Autumn 2025 Press Review – Arthritis Care and Research

April 2025 to July 2025

Author: Antony Psarras

Risk of Incident Heart Failure and Heart Failure Subtypes in Patients With Rheumatoid Arthritis

Kawano et al. (10.1002/acr.25481) identified incident HF and categorized HF subtypes based on EF closest to the HF incident date in 1,445 patients with RA and 4,335 matched non-RA comparators. HFpEF was the most common HF subtype in both groups (65% in RA vs 59% in non-RA). Patients with RA had an HR of 1.79 (95% confidence interval [CI] 1.38–2.32) for incident HF compared with those without RA after adjusting for CVD risk factors. Patients with RA had a higher rate of HFpEF (HR 1.99, 95% CI 1.43–2.77), but there was no statistical difference in the HFrEF rate (HR 1.45, 95% CI 0.81–2.60). Conclusion: RA was associated with a higher rate of HF overall compared with non-RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA.

Immunosuppressive Drugs in Early Systemic Sclerosis and Prevention of Damage Accrual

Baron et al. (10.1002/acr.25467) investigated whether receiving immunosuppresants (ISs) may reduce global organ damage accrual in patients with early SSc. This was a retrospective study of patients with two or fewer years of disease duration in Canadian and Australian cohorts with SSc. Patients with either limited cutaneous SSc (lcSSc) or diffuse cutaneous SSc (dcSSc) were observed separately and divided into groups who were either ever or never exposed to ISs. The SCTC-DI was the outcome, and inverse probability of treatment weighting (IPTW) was used to balance the study groups and to fit a marginal structural generalised estimating equation model. In the cohort with lcSSc, there were 210 patients, of whom 34% were exposed to ISs at some time. Exposure to ISs was associated with lower damage scores. In the cohort with dcSSc, there were 192 patients, of whom 76% were exposed to ISs at some time. Exposure to ISs was not associated with damage scores. Conclusion: protective effect of receiving ISs on damage accrual in patients with lcSSc. But unable to determine such an effect in patients with dcSSc.

Gout Flares After Stopping Anti-Inflammatory Prophylaxis: A Rapid Literature Review and Meta-Analysis

Stamp et al. (doi.org/10.1002/acr.25486) performed a rapid literature review and meta-analysis. PubMed was searched from inception to February 2024. Eligibility criteria included any clinical trial of people with gout with at least one arm starting or intensifying urate-lowering therapy (ULT) with coprescription of anti-inflammatory prophylaxis and that had the percentage of participants experiencing one or more gout flares reported during and after the period of prophylaxis. Gout flares were found to be common after stopping anti-inflammatory prophylaxis, but returned to levels seen during prophylaxis. Patients should be cautioned about the risk of gout flares and have a plan for effective gout flare management in the three months after stopping anti-inflammatory prophylaxis.

Predictors of Mortality in Antiphospholipid Antibody–Positive Patients: Prospective Results From Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository

Ahmadzadeh et al. (10.1002/acr.25503)  investigated the mortality rate as well as the causes and predictors of death in antiphospholipid antibody (aPL)–positive patients with and without antiphospholipid syndrome (APS) classification. Of 967 patients, 43 (5%) were deceased after a median follow-up of 5.3 years. Based on the univariate analysis, deceased patients, compared to living patients, were more likely to be older and have a history of arterial thrombosis, catastrophic APS, concomitant systemic autoimmune diseases (SAIDs), and baseline cardiovascular disease (CVD) risk factors. Based on the Cox proportional hazards model adjusted for age and for each of the strongest predictors of death, arterial thrombosis (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.50–5.76), concomitant SAIDs (HR 2.97, 95% 1.56–5.63), and baseline any CVD risk factor (HR 2.43, 95% CI 1.05–5.71) were significantly associated with mortality. Conclusion: In this cohort of persistently aPL-positive patients, the mortality rate was 5% after a median follow-up of five years and was highest for patients ≥60 years old at registry entry. History of arterial thrombosis, concomitant SAIDs, and baseline any CVD risk factor independently predicted future death.

Comparing Rituximab and Cyclophosphamide in Induction Therapy for Childhood-Onset Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: An ARChiVe Registry Cohort Study

Gagne et al. (10.1002/acr.25455) identified patients with GPA and MPA from a registry of Childhood Vasculitis, who received induction with RTX or CYC. Pediatric Vasculitis Activity Score (PVAS) and Pediatric Vasculitis Damage Index (pVDI) score evaluated disease activity and damage. Descriptive statistics summarized patient characteristics. RTX and CYC comparisons used logistic regression for primary outcomes of postinduction remission (PVAS = 0) or low disease activity (PVAS ≤ 2). Among 104 patients, 43% received RTX, 46% CYC, 11% both. Treatment groups did not significantly differ for diagnosis PVAS and onset age. There was no difference in remission among the groups (63% overall; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.45–2.52). Hospitalizations occurred in 22% of patients receiving RTX versus 10% patients receiving CYC (OR 2.27, 95% CI 0.73–7.05). The median 12-month pVDI score was 1 in both groups (OR 0.98, 95% CI 0.43–2.22). Conclusion: This was the first study comparing CYC and RTX for induction in pediatric GPA and MPA. No significant differences were shown in rates of remission, severe adverse events, or organ damage. Limitations included lack of standardized treatment regimens, retrospectivity, and lack of longitudinal adverse drug-related event data.