The Lancet Rheumatology

October to November 2022

Authors: Sytske Anne Bergstra and Emre Bilgin

Elhai et al. (doi: 10.1016/S2665-9913(22)00217-X) compared the performance of stratification into cutaneous subtypes, stratification by autoantibody status or a combination of both, to predict disease outcomes in 10.711 systemic sclerosis patients included in the international EUSTAR database. Compared to a cutaneous-only model, the antibody-only model better predicted overall survival (NRI, 0.57, 95% CI 0.4, 0.71 vs. 0.29, 95% CI 0.19, 0.39), disease progression (NRI, 0.36, 95% CI 0.29, 0.46 vs. 0.21, 95% CI 0.14, 0.28), renal crisis (AUC, 0.72, 95% CI 0.70, 0.74 vs. 0.66, 95% CI 0.64, 0.69) and lung fibrosis (AUC, 0.76, 95% CI 0.75, 0.77 vs. 0.71, 95% CI 0.70, 0.72).

Kandane-Rathnavake et al. (doi: 10.106/S266509913(22)00304-6) et al. investigated the attainment of low disease activity state (LLDAS) and risk of mortality in 3811 Systemic lupus erythematosus  (SLE) patients included in the Asia Pacific Lupus Collaboration. Being in LLDAS for at least 50% of observed time was associated with a reduced risk of mortality (HR, 0.51, 95% CI 0.31, 0.85). Attaining remission did not further reduce this risk (HR 0.52, 95% CI 0.29, 0.93). The use of remission definitions with lower thresholds of glucocorticoid use was associated with further reductions in risk of mortality (<5 mg/day prednisone: HR 0.31, 95% CI 0.12, 0.77, glucocorticoid free remission: HR 0.13, 95% CI 0.02, 0.96).

Murarasu et al. (doi: 10.1016/S2665-9913(22)00308-3) studied the risk of thrombotic and severe haemorrhagic complications during pregnancy and post partum for women with antiphospholipid syndrome in a prospective cohort of 168 patients. 16 patients (10%, 95% CI 5, 15) had a thrombotic or severe haemorrhagic event. There were no deaths during the study.

Russell et al. (doi: 10.1016/S2665-9913(22)00305-8) studied the effects of the pandemic on diagnostic incidence and care delivery for inflammatory arthritis in England in a population-level cohort study based on primary care and hospital data of 17.7 million adults. New inflammatory arthritis diagnosis decreased by 20.3% during the pandemic, relative to the preceding year. The median time to first rheumatology assessment was shorter during the pandemic than before (18, IQR 8-35 vs. 21, IQR 9-41 days). The proportion of patients prescribed DMARDs in primary care was similar before and during the pandemic; however, during the pandemic, fewer people were prescribed methotrexate or leflunomide, and more were prescribed sulfasalazine or hydroxychloroquine.

Scolnik et al. (doi: 10.1016/S2665-9913(22)00260-0) published the first evidence-based PANLAR guidelines for the treatment of giant cell arteritis. These guidelines were tailored for Latin-America, taking into account the socio-economic characteristics, including access to care and biological treatments. Nine recommendations and one expert opinion statement for the treatment of giant cell arteritis were developed. These recommendations include guidance for the use of glucocorticoids, tocilizumab, methotrexate, and aspirin for patients with giant cell arteritis.

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.

Cover art by Grace Russell. The Lancet Rheumatology, January 2023, Vol. 5, Number 1e1-e58

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