This patient was given a diagnosis of Gianotti Crosti syndrome (GCS; also called infantile acrodermatitis of childhood), which is a self-resolving (often dramatic) dermatosis triggered by a viral infection or immunization. Patients with this syndrome develop papules, vesicles, and plaques on their face, hands, feet, and extremities a week (or more) after having a viral illness or receiving an immunization. In patients with darker skin types, lesions may appear purple to brown rather than bright red to red/orange. The syndrome typically occurs in children between the ages of 1 to 4 years, but almost all patients are under the age of 15.¹ Scratching and sleep disturbance are common. The condition typically resolves on its own after 3 or 4 weeks.

Globally, the hepatitis B virus (HBV) is the most common cause of GCS.¹ Other reported triggering viruses include hepatitis A and C, cytomegalovirus, Epstein-Barr virus, enteroviruses, HIV, parainfluenza viruses, parvoviruses, rubella, and COVID-19.²

Since the cause of this patient’s case of GCS was likely linked to a viral infection that produced the loose stools in a population with low-HBV risk, no further serologic testing was performed. Serologic testing may have been necessary if other infections, disease risks, or symptoms were identified. To relieve itching, topical triamcinolone 0.1% cream was prescribed for use once to twice daily on the extremities and hydrocortisone 1% cream was prescribed once to twice daily for use on the child’s face. At the 6-week follow-up visit, the lesions had resolved; light pink discoloration remained but was expected to further fade. In patients with darker skin, post-inflammatory hyperpigmentation may take several months to resolve.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

This patient was given a diagnosis of Gianotti Crosti syndrome (GCS; also called infantile acrodermatitis of childhood), which is a self-resolving (often dramatic) dermatosis triggered by a viral infection or immunization. Patients with this syndrome develop papules, vesicles, and plaques on their face, hands, feet, and extremities a week (or more) after having a viral illness or receiving an immunization. In patients with darker skin types, lesions may appear purple to brown rather than bright red to red/orange. The syndrome typically occurs in children between the ages of 1 to 4 years, but almost all patients are under the age of 15.¹ Scratching and sleep disturbance are common. The condition typically resolves on its own after 3 or 4 weeks.

Globally, the hepatitis B virus (HBV) is the most common cause of GCS.¹ Other reported triggering viruses include hepatitis A and C, cytomegalovirus, Epstein-Barr virus, enteroviruses, HIV, parainfluenza viruses, parvoviruses, rubella, and COVID-19.²

Since the cause of this patient’s case of GCS was likely linked to a viral infection that produced the loose stools in a population with low-HBV risk, no further serologic testing was performed. Serologic testing may have been necessary if other infections, disease risks, or symptoms were identified. To relieve itching, topical triamcinolone 0.1% cream was prescribed for use once to twice daily on the extremities and hydrocortisone 1% cream was prescribed once to twice daily for use on the child’s face. At the 6-week follow-up visit, the lesions had resolved; light pink discoloration remained but was expected to further fade. In patients with darker skin, post-inflammatory hyperpigmentation may take several months to resolve.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

This patient was given a diagnosis of Gianotti Crosti syndrome (GCS; also called infantile acrodermatitis of childhood), which is a self-resolving (often dramatic) dermatosis triggered by a viral infection or immunization. Patients with this syndrome develop papules, vesicles, and plaques on their face, hands, feet, and extremities a week (or more) after having a viral illness or receiving an immunization. In patients with darker skin types, lesions may appear purple to brown rather than bright red to red/orange. The syndrome typically occurs in children between the ages of 1 to 4 years, but almost all patients are under the age of 15.¹ Scratching and sleep disturbance are common. The condition typically resolves on its own after 3 or 4 weeks.

Globally, the hepatitis B virus (HBV) is the most common cause of GCS.¹ Other reported triggering viruses include hepatitis A and C, cytomegalovirus, Epstein-Barr virus, enteroviruses, HIV, parainfluenza viruses, parvoviruses, rubella, and COVID-19.²

Since the cause of this patient’s case of GCS was likely linked to a viral infection that produced the loose stools in a population with low-HBV risk, no further serologic testing was performed. Serologic testing may have been necessary if other infections, disease risks, or symptoms were identified. To relieve itching, topical triamcinolone 0.1% cream was prescribed for use once to twice daily on the extremities and hydrocortisone 1% cream was prescribed once to twice daily for use on the child’s face. At the 6-week follow-up visit, the lesions had resolved; light pink discoloration remained but was expected to further fade. In patients with darker skin, post-inflammatory hyperpigmentation may take several months to resolve.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Dr Robert Shin, from Georgetown University Hospital, highlights key presentations in disease-modifying therapy for multiple sclerosis (MS) presented at the 2022 annual meeting of the Consortium of Multiple Sclerosis Centers. 

First, Dr Shin discusses BTK inhibitors as an emerging treatment for multiple forms of MS, including progressive MS. 

Next, he shares preliminary results from the DISCOMS trial, which studied the safety of discontinuing vs continuing disease-modifying therapy in older MS patients. Although discontinuation was associated with more disease, Dr Shin suggests that a rigorous review of the data reveals no significant difference between the two groups. He comments that more data are needed. 

Dr Shin closes his commentary by highlighting a presentation focused on COVID and MS patients, specifically covering immune response to the COVID-19 vaccine in people being treated for MS.  

--

Professor, Department of Neurology, MedStar Georgetown University Hospital; Director, Georgetown MS and Neuroimmunology Center, Washington, DC 

Robert Shin, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

Dr Robert Shin, from Georgetown University Hospital, highlights key presentations in disease-modifying therapy for multiple sclerosis (MS) presented at the 2022 annual meeting of the Consortium of Multiple Sclerosis Centers. 

First, Dr Shin discusses BTK inhibitors as an emerging treatment for multiple forms of MS, including progressive MS. 

Next, he shares preliminary results from the DISCOMS trial, which studied the safety of discontinuing vs continuing disease-modifying therapy in older MS patients. Although discontinuation was associated with more disease, Dr Shin suggests that a rigorous review of the data reveals no significant difference between the two groups. He comments that more data are needed. 

Dr Shin closes his commentary by highlighting a presentation focused on COVID and MS patients, specifically covering immune response to the COVID-19 vaccine in people being treated for MS.  

--

Professor, Department of Neurology, MedStar Georgetown University Hospital; Director, Georgetown MS and Neuroimmunology Center, Washington, DC 

Robert Shin, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

Dr Robert Shin, from Georgetown University Hospital, highlights key presentations in disease-modifying therapy for multiple sclerosis (MS) presented at the 2022 annual meeting of the Consortium of Multiple Sclerosis Centers. 

First, Dr Shin discusses BTK inhibitors as an emerging treatment for multiple forms of MS, including progressive MS. 

Next, he shares preliminary results from the DISCOMS trial, which studied the safety of discontinuing vs continuing disease-modifying therapy in older MS patients. Although discontinuation was associated with more disease, Dr Shin suggests that a rigorous review of the data reveals no significant difference between the two groups. He comments that more data are needed. 

Dr Shin closes his commentary by highlighting a presentation focused on COVID and MS patients, specifically covering immune response to the COVID-19 vaccine in people being treated for MS.  

--

Professor, Department of Neurology, MedStar Georgetown University Hospital; Director, Georgetown MS and Neuroimmunology Center, Washington, DC 

Robert Shin, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion; Biogen; Bristol Myers Squibb; EMD Serono; Genentech; Horizon; Novartis; Roche; Sanofi Genzyme 

 The study by D'Amico and colleagues underscores the importance of using biologic therapies early in the postoperative course to prevent endoscopic recurrence. Patients who require surgery should initiate biologic therapy as soon as they have completed postoperative healing. This will help prevent a recurrence of their Crohn's disease and limit the need for subsequent surgery in the future. Proactive monitoring for postoperative recurrence and prompt management of any inflammation identified is vital in improving long-term outcomes.

 Meanwhile, Rosiou and colleagues highlight the importance of communication with the entire care team regarding the management of IBD flares. Proactive patient education about notifying the primary gastroenterology provider if they experience flare symptoms can help prevent inappropriate or excess steroid exposure. Steroid-sparing strategies for the induction and maintenance of IBD remission are pivotal in preventing side effects and long-term complications of steroid exposure. Steroids should be used as a short-term therapy while bridging to a safe and appropriate maintenance regimen.

 The study by D'Amico and colleagues underscores the importance of using biologic therapies early in the postoperative course to prevent endoscopic recurrence. Patients who require surgery should initiate biologic therapy as soon as they have completed postoperative healing. This will help prevent a recurrence of their Crohn's disease and limit the need for subsequent surgery in the future. Proactive monitoring for postoperative recurrence and prompt management of any inflammation identified is vital in improving long-term outcomes.

 Meanwhile, Rosiou and colleagues highlight the importance of communication with the entire care team regarding the management of IBD flares. Proactive patient education about notifying the primary gastroenterology provider if they experience flare symptoms can help prevent inappropriate or excess steroid exposure. Steroid-sparing strategies for the induction and maintenance of IBD remission are pivotal in preventing side effects and long-term complications of steroid exposure. Steroids should be used as a short-term therapy while bridging to a safe and appropriate maintenance regimen.

 The study by D'Amico and colleagues underscores the importance of using biologic therapies early in the postoperative course to prevent endoscopic recurrence. Patients who require surgery should initiate biologic therapy as soon as they have completed postoperative healing. This will help prevent a recurrence of their Crohn's disease and limit the need for subsequent surgery in the future. Proactive monitoring for postoperative recurrence and prompt management of any inflammation identified is vital in improving long-term outcomes.

 Meanwhile, Rosiou and colleagues highlight the importance of communication with the entire care team regarding the management of IBD flares. Proactive patient education about notifying the primary gastroenterology provider if they experience flare symptoms can help prevent inappropriate or excess steroid exposure. Steroid-sparing strategies for the induction and maintenance of IBD remission are pivotal in preventing side effects and long-term complications of steroid exposure. Steroids should be used as a short-term therapy while bridging to a safe and appropriate maintenance regimen.

Key clinical point: Patients with both chronic kidney disease (CKD) and rheumatoid arthritis (RA) were at an increased risk for mortality compared with those with CKD alone, with RA having no impact on progressive renal decline.

Major finding: Presence of both CKD and RA vs. CKD alone was associated with an increased risk for all-cause mortality (adjusted hazard ratio [aHR] 1.73; 95% CI 1.27-2.35) and composite of myocardial infarction, cerebrovascular accident, heart failure, or death (aHR 1.65; 95% CI 1.27-2.15), without significantly increasing the risk for progressive renal decline.

Study details: The data come from a retrospective study including 3333 patients with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study, of which 83 patients had RA and were taking a disease-modifying antirheumatic therapy.

Disclosures: CRIC study was supported by the US National Institute of Diabetes and Digestive and Kidney Diseases. No conflicts of interest were declared.

Source: Ezeanuna MN et al. Association of rheumatoid arthritis with mortality in chronic kidney disease: a cohort study. Clin Rheumatol. 2022 (May 25). Doi: 10.1007/s10067-022-06223-x

Key clinical point: Patients with both chronic kidney disease (CKD) and rheumatoid arthritis (RA) were at an increased risk for mortality compared with those with CKD alone, with RA having no impact on progressive renal decline.

Major finding: Presence of both CKD and RA vs. CKD alone was associated with an increased risk for all-cause mortality (adjusted hazard ratio [aHR] 1.73; 95% CI 1.27-2.35) and composite of myocardial infarction, cerebrovascular accident, heart failure, or death (aHR 1.65; 95% CI 1.27-2.15), without significantly increasing the risk for progressive renal decline.

Study details: The data come from a retrospective study including 3333 patients with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study, of which 83 patients had RA and were taking a disease-modifying antirheumatic therapy.

Disclosures: CRIC study was supported by the US National Institute of Diabetes and Digestive and Kidney Diseases. No conflicts of interest were declared.

Source: Ezeanuna MN et al. Association of rheumatoid arthritis with mortality in chronic kidney disease: a cohort study. Clin Rheumatol. 2022 (May 25). Doi: 10.1007/s10067-022-06223-x

Key clinical point: Patients with both chronic kidney disease (CKD) and rheumatoid arthritis (RA) were at an increased risk for mortality compared with those with CKD alone, with RA having no impact on progressive renal decline.

Major finding: Presence of both CKD and RA vs. CKD alone was associated with an increased risk for all-cause mortality (adjusted hazard ratio [aHR] 1.73; 95% CI 1.27-2.35) and composite of myocardial infarction, cerebrovascular accident, heart failure, or death (aHR 1.65; 95% CI 1.27-2.15), without significantly increasing the risk for progressive renal decline.

Study details: The data come from a retrospective study including 3333 patients with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study, of which 83 patients had RA and were taking a disease-modifying antirheumatic therapy.

Disclosures: CRIC study was supported by the US National Institute of Diabetes and Digestive and Kidney Diseases. No conflicts of interest were declared.

Source: Ezeanuna MN et al. Association of rheumatoid arthritis with mortality in chronic kidney disease: a cohort study. Clin Rheumatol. 2022 (May 25). Doi: 10.1007/s10067-022-06223-x

Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6