Rheumatology (Oxford)

August to November 2022

Authors: Anastasia Madenidou and Sizheng Steven Zhao

Many rheumatologists across the world are trained to prescribe methotrexate (MTX) and folic acid on different days, the latter to reduce side effects of MTX. Using a rat model of arthritis, Dalix et al (10.1093/rheumatology/keac579) showed that co-administration of both on the same day did not reduce the efficacy of MTX, compared to folic acid given the day after. If these results are transferable to humans, co-administration may be sufficiently more convenient as to improve adherence.

Webers et al (10.1093/rheumatology/keac580) compared the effect of NSAIDs, conventional synthetic DMARDs and TNF inhibitors on depressive symptoms (measured using the HADS) in people with spondyloarthritis (SpA). This is an important question because depressive symptoms are common in SpA and can influence treatment outcomes. Using data from 304 patients, depressive symptoms improved across all three groups. TNF inhibitors had the greatest effect, but likely explained by their stronger effect on disease activity.

Thiele et al (10.1093/rheumatology/keac587) investigated the effect of additionally prescribing MTX for biologic treatment of juvenile idiopathic arthritis (JIA) using a propensity matched design in over 2000 patients. Additionally giving MTX improved effectiveness of biologic treatment in polyarticular JIA without seriously compromising treatment safety. The effect seemed to apply to TNF inhibitors more than tocilizumab, which is in keeping with analogous studies in adults.

Westerlind et al (10.1093/rheumatology/keac601) studied the link between autoantibodies and risk of venous thromboembolism in rheumatoid arthritis (RA). IgG anti-CCP, present in 65% of the cohort, was associated with VTE in a dose-response manner. IgM rheumatoid factor was also associated with VTEs. These findings were independent of age, sex, smoking and shared epitope.

Russell et al (10.1093/rheumatology/keac551) updated the UK’s guideline on immunomodulatory drug prescribing in pregnancy. Although these are UK guidelines, readers from other countries may also benefit from these evidence-based guidelines. Table 1 provides a useful summary to have in clinics. Updates include the use of TNF inhibitors in all trimesters and breastfeeding in the context of severe disease.

Kearsley-Fleet et al (10.1093/rheumatology/keac463) examined the tapering, withdrawal and restarting of biologics in people with JIA in remission, using the UK’s JIA Biologics Register. One in 5 individuals stopped treatment after ~2 years, but 55% restarted. Factors associated with successful cessation of biologics included absence of uveitis, tocilizumab-use and earlier initiation of biologics. 

About the AuthorS

Anastasia Madenidou

Anastasia is a rheumatology trainee and a Clinical Research Fellow at the Centre of Musculoskeletal Research, University of Manchester. Her research work focuses on omics techniques to cluster lupus patients according to their molecular profile. Anastasia is the Deputy Chair of the British Rheumatology Society Trainee Committee and a member of the Newsletter Sub-Committee.

Sizheng Steven Zhao

Steven is a rheumatologist and epidemiologist at the University of Manchester, UK. His research focuses on inflammatory arthritis and drug safety, for which he uses registry, routine healthcare and genetic data.

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