APRIL 2024 to JULY 2024
Author: Guillermo Carvajal Alegria & Miranda van Lunteren
Seminars in Arthritis and Rheumatism
Adverse cardiovascular events in rheumatoid arthritis patients treated with JAK inhibitors: An analysis of postmarketing spontaneous safety reports
Goldman et al. (10.1016/j.semarthrit.2024.152461) used FDA adverse event reporting system in a retrospective pharmacovigilance study to investigate the risk of adverse cardiovascular events and venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus Kinase (JAK) inhibitors compared to biologic disease-modifying antirheumatic drugs (bDMARDs). The safety reports of 75,407 RA patients showed that JAK inhibitors were associated with an increased reporting of VTE [n=1.393, adjusted reporting odds ratio (adj.ROR) = 2.11 (1.97−2.25)], stroke [n=973, adj.ROR = 1.25 (1.16−1.34)], ischemic heart disease [n=999, adj.ROR = 1.23 (1.13−1.33)], peripheral edema [n=2699, adj.ROR = 1.22 (1.17−1.28)], and tachyarrhythmias [n=370, adj.ROR = 1.15 (1.00–1.33)] compared to bDMARDs. Most events occurred in the first year after treatment initiation.
Clinical and imaging outcomes of different phenotypes of axial spondyloarthritis: 5-year analysis of the DESIR cohort
Sepriano et al. (10.1016/j.semarthrit.2024.152424) compared the long-term outcomes of three phenotypes of axial spondyloarthritis (axSpA), ‘Axial’, ‘Inflammatory back pain (IBP)+Peripheral’ and ‘At risk’, among 576 patients in the DESIR cohort. Over five years, ‘At risk’ patients experienced worse disability (∆BASFI: −0.4 vs. -1.3 to −0.9) and less improvement in quality of life (∆SF36 physical domain: +2 vs. +4 to +6 and mental domain +3 vs. +2 to +7) compared to ‘Axial’ and ‘IBP+Peripheral’ patients, with a significant impact noted in those on bDMARDs. Imaging outcomes were worse in the ‘Axial’ phenotype. These findings suggest that treatment strategies might need to be tailored based on axSpA phenotype.
An OMERACT study to define independence in the context of rheumatoid arthritis remission from the patient perspective
Flurey et al. (10.1016/j.semarthrit.2024.152526) explored the concept of “independence” in rheumatoid arthritis (RA) remission from the patient perspective. Independence encompasses more than physical and functional abilities; it includes full participation without adjusting for RA and cognitive freedom from disease-related thoughts. Five focus groups of 19 patients identified different stages of independence – ranging from ‘Practically independent’ to ‘Full autonomy’. The role of assistance (people/devices) in achieving independence was seen as ambiguous. It is needed to take forward the important issues raised in these focus groups to developing a measure for independence in the context of RA remission from the patient perspective.
Real-world application of the pediatric Glucocorticoid Toxicity Index in childhood-onset lupus
Zhang et al. (10.1016/j.semarthrit.2024.152516) evaluated the feasibility and construct validity of the pediatric Glucocorticoid Toxicity Index (pGTI) in patients with pediatric-onset systemic lupus erythematosus (pSLE). A high burden of glucocorticoid (GC)-related morbidity was found among 126 patients with pSLE. Most common toxicities were worsening of blood pressure (47%), mood disturbance (25%), increased body mass index (BMI), striae, and sleep disturbance (21% each). Decreased growth velocity was observed in 18%. Greater cumulative toxicity was associated with younger age, elevated BMI, and rituximab use at the time of GC initiation. The pGTI demonstrated feasibility and construct validity, showing a dose-response relationship between GC exposure and toxicity.
Risk and predictors of fractures in early rheumatoid arthritis – A long term follow up study of an inception cohort
Theander et al. (10.1016/j.semarthrit.2024.152497) reports that patients with newly diagnosed rheumatoid arthritis (RA) have a higher risk of fractures [adjusted hazard ratio (adj.HR)=1.52, 95%CI 1.13;2.06] compared to matched population controls. Among these 233 patients, high age, low body mass index, and low bone mineral density (BMD) were baseline predictors of future fractures; baseline RA disease characteristics were not. Fracture risk was related to worse disability (higher Health Assessment Questionnaire, HAQ, scores) [adj.HR=1.33 per SD, 95%CI 1.09;1.63] and BMD [Z-scores femoral neck 0.75 (0.59-0.95) and lumbar spine 0.69 (0.54-0.88)] over time.
Guillermo Carvajal Alegria
Guillermo is an associate professor of rheumatology at the University of Tours and in the rheumatology department of the Tours University Hospital, France. His research interest are polymyalgia rheumatica and giant cell arteritis, ultrasonography and procedures for clinical research and administration of biopharmaceuticals for scientific research. He is part of the board of directors of the French Rheumatology Society and of steering committee of the French College of Teaching Rheumatologists. He is a member of the EMEUNET Visibility & Global Affairs sub-committee.
Miranda van Lunteren
Miranda is a post-doctoral clinical researcher and clinical study coordinator at Department of Rheumatology of the Leiden University Medical Center in Leiden. In 2020 she obtained her PhD on the burden of early axial spondyloarthritis. Her major research interest is axial spondyloarthritis, with a focus on observational studies, imaging and patient-reported outcomes. She has an interest in methodology and clinical trials. Miranda is the study coordinator of the ASAS CLASSIC study, a member of the Y-ASAS Website Subgroup and of the EMEUNET Social Media Sub-Committee.