August to November 2022
Authors: Sytske Anne Bergstra and Emre Bilgin
Smolen J. et al. (doi:10.1136/ard-2022-223356) published the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis (RA). In brief, methotrexate (MTX) plus glucocorticoids (GCs) is recommended as initial therapy; in case of the ineffectiveness with poor prognostic factors, any bDMARD should be added to the csDMARD; after careful consideration of risks of major cardiovascular events (MACEs), malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended.
Ramiro S. et al. (doi:10.1136/ard-2022-223296) published the 2022 update of the ASAS-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Overall, five overarching principles and 15 recommendations (8 unchanged, three minor edits on nomenclature, two relevantly updated, and two newly formulated) focusing on personalized management were included.
Curtis J. et al. (doi:10.1136/ard-2022-222543) investigated the malignancy risk with tofacitinib versus TNF inhibitors in rheumatoid arthritis as a post hoc analysis of the ORAL Surveillance trial. Up to 18 months of follow-up, overall cancer risk was similar between tofacitinib and TNFi groups, however; risk was higher in tofacitinib afterward. History of atherosclerotic cardiovascular disease (ASCVD) or increased CV risk was associated with increased malignancy risk.
Charles-Schoeman et al. (doi:10.1136/ard-2022-222259) investigated the major cardiovascular event risk with tofacitinib versus TNF inhibitors in rheumatoid arthritis as a post hoc analysis of the ORAL Surveillance trial. In patients with a history of ASCVD, MACE incidence was significantly higher in both tofacitinib groups (2X5 mg (8.3%), 2X10 mg (7.7%)) than TNFi group (4.2%); whereas risk of MACE was similar for both treatment groups in patients without a history of ASCVD.
Adamska J et al. (doi:10.1136/ard-2021-221925) investigated the effects of myeloablative autologous hematopoietic stem cell transplant (HSCT) on B cells in patients with systemic sclerosis from Scleroderma: Cyclophosphamide or Transplantation (SCOT) Trial. They found that myeloablative autologous HSCT was associated with a sustained increase in IgM isotype antibodies bearing a low mutation rate and a reduced clonal expression of IGH repertoires suggesting a more naïve state and eliminating pathogenic B cells.
Zhou D et al. (doi:10.1136/ard-2022-222935) reported the diversity of complement C4, C4A, and C4B in patients with idiopathic inflammatory myositis (IIM). Low gene copy number (GCN) of C4T and C4A deficiency were strongly correlated with increased risk of IIM (OR 2.58 (2.28–2.91) for C4T, and OR 2.82 (2.48–3.21) for C4A deficiency). Among patients with C4A deficiency, the presence of HLA-DR3 became a risk factor for IIM with an OR of 11.02 (1.44–84.4). Anti-Jo-1 or with anti-PM/Scl had significantly lower C4 plasma concentrations than those without these autoantibodies. Lopes A. et al. (doi:10.1136/ard-2022-222728) described the regulation of immune pathways related to type 2 conventional dendritic cells (cDC2s) in patients with primary Sjögren’s syndrome. Transcriptomic analysis of cDC2s revealed alterations in type I interferon (IFN), toll-like receptor (TLR), antigen processing, and presentation pathways which were strongly linked to anti-SSA positivity and the presence of type I IFNs. This novel molecular and functional data may yield novel avenues for treatment.
Gamerith G. et al. (doi:10.1136/ard-2022-222479) investigated the role of soluble immune checkpoints (sICPs) in predicting treatment resistance, relapse, and infections in patients with ANCA-associated vasculitis (AAV) using the samples from the RAVE trial. In patients receiving RTX as induction, the combination of lower soluble (s)Lag-3 (<90 pg/mL) and higher sCD27 (>3000 pg/mL) predicted therapy failure, high baseline values of sTim-3 (>1200 pg/mL), sCD27 (>1250 pg/mL) and sBTLA (>1000 pg/mL) were associated with both sustained remission and infectious complications; these results could not be replicated in patients randomized to receive cyclophosphamide/azathioprine.
Henkel C. et al. (doi:10.1136/ard-2022-223199) investigated if there is a genetic difference in patients with knee and hip osteoarthritis who needed or not joint replacement. 52 sequence variants (knee osteoarthritis; surgical: 17, non-surgical: 3 / hip osteoarthritis; surgical: 34, non-surgical: 1) were identified. For the surgical phenotypes, ten novel variants (except rs13107325 in SLC39A8) significance and effect sizes were higher for the surgical phenotypes. In contrast, genetic correlations with pain phenotypes tended to be stronger in the non-surgical groups.
About the AuthorS
Sytske Anne Bergstra
Sytske Anne is a post-doctoral researcher at the department of rheumatology of the Leiden University Medical Center and the project coordinator of the METEOR registry. Her main interests are rheumatoid arthritis, methodology, real world data and international comparisons. Sytske Anne is a member of the Social Media Sub-Committee.
Emre Bilgin
Emre is a rheumatologist at Hacettepe University where he is doing his MSc on epidemiology. His main interests are rheumatoid arthritis, adult Still’s disease and ANCA-associated vasculitis, aside from his enthusiasm for editorial activities. Emre is a member of the Social Media Sub-Committee.