Winter Press Review 2024 – Seminars in Arthritis and Rheumatology

August 2023 to November 2023

Authors: Dalifer Freites Nuñez and Alejandro Gómez Gómez

Seminars in Arthritis and Rheumatology

Non-pharmacological interventions in Fibromyalgia

Bidonde et al. (doi.org/10.1016/j.semarthrit.2023.152248) aimed to examine the efficacy and safety of non-pharmacological interventions for Fibromyalgia syndrome (FMS) in adults reported in ten Cochrane Reviews reporting 181 randomized or quasi- randomized trials. They found low certainty evidence of clinically relevant positive effects of aerobic and mixed exercise training and for cognitive behavioural therapies (CBTs) at reducing mobility difficulties and of mixed exercise training and CBTs for improving HRQoL at the end of the intervention; and low certainty evidence clinically relevant for mixed exercise and CBTs for reducing mobility difficulties at an average follow up of 24 weeks, and for mixed exercise on HRQoL at an average follow up of 24 weeks.

Antifibrotics in RA-ILD

Juge et al. (doi.org/10.1016/j.semarthrit.2023.152312) investigated the effectiveness and tolerability of antifibrotics in a real-world cohort including 74 patients with rheumatoid arthritis-associated interstitial lung diseases (RA-ILD), 40 patients initiated nintedanib and 34 pirfenidone. Asignificant improvement in the estimated slope of percent predicted forced vital capacity (FVCpp) after antifibrotic initiation (−0.3 % per year vs. −6.2 % before initiation) was found, with similar FVCpp trajectory and retention time (142 weeks) between drugs. A 35% of patients died and 5 % had undergone lung transplantation during follow-up, finding male sex and heavy smoking each associated with a composite of both outcomes. AEs were frequently reported (55% patients), particularly GI, and discontinuation was common (46 % patients, mostly due to GI AEs). 

Disease activity in PsA

Ortolan et al. (doi.org/10.1016/j.semarthrit.2023.152237) described the frequency and explored predictors for minimal disease activity (MDA) in a real-life psoriatic arthritis (PsA) cohort, and for low disease activity (LDA) in patients with axial involvement (axPsA). Across all evaluations, 52–61% reached MDA, and 17–24% achieved ASDAS-LDA. AxPsA, fibromyalgia, OA and BMI≥35 were less frequently observed in patients with sustained MDA. Factors significantly and independently negatively associated with MDA were age, bDMARDs/tsDMARDs duration, axPsA, fibromyalgia, OA and BMI≥35. Age, fibromyalgia and OA were also independently associated with ASDAS-LDA. Authors suggest that MDA is an attainable target in real-life, but axPsA represents a difficult-to-treat subset.  

JAK inhibitors in Australian RA patients

Scheepers et al. (doi.org/10.1016/j.semarthrit.2023.152314) compared the persistence of DMARDs, with a focus on Janus kinase (JAK) inhibitors in Australian RA patients. Twelve-month persistence rates were 72% for upadacitinib, 61% for baricitinib, 58% for subcutaneous TNFi, 55% for tocilizumab, 53% for tofacitinib, and 49% for abatacept (ABA). Persistence rates on first-line JAK inhibitors were 68% for upadacitinib and baricitinib and 55% for tofacitinib, and 49% for TNFi, 55% for ABA, and 57% for tocilizumab; rates were sustained for upadacitinib, TNFi, and tocilizumab but dropped to 59% for baricitinib and 47% for ABA in the second-line treatment. For each b/tsDMARD, persistence rates were higher when combined with methotrexate or other csDMARDs. All agents appeared to be corticosteroid sparing. 

DECT in gout

Stewart et al. (doi.org/10.1016/j.semarthrit.2023.152303) explored the ability of five analysis methods to normalize dual energy computed tomography (DECT) urate volume (UV) data and determine change in DECT UV over time. No data treatment method successfully normalized the distribution of DECT UV. For both simulated and validation data sets, significant reductions in DECT UV were observed between baseline and year 1 across all data treatment methods, and there were no significant differences in Cohen’s d effect sizes. Normalizing highly skewed DECT UV data is challenging, and adopting commonly used transformation techniques may not significantly improve the ability to determine differences in measures of central tendency when comparing the change in DECT UV over time.

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