December 2023 to March 2024
Author: Stephanie Ling
Rheumatology (Oxford)
Higher serum levels of TNF inhibitors in PsA patients with good response
Curry et al (doi: 10.1093/rheumatology/kead666) studied 201 patients with psoriatic arthritis (PsA) treated with adalimumab or etanercept, and they found that PsARC and EULAR good responders had significantly increased non-trough serum drug levels of both adalimumab and etanercept. They suggested that interventions to optimise serum drug levels may improve treatment response.
Predictors of renal flare in systemic lupus erythematosus
Jägerback et al (doi: 10.1093/rheumatology/keae023) used data from four belimumab trials to attempt identification of predictors of renal flares in patients with systemic lupus erythematosus (SLE); enrolled patients were initially recruited to these trials for active extra-renal disease. The following variables were found to be determinants of renal flares: current/former renal involvement (HR 15.4, p<0.001), low serum albumin (HR 0.9, p<0.001), proteinuria (HR: 1.6, p<0.001) and low C3 (HR: 2.9, p<0.001).
Addressing clinic letters to patients or other health-care practitioners?
Sharp et al (doi: 10.1093/rheumatologykeae093) outline in an editorial the importance of changing the way that rheumatology clinic letters are written by addressing them directly to patients, instead of other healthcare professionals (HCPs). They argue that by addressing letters to patients, this will aid patient engagement and acknowledge different levels of health literacy in patient populations; low health literacy has previously been linked to poorer health outcomes. They outline some barriers to changing to addressing letters to patients, and they advocate for more widespread uptake of this practice.
Anti-IL-1/6 agents may mask criteria-features of macrophage activation syndrome
Ulu et al (doi: 10.1093/rheumatology/keae124) studied 162 patients with systemic juvenile idiopathic arthritis (sJIA)-associated macrophage activation syndrome (MAS) in Turkey to investigate the effect of anti-IL-1/-6 drugs on this presentation. 45/162 patients were receiving anti-IL-1/-6 agents prior to diagnosis with MAS, and clinical and laboratory features of MAS were found to be suppressed in these patients e.g. platelet count, ferritin, CRP, ESR and fever duration. 26.6% of these patients on anti-IL-1/-6 agents did not meet 2016 MAS criteria at presentation. Therefore, MAS should still be considered as a differential diagnosis in patients treated with these drugs, even if classification criteria are not met, as this is a potentially dangerous condition if left untreated.
No relevant effects on progression of high-dose methylprednisolone in early systemic sclerosis
Kersten et al (doi: 10.1093/rheumatology/keae156) present the results of the Hit Hard and Early RCT, which hypothesised that high-dose intravenous glucocorticoids would induce remission in patients diagnosed with very early systemic sclerosis (SSc). At a ratio of 2:1, patients received IV methylprednisolone 1,000 mg for 3 consecutive days 3 times separated by 1 month vs placebo. Following screening of 87 patients, only 30 were eventually recruited to the trial. The investigators found no clinically relevant effect of short-term methylprednisolone treatment in patients recruited to the trial, with a substantial proportion of patients demonstrating disease progression, despite low study numbers. These findings will add an additional factor to consider when balancing risks and benefits of steroid treatment in patients with SSc.
Stephanie Ling
Steph is an NIHR Academic Clinical Lecturer at the University of Manchester and a rheumatology trainee in Manchester, UK. Her main research interest concerns treatment response to biologics in patients with rheumatoid arthritis. This is her first year as member of the EMEUNET Newsletter sub-committee.