August 2023 to November 2023
Authors: Dalifer Freites Nuñez and Alejandro Gómez Gómez
Arthritis & Rheumatology
Defining Symptomatic CPPD: The 2023 ACR/EULAR Classification Criteria
Abhishek et al. (doi.org/10.1002/art.42619) published the 2023 ACR/EULAR classification criteria for symptomatic CPPD disease. Patients with joint pain, swelling, or tenderness (entry criterion) not fully explained by an alternative disease (exclusion criterion), were classified as having CPPD disease if crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid were present. In the absence of these findings, a score >56 points using weighted criteria (clinical features, associated metabolic disorders, laboratory and imaging) classified as CPPD disease. These criteria had a sensitivity of 92.2% and 99.2% and a specificity of 87.9% and 92.5% in the derivation and in the validation cohort, respectively.
2023 ACR/EULAR Criteria for Antiphospholipid Syndrome
Barbhaiya et al. (doi.org/10.1002/art.42624) developed the 2023 ACR/EULAR antiphospholipid syndrome classification criteria. An entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion was defined, followed by additive weighted criteria clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant, and solid-phase ELISA for IgG/IgM anticardiolipin and/or anti–β2-glycoprotein I antibodies). Patients with at least 3 points from each set of domains are classified as having APS. In the validation cohort, the new APS had a specificity of 99% and a sensitivity of 84%.
Methotrexate Efficacy and Safety in Combination Therapies for Early RA
Lend et al.(doi.org/10.1002/art.42730) evaluated methotrexate (MTX) safety and influence of dose on efficacy outcomes in combination with certolizumab-pegol, abatacept (ABA), or tocilizumab and with active conventional treatment (ACT) in early rheumatoid arthritis (RA). Treatment-naïve patients (812) were randomized in the NORD-STAR trial to receive MTX with each biological treatment or ACT. With ACT as the reference, MTX-associated side effects were higher when combined with tocilizumab (HR: 1.48, 95% CI: 1.20 to 1.84), but not with certolizumab-pegol or ABA, and MTX dose was lower when combined with tocilizumab or ABA (significantly), and with certolizumab-pegol (numerically). MTX dose reductions were not associated with decreased CDAI remission rates within any of the combinations.
Cluster-Based Clinical Phenotypes in SLE
Manion et al. (doi.org/10.1002/art.42776) identified five clusters of subjects that variably contained active and quiescent systemic lupus erythematosus patients and that had distinct clinical phenotypes. Patients with increased T peripheral helper, activated B, and age-associated B cells were the most likely to be flaring at baseline and to remain active or flare over the subsequent year. Those with increased T helper cells without B cell changes, or increased Th1 cells and innate immune populations, mostly became quiescent on follow-up.
G-PROB: Early Inflammatory Arthritis Diagnosis with Genetic Probability Assessment
Hum et al.(doi.org/10.1002/art.42760) assessed a genetic probability tool to help diagnosis in the rheumatology outpatient setting in a cohort of patients with early inflammatory arthritis (NOAR), using a genetic probability tool (G-PROB). They found that this tool converts complex genetic information into interpretable conditional probabilities which may be especially helpful at eliminating unlikely diagnoses. G-probabilities <5% corresponded to a negative predictive value of 96.0% where it was possible to suggest >2 unlikely diseases for 94% of patients, and >3 for 53.7% of patients. G-probabilities >50% corresponded to a positive predictive value of 70.4%. In 55.7% of patients, the disease with the highest G-probability corresponded to clinician diagnosis.
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Dálifer Freites Núñez
Rheumatologist at Hospital Clínico San Carlos, Madrid- Spain and PhD candidate at Complutense University of Madrid. Dálifer is a member of the EMEUNET Social Media committee with a genuine interest and enthusiasm in research on Immune-mediated inflammatory diseases and its treatments.
Alejandro Gómez
Alejandro is a consultant rheumatologist at Hospital Universitari Vall d’Hebron, in Barcelona and PhD candidate at Complutense University of Madrid. His main clinical and research interests are Sjögren Syndrome, Uveitis and Crystal-induced Arthritis. Alejandro is a member of Social Media Sub-Committee.