August 2023 to November 2023
Author: Victoria Konzett
Miscellaneous
Sarilumab in polymyalgia rheumatica
Spiera et al (doi.org/10.1056/NEJMoa2303452) investigated Sarilumab, an interleukin (IL)-6 blocking monoclonal antibody, for treatment of polymyalgia rheumatica (PMR), in a 52-week, phase 3, randomized controlled trial. 118 patients were treated with Sarilumab 200mg every other week (incl. a 14-week prednisone taper) or placebo (incl. a 52-week prednisone taper). The primary endpoint was defined as sustained remission through weeks 12 and 52 (resolution of signs and symptoms, normalization of C-reactive protein levels, absence of disease flares, adherence to prednisone taper), and met for Sarilumab, with sustained remission at week 52 achieved by 28% of patients in the treatment group, vs 10% in the placebo group (p=0.02). Cumulative glucocorticoid exposure was significantly lower in Sarilumab treated patients (p<0.001), and the overall safety profile acceptable, albeit treatment-related discontinuations occurring more frequently with the IL-6 blocker (12% vs 7%, respectively).
SGLT-2 inhibitors in gout
Wei et al. (doi.org/10.1001/jamanetworkopen.2023.30885) found a reduced risk for disease flares and overall mortality in patients with gout and type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitors (SGLT-2i), compared with other anti-diabetic medications. In a retrospective cohort study of nearly 6,000 patients from Great Britain who were followed for a median of almost 3 years, the authors estimated hazard ratios of 0.79 (95%CI: 0.65 to 0.9) for risk of recurrent gout flares, and 0.71 (95%CI: 0.52 to 0.97) for all-cause mortality, indicating benefits of SGLT-2i in these oftentimes co-occurring diseases, sharing comparable risk factors.
Shorter telomeres are associated with RA-ILD
Doyle et al. (doi.org/10.1136/thorax-2023-220022) showed that shorter telomere lengths, caused both by genetic factors like single nucleotide polymorphisms (SNPs) and loss-of-function mutations as well as ageing and lifestyle factors like smoking, were associated with interstitial lung disease (ILD) manifestation and severity in patients with rheumatoid arthritis (RA). In a case-control study of 355 and 195 patients from France and the United States, respectively, the authors found shorter telomere lengths in RA-ILD vs RA-nonILD, and associations with reduced forced vital capacity (FVC) values in ILD patients. Comparable trends were not observed for lung diffusion capacity for carbon (DLCO) and UIP pattern subtypes in high resolution CT scans in this study.
PD1+CD8+ T cells are pathogenic in idiopathic inflammatory myopathies
Sasaki et al. (doi:org/10.1016/j.jaut.2023.103131) described associations between Programmed-cell-death 1 (PD-1) expression and T-cell activation as well as exhaustion in idiopathic inflammatory myopathies (IIM). The authors identified PD1+CD8+T-cells as a pathogenic subset in these conditions and found a protective role of muscular PD1 ligand expression, which signals downstream Interferon gamma (INFy) regulated pathways.
Pizza consumption and rheumatoid arthritis disease activity
De Vita et al. (doi.org/10.3390/nu15153449) published data that support regular pizza consumption in patients with rheumatoid arthritis. In a cross-sectional analysis of 365 patients from Italy, consumption of at least one half-pizza per week (vs less than two halves per month) was associated with significantly lower disease activity states. The effect attributed to the beneficial effects of ingredients like mozzarella cheese and olive oil in this study.
Victoria Konzett
Victoria is a resident for internal medicine and PhD fellow at the Division of Rheumatology at the Medical University of Vienna, Austria. Her major research interests are clinical and translational research projects in rheumatoid and psoriatic arthritis, focusing mainly on trial data, at risk stages and outcomes research in both diseases. Victoria is a member of the Newsletter Sub-Committee and the Young Division of the Austrian Society of Rheumatology.