Winter Press Review 2024 – Annals of Rheumatic Diseases

August 2023 to November 2023

Authors: Aleksandra Opinc-Roziak and Giacomo Cafaro

Annals of the Rheumatic Diseases

EULAR 2023 update on recommendations for use of imaging in primary large vessel vasculitis

Dejaco et al (doi:10.1136/ard-2023-224543) prepared the update of EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis. A systematic literature review was performed, and the recommendations were based on evidence and expert opinion, iterating until a voting consensus was reached. Ultrasound should be the first-line imaging examination in patients with suspected giant cell arteritis. Axillary arteries should be routinely examined. MRI is the preferred imaging modality for Takayasu arteritis. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring. 

Effect of initial glucocorticoid bridging in patients with RA on cumulative use over time

Van Ouwerkerk et al (doi: 10.1136/ard-2023-224270) compared the effects and cumulative use of glucocorticoids (GC) in patients with rheumatoid arthritis (RA) who received and did not receive initial GC bridging therapy, based on 3 trials (BeSt, CareRA and COBRA trials). Mean DAS28 did not differ between groups, yet significantly faster improvement was noted in the bridger group. Bridgers required significantly fewer changes in DMARDs. However, GC bridging resulted in a higher cumulative GC dose over 2 years. 

EULAR recommendations for non-pharmacological management of patients with SLE and SSc

Parodis et al (doi: 10.1136/ard-2023-224416) prepared evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), which should be personalised and complement pharmacological treatment. Physical exercise, smoking cessation and avoidance of cold exposure should be advised in both SLE and SSc patients. Patients with SLE can benefit from photoprotection and psychosocial interventions, while patients with SSc should be advised to perform mouth and hand exercises.

Comparison between rituximab and cyclophosphamide therapy in patients with life-threatening ANCA-associated vasculitis

Ishikawa et al (doi: 10.1136/ard-2023-224472)  compared the effectiveness and safety of RTX in life-threatening anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) to those of intravenous cyclophosphamide (IVCY). No significant differences were noted between groups with respect to in-hospital mortality. Patients who received RTX were at lower risk of fungal infections (adjusted OR: 0.45, 95% CI: 0.23 to 0.84) and pneumocystis pneumonia (adjusted OR: 0.58, 95% CI 0.32 to 1.00), yet more frequently required haemodialysis at discharge due to severe renal impairment (adjusted OR:  2.58, 95% CI: 1.02 to 6.91). 

EULAR 2023 update on recommendations for management of SLE

Fanouriakis et al (doi: 10.1136/ard-2023-224762) published the 2023 update of the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on expert consensus. Recommendations include that hydroxychloroquine should be the first-line drug in all patients, GC are considered ‘bridging therapy’ to be used in active disease and minimised or withdrawn in maintenance treatment, and that immunosuppressive drugs or biologic agents should be administered as disease-controlling drugs. In organ-threatening and refractory SLE, cyclophosphamide or rituximab could be useful.

Proteomics analysis defines sub-types of patients with Sjögren’s syndrome

Berry et al (doi: 10.1136/ard-2023-224503) performed analysis of protein expression with network reconstruction to assess heterogeneity in Sjögren’s syndrome (SS). The authors found that clinical subtypes of SS, distinguished by the Newcastle Sjögren’s Stratification Tool (NSST), differ in the expression of chemokines, cytokines, TRIM21 and several transcription factors associated with energy metabolism and redox balance. Observed differences imply the need to individualise therapy.

Novel definitions for RA flare

Konzett et al (doi: 10.1136/ard-2023-224742) proposed novel definitions for rheumatoid arthritis flare based on the quantitative Simplified and Clinical Disease Activity Indices (SDAI and CDAI, respectively). Two large independent real-world cohorts (the Norwegian Disease-Modifying Anti-Rheumatic Drug Registry, NOR-DMARD, and the Vienna RA cohort) were analysed and used for validation. Flare was defined as an increase in SDAI of 4.7 and CDAI of 4.5.

Immunophenotyping of peripheral immune cells of patients with autoimmune RMDs

Hiroaki et al (doi: 10.1136/ard-2023-224537) conducted large-scale cohort-wide immunophenotyping of peripheral immune cells in patients with autoimmune rheumatic diseases with the use of cytometric methods. Owing to such comprehensive analysis, similarities and discrepancies in immune cell specificity were identified e.g. a similar immunological network was found between mixed connective tissue disease and SLE. Individual patient-level differences imply heterogeneity in disease activity and treatment responses.

Global trends in prevalence of MSK diseases in women of child-bearing age

Cao et al (doi: 10.1136/ard-2023-224530) analysed temporal trends in the prevalence of musculoskeletal diseases in women of childbearing age (WCBA) at several levels – global, regional and national, from 1990 to 2019. Musculoskeletal disorders affected 354.57 million WCBA globally in 2019. An overall decreasing tendency was observed in the last 30 years, with a global net drift of −0.06% per year. However, in 138 countries, an increasing trend was noted, and several populations were characterised by unfavourable tendencies.

Long-term effects of glucocorticoid treatment of ANCA-associated vasculitis without renal or pulmonary involvement

Furuta et al (doi: 10.1136/ard-2023-224343) assessed the long-term effects of treatment in ANCA-associated vasculitis without severe glomerulonephritis or alveolar haemorrhage. 140 patients were randomised to receive rituximab together with a reduced dose (0.5 mg/kg/day) or high-dose (1 mg/kg/day) of prednisolone. At 24 months, disease relapses were noted with similar frequency, regardless of the dose of GC. Patients receiving reduced doses of prednisolone were at lower risk of severe adverse events.

Factors associated with syndesmophyte formation in a cohort of patients with PsA

De Hooge et al (doi: 10.1136/ard-2023-224501) performed a prospective analysis of a multicentre cohort of patients with psoriatic arthritis (PsA) to identify factors associated with a higher risk of syndesmophyte formation. Syndesmophytes were rarely observed in PsA, as in 2 years of observation, only in 11 out of 150 patients were new syndesmophytes were noted. Patients with radiographically confirmed axial involvement and patients with higher CRP were at greater risk of syndesmophyte development.