Autumn 2023 Press Review – ACR

April 2023 to July 2023

Authors: Anastasia Madenidou and Juan Camilo Sarmiento

Arthritis Care & Research

The impact of multimorbidity on RA disease activity

Dutt et al. (doi: 10.1002/acr.25184) assessed multimorbidity patterns in RA within the Veterans Affairs Rheumatoid Arthritis (VARA) registry. Among 2,956 participants: mental health and substance abuse (β 0.12 [0.00, 0.23]), cardiovascular (β 0.25 [0.12, 0.38]), and chronic pain (β 0.21 [0.11, 0.31]) multimorbidity were associated with higher DAS28 scores. The number of multimorbidity patterns present was highly associated with DAS28 and MDHAQ (p<0.001), and patients with all four multimorbidity patterns had the highest DAS28 (β 0.59 [0.36, 0.83]) and MDHAQ (β 0.27 [0.16, 0.39]) scores.

Digital quality measures in SLE

Bartels et al. (doi: 10.1002/acr.25143) aimed to develop readily measurable digital quality measure statements for clinical care in SLE using a multistep process guided by consensus methods. Using a modified Delphi process, an ACR workgroup of SLE experts reviewed guidelines from 2000 to 2020 on treatment, monitoring, and phenotyping of patients with lupus. Review of guidelines resulted in quality measure statements:  5 met high consensus for importance and feasibility, including 2 on treatment and 3 on laboratory monitoring measures. The 3 highest-ranked statements were recommended for further measure specification as SLE digital quality measures: 1) HCQ use, 2) limiting GC use >7.5 mg/d to <6 months, and 3) end-organ monitoring of kidney function and urine protein excretion at least every 6 months.

The relationship between axSpA disease activity measures and global functioning

Kiefer D, et al. (doi: 10.1002/acr.25204) investigated the relationship between global functioning and clinical measures of disease activity, physical function, spinal mobility, and radiographic damage in axSpA. In 103 patients, ASAS HI scores correlated significantly with PRO scores (BASDAI, r=0.36, BASFI, r=0.48 and back pain, r=0.41; all p<0.001). In contrast, no significant correlation between ASAS HI and ROM and ROK (r between -0.08 and 0.09) and radiographic damage in SIJ and spine (all r between 0.03 and 0.004) were seen, respectively.

Predictors of placebo response to intra-articular therapy in osteoarthritis

P Yu et al. (doi: 10.1002/acr.25212) evaluated potential predictors of placebo response with intra-articular (IA) injections for knee/hip OA using individual participant data (IPD) from existing trials. Randomized placebo-controlled trials evaluating IA glucocorticoid or hyaluronic acid published to September 2018 were selected. Administration of local anesthetics or ultrasound guidance may reduce IA placebo response at short-term follow-up. At mid-term follow-up, participants with worse baseline function scores may be less likely to respond to IA placebo, and mid-to-long trial duration may enhance placebo response

Adverse events to nintedanib and the risk of malnutrition

Volkmann et al. (doi: 10.1002/acr.25176) assessed adverse events (AEs) in relation to baseline BMI and the risk of malnutrition in patients with SSc-ILD treated with nintedanib at SENSCIS trial. The AE profile of nintedanib was similar between subgroups with a baseline BMI ≤20 kg/m² and a baseline BMI >20 kg/m². In these subgroups, AEs led to treatment discontinuation in 16.7% and 15.9% of the nintedanib group and 13.5% and 8.0% of the placebo group, respectively. Based on the modified MUST, the proportions of patients who had a low risk of malnutrition at baseline and at their last assessment were 74.0% in the nintedanib group and 78.1% in the placebo group.