 95% CI, 2.33-2.86), herpes zoster (IR, 3.0; 95% CI, 2.70-3.28), major adverse cardiovascular events (IR, 0.5; 95% CI, 0.40-0.64), and malignancies excluding nonmelanoma skin cancer (IR, 0.9; 95% CI, 0.77-1.09) remained stable from previous report.

Study details: This was an integrated analysis of 9 randomized clinical trials and 1 long-term extension trial including 3,770 patients with RA who received any dose of baricitinib.

Disclosures: Eli Lilly and Company funded this research. W Deberdt, M Issa, JR Terres, and N Bello reported being employees and stockholders of Eli Lilly and Company. The other authors reported receiving grant/research assistance and consultancy/speakers’ fees from various companies including Eli Lilly.

Source: Taylor PC et al. Ann Rheum Dis. 2021 Oct 27. doi: 10.1136/annrheumdis-2021-221276.

Key clinical point: Baricitinib maintained a stable safety profile with no new safety signals even with long-term exposure of up to 9.3 years in patients with active rheumatoid arthritis (RA).

Major finding: Incidence rates (IRs) per 100 patient-years at risk for serious infections (incidence ratio [IR], 2.6; 95% CI, 2.33-2.86), herpes zoster (IR, 3.0; 95% CI, 2.70-3.28), major adverse cardiovascular events (IR, 0.5; 95% CI, 0.40-0.64), and malignancies excluding nonmelanoma skin cancer (IR, 0.9; 95% CI, 0.77-1.09) remained stable from previous report.

Study details: This was an integrated analysis of 9 randomized clinical trials and 1 long-term extension trial including 3,770 patients with RA who received any dose of baricitinib.

Disclosures: Eli Lilly and Company funded this research. W Deberdt, M Issa, JR Terres, and N Bello reported being employees and stockholders of Eli Lilly and Company. The other authors reported receiving grant/research assistance and consultancy/speakers’ fees from various companies including Eli Lilly.

Source: Taylor PC et al. Ann Rheum Dis. 2021 Oct 27. doi: 10.1136/annrheumdis-2021-221276.

Key clinical point: Baricitinib maintained a stable safety profile with no new safety signals even with long-term exposure of up to 9.3 years in patients with active rheumatoid arthritis (RA).

Major finding: Incidence rates (IRs) per 100 patient-years at risk for serious infections (incidence ratio [IR], 2.6; 95% CI, 2.33-2.86), herpes zoster (IR, 3.0; 95% CI, 2.70-3.28), major adverse cardiovascular events (IR, 0.5; 95% CI, 0.40-0.64), and malignancies excluding nonmelanoma skin cancer (IR, 0.9; 95% CI, 0.77-1.09) remained stable from previous report.

Study details: This was an integrated analysis of 9 randomized clinical trials and 1 long-term extension trial including 3,770 patients with RA who received any dose of baricitinib.

Disclosures: Eli Lilly and Company funded this research. W Deberdt, M Issa, JR Terres, and N Bello reported being employees and stockholders of Eli Lilly and Company. The other authors reported receiving grant/research assistance and consultancy/speakers’ fees from various companies including Eli Lilly.

Source: Taylor PC et al. Ann Rheum Dis. 2021 Oct 27. doi: 10.1136/annrheumdis-2021-221276.

Key clinical point: Biological disease-modifying antirheumatic drug (bDMARD) monotherapy may increase the risk for progression of preexisting distal interphalangeal (DIP) osteoarthritis in patients with rheumatoid arthritis (RA), primarily by promoting osteophyte growth.

Major finding: Compared with conventional synthetic DMARD (csDMARD) monotherapy, bDMARD monotherapy was associated with an increased risk for radiographic progression of existing DIP osteoarthritis (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.07-1.69), with osteophyte progression (aHR, 1.74; 95% CI, 1.11-2.74) being the most elevated osteoarthritis feature with bDMARD vs. csDMARD use.

Study details: This study included 2,234 adult patients with RA from a longitudinal Swiss registry of rheumatic diseases, who had at least 2 hand radiographs and were grouped into cohorts with (n=1,340) or without (n=894) DIP osteoarthritis at baseline.

Disclosures: This study was sponsored by pharmaceutical companies like AbbVie, Amgen, and Gilead. All the authors declared no conflict of interests.

Source: Lechtenboehmer CA et al. Arthritis Res Ther. 2021 Oct 26. doi: 10.1186/s13075-021-02654-0.

Key clinical point: Biological disease-modifying antirheumatic drug (bDMARD) monotherapy may increase the risk for progression of preexisting distal interphalangeal (DIP) osteoarthritis in patients with rheumatoid arthritis (RA), primarily by promoting osteophyte growth.

Major finding: Compared with conventional synthetic DMARD (csDMARD) monotherapy, bDMARD monotherapy was associated with an increased risk for radiographic progression of existing DIP osteoarthritis (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.07-1.69), with osteophyte progression (aHR, 1.74; 95% CI, 1.11-2.74) being the most elevated osteoarthritis feature with bDMARD vs. csDMARD use.

Study details: This study included 2,234 adult patients with RA from a longitudinal Swiss registry of rheumatic diseases, who had at least 2 hand radiographs and were grouped into cohorts with (n=1,340) or without (n=894) DIP osteoarthritis at baseline.

Disclosures: This study was sponsored by pharmaceutical companies like AbbVie, Amgen, and Gilead. All the authors declared no conflict of interests.

Source: Lechtenboehmer CA et al. Arthritis Res Ther. 2021 Oct 26. doi: 10.1186/s13075-021-02654-0.

Key clinical point: Biological disease-modifying antirheumatic drug (bDMARD) monotherapy may increase the risk for progression of preexisting distal interphalangeal (DIP) osteoarthritis in patients with rheumatoid arthritis (RA), primarily by promoting osteophyte growth.

Major finding: Compared with conventional synthetic DMARD (csDMARD) monotherapy, bDMARD monotherapy was associated with an increased risk for radiographic progression of existing DIP osteoarthritis (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.07-1.69), with osteophyte progression (aHR, 1.74; 95% CI, 1.11-2.74) being the most elevated osteoarthritis feature with bDMARD vs. csDMARD use.

Study details: This study included 2,234 adult patients with RA from a longitudinal Swiss registry of rheumatic diseases, who had at least 2 hand radiographs and were grouped into cohorts with (n=1,340) or without (n=894) DIP osteoarthritis at baseline.

Disclosures: This study was sponsored by pharmaceutical companies like AbbVie, Amgen, and Gilead. All the authors declared no conflict of interests.

Source: Lechtenboehmer CA et al. Arthritis Res Ther. 2021 Oct 26. doi: 10.1186/s13075-021-02654-0.