Winter 2025 Press Review – Annals of Rheumatic Diseases

August 2024 to November 2024

Author:  Krystel Aouad & Victoria Sadovici-Bobeica

EULAR recommendations for the treatment of systemic sclerosis: 2023 update

The updated 2023 EULAR recommendations (10.1136/ard-2024-226430) for the treatment of systemic sclerosis (SSc) include 22 recommendations across 8 clinical domains, with a focus on skin fibrosis and interstitial lung disease (ILD). New treatments recommended include mycophenolate mofetil, nintedanib, rituximab, and tocilizumab for managing these key disease manifestations. The guidelines provide first- and second-line therapies for several conditions, including pulmonary arterial hypertension, and emphasize a new research agenda targeting vascular, gastrointestinal, and musculoskeletal manifestations, as well as digital ulcers. These updates highlight the importance of targeted therapies and combination treatments in SSc management.

Ivarmacitinib, a selective Janus kinase 1 inhibitor, in patients with moderate-to-severe active rheumatoid arthritis and inadequate response to conventional synthetic DMARDs: results from a phase III randomised clinical trial

Liu J et al. (10.1136/ard-2024-226385) assess the efficacy/safety of ivarmacitinib, a selective Janus kinase (JAK) 1 inhibitor, in patients with moderate-to-severe active rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic csDMARDs. At week 24 of this phase III study (NCT04333771), both ivarmacitinib 4 mg (70.4%) and 8 mg (75.1%) groups showed significantly higher ACR20 response rates compared to placebo (40.4%; p<0.0001). Improvements were sustained through 52 weeks, with similar safety profiles across groups, though infection-related adverse events were slightly higher in the ivarmacitinib groups. Ivarmacitinib shows potential as a therapeutic option for RA patients.

Evidence that autoantibody production may be driven by acute Epstein-Barr virus infection in Sjögren’s disease

Hudson et al. (10.1136/ard-2024-226156) examined the role of acute Epstein-Barr virus (EBV) infection in the development of autoantibodies associated with Sjögren’s disease (SD) in a previously healthy patient who developed SD after primary EBV infection. The study found that anti-Ro52 and anti-Ro60 autoantibodies appeared 7 days post-infection and switched from IgM to IgG, suggesting EBV’s role in promoting their production. Over 7 months, antibodies against EBNA1 and U1RNP also increased, indicating molecular mimicry as a mechanism. The findings suggest that primary EBV infection can induce anti-Ro60/anti-Ro52 and anti-U1RNP responses through distinct mechanisms.

Relationship between serum urate and changes in dual-energy CT monosodium urate crystal volume over 1 year in people with gout: an individual participant data analysis

Kelly et al. (10.1136/ard-2024-226059) examined the relationship between serum urate levels and changes in monosodium urate (MSU) crystal volume over 1 year in people with gout. Using dual-energy CT (DECT) scans, the study found that MSU crystal dissolution occurred at serum urate levels below 0.24 mmol/L, while crystal formation was observed at levels ≥0.48 mmol/L. Reductions in DECT urate volume were noted at serum urate levels below 0.42 mmol/L, whereas increased volumes occurred above 0.48 mmol/L. These findings suggest that maintaining serum urate below 0.24 mmol/L may promote crystal dissolution in gout. 

Disease activity of rheumatoid arthritis and kidney function decline: a large prospective registry study

Fukui et al. (10.1136/ard-2024-226156) analyzed data from a multicenter RA registry (31 129 patients, 2001–2022) to assess the impact of longitudinal RA disease activity on kidney function. Patients with higher Clinical Disease Activity Index (CDAI) scores experienced greater declines in estimated glomerular filtration rate (eGFR) compared to those in remission. Specifically, high disease activity was associated with an additional annual eGFR decline of −0.18 mL/min/1.73 m², and an increased risk of developing chronic kidney disease (CKD) stage G3a (HR 1.27) and G3b (HR 1.93). The study suggests that RA disease activity accelerates kidney function decline and increases the risk of CKD.

Relapse risk in stable SLE patients after glucocorticoid withdrawal

Fei et al. (10.1136/ard-2024-225826) explored the relapse rate after glucocorticoid (GC) withdrawal with or without hydroxychloroquine (HCQ) maintenance in sustained clinically inactive systemic lupus erythematosus (SLE). The study included 333 participants, who were randomly assigned to three groups: drug-free group (both GC and HCQ withdrawal); HCQ group (discontinued GC but maintained HCQ); dual maintenance group (both GC and HCQ continued). The relapse rates in the three groups were 26.1%, 11.2% and 4.7%, respectively. The authors concluded that HCQ maintenance can exert a protective role in preventing disease relapse after GC withdrawal.

Shared lung and joint T cell repertoire in early rheumatoid arthritis driven by cigarette smoking

Venken K et al. (10.1136/ard-2024-226284) studied the T cell features in lung and inflamed joints in smoking versus non-smoking patients. T cells in paired bronchoalveolar lavage fluid, blood and inflamed synovium tissue samples from 17 new-onset treatment naïve ACPA+RA patients were examined. As a result, identical TCR clonalities were present in matched lung and joint samples of RA smokers. The authors concluded that there is a profound interplay between a strong MHC predisposition, smoking and induction of autoimmunity by shaping the TCR repertoire.

Comparison of two strategies of glucocorticoid withdrawal in patients with rheumatoid arthritis in low disease activity

Ruyssen-Witrand et al. (10.1136/ard-2024-226620) compared two strategies for their success in glucocorticoid (GC) discontinuation in patients with rheumatoid arthritis (RA) with low disease activity (LDA). Patients were randomly assigned in a 1:1 ratio to either replace prednisone with 20 mg/day of hydrocortisone for 3 months, then reduce to 10 mg/day for 3 months before discontinuation or to taper prednisone by 1 mg/day every month until complete discontinuation. At 12 months, 29 patients in the first group and 23 patients in the second group achieved GC discontinuation. A hydrocortisone replacement strategy was not superior to a prednisone tapering strategy for achieving GC discontinuation.

Efficacy and safety of infliximab or adalimumab in severe mucocutaneous Behçet’s syndrome refractory to traditional immunosuppressants

Talarico et al. (10.1136/ard-2024-226113) evaluated the efficacy and safety of either infliximab (IFX) or adalimumab (ADA) in patients with Behçet’s syndrome (BS) with severe mucocutaneous involvement, in a phase 3, multicentre, prospective, randomised, active-controlled, parallel-group study. 42 patients were randomly assigned to the IFX group (n=22) or to the ADA group (n=18). A total of 14 (64%) responders in the IFX group and 17 (94%) in the ADA group were observed. The overall results of this study confirmed the effectiveness of both IFX and ADA in achieving remission in patients with BS affected by mucocutaneous involvement.

Age, anticoagulants, hypertension and cardiovascular genetic traits predict cranial ischaemic complications in patients with GCA

Chaddock et al. (10.1136/ard-2024-225515) aimed to determine whether cranial ischaemic complications at the presentation of giant cell arteritis (GCA) were associated with pre-existing cardiovascular (CV) risk factors, CV disease or genetic risk of CV-related traits. In a sample of 1946 GCA patients, the authors have conducted a multivariate analysis. Age and hypertension were risk factors for cranial ischaemic complications at GCA presentation, and anticoagulation appeared protective.