RMD Open

August to November 2022

Authors: Sytske Anne Bergstra and Emre Bilgin

Secher et al. (doi: 10.1136/rmdopen-2022-002445) studied the risk of pre-eclampsia in singleton pregnancies in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), by linking medical birth registers to Swedish (SRQ) and Danish (DANBIO) rheumatology registers. Women with PsA (aOR 1.85, 95% CI 1.10 to 3.12)- but not AxSpA, (aOR 1.17, 95% CI 0.76 to 1.78)- had an increased risk of pre-eclampsia compared to controls. In women with RA an increased risk of pre-eclampsia was observed in those receiving combination therapy before (aOR 1.59, 95% CI 1.07 to 2.37), or during pregnancy (aOR 1.53, 95% CI 0.97 to 2.39)  and with a high RA disease load (aOR 1.96, 95% CI 1.26 to 3.04).

Murray-Brown et al. (doi: 10.1136/rmdopen-2022-002563) characterised T peripheral helper (Tph) cells, which drive B cell differentiation, in treatment-naïve, early RA to determine whether these cells accumulate prior to fully established disease. They demonstrated differentially enriched Tph cells in early RA, compared with healthy and osteoarthritis controls. Within the synovium, Tph cells far outnumbered T follicular helper cells, they were located in close proximity to B cells in follicular and diffuse infiltrates, and their numbers correlated with B cell numbers. The authors suggest that this lays the potential of using Tph-based therapeutic approaches for disease interception prior to fully established RA.

Montag et al. (doi: 10.1136/rmdopen-2022-002520) studied the medication burden in 1306 young adults with juvenile idiopatic arthritis (JIA). One in four patients reported polypharmacy. JIA patients with a late start of bDMARDs were more likely to use DMARDs (p<0.001), systemic glucocorticoids (p=0.028) and antidepressants (p=0.022) in adulthood in comparison to those with an early bDMARD start. Patients with rheumatoid factor-positive polyarthritis and systemic JIA had the highest medication burden among the JIA categories, including the highest rates of glucocorticoid use (35% and 32%) as well as antihypertensive (5% and 11%) and antithrombotic use (3.5% and 4.5%).

Micheroli et al. (doi: 10.1136/rmdopen-2022-002551) studied the effect of TNFi on sacroiliac joint radiographic progression in 894 two-year radiographic intervals in 515 axSpA patients from the Swiss Clinical Quality Management cohort with up to 12 years of follow-up. TNFi were associated with retardation of sacroiliac joint radiographic progression when treatment was continued for at least one year during a 2-year interval (OR 0.21, 95% CI 0.08 to 0.55).

Xu et al. (doi: 10.1136/rmdopen-2022-002”424) studied the association between the infection profile during the first 3 months after diagnosis and 1-year survival of 415 newly diagnosed patients with ANCA-associated vasculitis (AAV). 337 infection episodes were identified among 220 patients during the first 3 months. Overall survival after 1 year was 73%. Infection was independently associated with 1-year mortality (aHR 2.32, 95% CI 1.27 to 4.23). Respiratory infection (4.36, 2.86 to 8.06), gram-negative bacterial infection (1.71, 1.01 to 2.91) and fungal infection (1.77, 1.07 to 2.94) were identified as a risk factor for 1-year mortality. Trimethoprim-sulfamethoxazole prophylaxis (aHR 0.55, 95% CI 0.31 to 0.97) was protective for 1-year mortality.

About the AuthorS