ANNALS OF THE RHEUMATIC DISEASES

December 2022 to March 2023

Authors: Daliya Pencheva and Cathy Melong

Sanges et al (doi.org/10.1136/ard-2022-223237) aimed to detect biomarkers in patients (pts) with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH), confirmed by right heart catheterisation (RHC). Correlation between 1129 proteins assessed by a high-throughput proteomic assay (SOMAscan) and pulmonary vascular resistance (PVR) in SSc-PAH was assessed. Chemerin (ρ=0.62, p=0.01) seemed to be a potential surrogate marker for haemodynamic severity in SSc-PAH, as it showed robust correlations with PVR. 

van Ouwerkerk et al (doi.org/10.1136/ard-2022-223443) investigated whether patients (pts) with rheumatoid arthritis (RA) can discontinue glucocorticoids (GC) after GC ‘bridging’ in the initial treatment step. Using data from 7 clinical trial arms (n=1653) that included a GC bridging schedule, they found that the probability of using GC after bridging therapy decreased from 0.18 to 0.07 in 1-18 months, with higher initial doses and longer schedules increasing cumulative doses and continuous use at 2 years (0.30) in oral GC bridging studies.

Dejaco et al (doi.org/10.1136/ard-2022-223367) developed the provisional Outcome Measures in Rheumatology (OMERACT) ultrasonography score for monitoring disease activity in giant cell arteritis (GCA). Agreement was obtained (92.7%) for the OMERACT GCA Ultrasonography Score (OGUS), calculated as follows: sum of intima–media thickness (IMT) measured in every segment divided by the rounded cut-off values of IMTs in each segment. The resulting value is then divided by the number of segments available. OGUS correlated moderately with erythrocyte sedimentation rate, C reactive protein and Birmingham Vasculitis Activity Score. 

Smith et al (doi: 10.1136/ard-2022-223328) aimed to harmonise existing evidence and expert opinion regarding ‘treat-to-target’ (T2T) in childhood-onset systemic lupus erythematosus (cSLE). The International Task Force’s considerations included preventing flare-ups and organ damage, minimizing glucocorticoid use, proactively addressing factors affecting health-related quality of life (fatigue, pain, mental health, educational challenges, medication side effects), and maintaining long-term targets.

Rodríguez-Carrio et al (doi: 10.1136/ard-2022-223628) developed evidence-based points to consider (PtC) for the measurement and reporting of type I interferon IFN-I assays in clinical research and IFN-I assays implementation in the clinical management of rheumatic and musculoskeletal diseases (RMD). Two overarching principles and 11 PtC were defined, addressing terminology, assay characteristics, reporting practices, and clinical applications, with the goal of facilitating IFN-I assay implementation in clinical practice and promoting interest beyond rheumatology.

Based on primary results from ORAL Surveillance, Kristensen et al (doi: 10.1136/ard-2022-223715) studied subpopulations with different relative risk (ie, ‘high-risk’ and ‘low-risk’) with tofacitinib versus tumour necrosis factor inhibitors (TNFi). Age ≥65 years or ever smoker defined a group with increased risk of malignancies (excluding non-melanoma skin cancer), major adverse cardiovascular events, myocardial infarction, venous thromboembolism and all-cause death with tofacitinib (combined doses) versus TNFi (HRs 1.41–5.19).

Using data from the RITAZAREM trial, Smith et al (doi: 10.1136/ard-2022-223559) conducted an international randomised controlled, open-label, superiority trial to compared the efficacy of repeat-dose rituximab to daily oral azathioprine (AZA) for prevention of relapse in patients (pts) with relapsing AAV in whom remission was reinduced with rituximab. They recruited 188 patients at the time of an AAV relapse from 29 centers in 7 countries between April 2013 and November 2016. Rituximab was superior to AZA in preventing relapse: HR 0.41 (95% CI 0.27 – 0.61, p<0.001). 19/85 (22%) pts in the rituximab group and 31/85 (36%) in the AZA group experienced at least one serious adverse event during the treatment period.

Baker et al (doi.org/10.1136/ard-2022-223640) conducted a retrospective cohort study with propensity score matching using claims data from Optum’s de-identified Clinformatics Data Mart (CDM) (January 2003 to June 2019) and electronic health record data from the Stanford Research Repository (STARR) (January 2010 to December 2020) to determine the incidence of osteoarthrits (OA) in pts with atopic disease compared with matched non-exposed patients. The authors identified 117 346 exposed patients with asthma or atopic dermatitis and 1 247 196 non-exposed patient. OA incidence was higher in pts with asthma or atopic dermatitis (26.9 per 1000 person-years) compared with non-exposed pts (19.1 per 1000 person-years), with an adjusted odds ratio (aOR) of 1.58 (95% CI 1.55 to 1.62) for developing OA.

Hellmich et al (doi: 10.1136/ard-2022-223764) provided updated guidance on antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) management in the latest EULAR recommendations. The updated recommendations include 4 overarching principles and 17 specific recommendations, such as biopsies and ANCA testing for diagnosis, high-dose glucocorticoids with rituximab or cyclophosphamide for remission induction, and rituximab for remission maintenance, with informed decision-making between physicians and patients remaining crucial due to data gaps.