August to November 2022
Author: Giacomo Cafaro
Hannah et al. (doi: 10.3899/jrheum.220383) performed a systematic literature review (SLR) and meta-analysis (MA) to evaluate predictors of mortality in inflammatory myopathy-associated interstitial lung disease. 62 studies were included in the meta-analysis. From a serological point of view, the presence of anti-melanoma-differentiation-associated protein (MDA)-5 (OR 6.20) and the absence of anti-aminoacyl-tRNA synthetase (OR 0.33) represented risk factors for mortality. The main clinical features with highest odds ratio (OR) for mortality were the presence of acute/subacute interstitial pneumonia (OR 8.31), fever (OR 2.71), dermatomyositis (OR 2.48) and ulceration (OR 1.97).
Another interesting SLR with MA was published by Meng et al. (doi: 10.3899/jrheum.220152) who evaluated 2000 rheumatoid arthritis (RA) patients from 10 studies investigating the ability to maintain remission after tapering or withdrawal of methotrexate (MTX) in patients treated with a combination therapy of MTX + biological or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARD). Although the studies included were significantly different in terms of medication taken, tapering scheme, duration of remission before tapering and follow-up time, the authors found an overall 90% maintenance of remission compared to patients who did not taper MTX.
Aggarwal et al. (doi: 10.1056/NEJMoa2117912) carried out a randomized, placebo-controlled trial of intravenous immune globulins (IVIG) for the treatment of dermatomyositis. IVIG were infused at 2 g/kg in 2-5 doses, for 4 cycles, every 4 weeks. All patients were allowed concomitant glucocorticoids and immunosuppressors (except for cyclophosphamide). At 16 weeks 79% of IVIG vs 44% of placebo achieved the primary end-point (total improvement score – TIS – improvement of at least 20%). Results in the same direction were obtained for most secondary end-points. However, IVIG was associated with a higher rate of adverse events, especially thromboembolism.
Fitzgerald et al. (doi: 10.1016/j.jbspin.2022.105420) performed an ancillary analysis of the ASAS PerSpA study on the overlap of fibromyalgia (FM) and spondyloarthritis (SpA), with a specific focus on enthesitis. Among the results obtained, they confirmed that the presence of FM does not overestimate the classification of SpA according to ASAS criteria. However, it significantly affects multiple disease activity scores, including BASDAI, BASFI and ASDAS, that are higher in the presence of FM. In particular, because changes of ASDAS represent the main outcome to guide treatment, the presence of FM should be carefully considered.
Carvajal Alegria et al. (doi: 10.1016/j.jbspin.2022.105459) retrospectively evaluated a cohort of 93 patients who underwent a second minor salivary gland biopsy after an initial biopsy performed for suspected primary Sjögren’s syndrome (pSS). Second biopsy was performed after a mean of 5.7 ± 4.3 years after the first and the concordance between 1st and 2nd biopsy in terms of positivity was very low both for pSS and non-pSS patients (κ = -0.04 and 0.18, respectively), though with no clear signs of evolution. However, in 13/93 (14%) patients, the results of the 2nd biopsy was a key element for a change of diagnosis.
About the Author
Giacomo is Assistant Professor and Consultant Rheumatologist at the Rheumatology Unit of the university of Perugia, Italy. He was PARTNER fellow at the Institute of Infection, Immunity and Inflammation at the University of Glasgow, working on stromal immunology in tendinopathy and PsA. His main research interests are T cell biology in autoimmune diseases, psoriatic arthritis, Sjögren’s syndrome and ultrasound in rheumatology. Giacomo is a member of the Newsletter sub-committee.