In the approach to treatment of patients with rheumatoid arthritis (RA), methotrexate monotherapy is often followed by addition of a biologic disease modifying anti-rheumatic drugs (bDMARDs) for best disease outcomes. Combination DMARDs therapy with methotrexate, hydroxychloroquine, and sulfasalazine (triple therapy) has been proposed as an alternative to biologic therapy. Combination methotrexate and leflunomide is not as frequently addressed in the literature, perhaps due in part to concerns about hepatotoxicity. Bredemeier et al address safety concerns regarding combination methotrexate and leflunomide in the treatment of patients with RA. In this multicenter Brazilian registry study, they compared adverse events (including infection) among patients receiving bDMARDs or JAK inhibitors. Patients treated with combination methotrexate and leflunomide had comparable rates of adverse effects as patients treated with either medication alone; infectious and serious adverse events were fewer compared to patients treated with bDMARDs or JAK inhibitors. Given this reassuring information, further study of the efficacy and durability of combination methotrexate and leflunomide therapy would be helpful to firmly establish its place in treatment of RA, especially among newer biologic choices.

Tofacitinib and tocilizumab, for example, have been under investigation for safety and efficacy, alone and in combination with conventional synthetic DMARDs (csDMARDs). Prior studies have suggested that tofacitinib is more effective in bDMARD-naïve patients than patients who have had inadequate efficacy with one or more bDMARDs. In this multicenter Japanese cohort study, Mori et al examine RA outcomes in new users of tofacitinib and tocilizumab. Clinical disease activity index (CDAI) responses and remission rates were significantly better among bDMARD-naïve patients receiving tofacitinib compared to those receiving tocilizumab; interestingly, this difference was not seen in patients who had previously received bDMARDs. Interpretation of these results is somewhat hampered by the use of the lower every-other-week tocilizimab injection dose, but they still raise the question as to whether timing and sequence of biologics can affect future response to therapy.

The role of conventional DMARDs has also been questioned in the converse role: tapering of therapy. Lillegraven et al compare tapering of csDMARDs to continuing therapy in this randomized multicenter Norwegian study. The possibility of biologic tapering in RA has previously been addressed with some evidence of success in the form of reduced frequency of administration. Unfortunately, despite being in stable remission, patients assigned to reduce csDMARDs to half-dose had more flares than those continuing therapy, suggesting that reducing csDMARDs to half-dose in RA patients in remission may not be easily accomplished. Whether this changes in patients with prolonged or “deep” remission is as yet unknown.

Finally, with all of these options for tailored therapy, how does our treatment of early RA fare? Combe et al report the 10-year outcomes of a French early RA cohort (ESPOIR), including patients with RA for <6 months recruited from 2003-2005. 521 patients were followed; at year 10, half were in DAS28 remission, and 14% in drug-free remission. Compared to outcomes from an earlier community- based study, patients in the ESPOIR cohort have better outcomes, possibly due to more aggressive treatment for RA, use of bDMARDs, or perhaps even earlier identification of patients for treatment. Due to the sizeable proportion of patients in drug-free remission, the impact of stringency of entry criteria should be considered, and a comparison to a later cohort with patients identified using 2019 ACR/EULAR criteria would be of great interest.

In the approach to treatment of patients with rheumatoid arthritis (RA), methotrexate monotherapy is often followed by addition of a biologic disease modifying anti-rheumatic drugs (bDMARDs) for best disease outcomes. Combination DMARDs therapy with methotrexate, hydroxychloroquine, and sulfasalazine (triple therapy) has been proposed as an alternative to biologic therapy. Combination methotrexate and leflunomide is not as frequently addressed in the literature, perhaps due in part to concerns about hepatotoxicity. Bredemeier et al address safety concerns regarding combination methotrexate and leflunomide in the treatment of patients with RA. In this multicenter Brazilian registry study, they compared adverse events (including infection) among patients receiving bDMARDs or JAK inhibitors. Patients treated with combination methotrexate and leflunomide had comparable rates of adverse effects as patients treated with either medication alone; infectious and serious adverse events were fewer compared to patients treated with bDMARDs or JAK inhibitors. Given this reassuring information, further study of the efficacy and durability of combination methotrexate and leflunomide therapy would be helpful to firmly establish its place in treatment of RA, especially among newer biologic choices.

Tofacitinib and tocilizumab, for example, have been under investigation for safety and efficacy, alone and in combination with conventional synthetic DMARDs (csDMARDs). Prior studies have suggested that tofacitinib is more effective in bDMARD-naïve patients than patients who have had inadequate efficacy with one or more bDMARDs. In this multicenter Japanese cohort study, Mori et al examine RA outcomes in new users of tofacitinib and tocilizumab. Clinical disease activity index (CDAI) responses and remission rates were significantly better among bDMARD-naïve patients receiving tofacitinib compared to those receiving tocilizumab; interestingly, this difference was not seen in patients who had previously received bDMARDs. Interpretation of these results is somewhat hampered by the use of the lower every-other-week tocilizimab injection dose, but they still raise the question as to whether timing and sequence of biologics can affect future response to therapy.

The role of conventional DMARDs has also been questioned in the converse role: tapering of therapy. Lillegraven et al compare tapering of csDMARDs to continuing therapy in this randomized multicenter Norwegian study. The possibility of biologic tapering in RA has previously been addressed with some evidence of success in the form of reduced frequency of administration. Unfortunately, despite being in stable remission, patients assigned to reduce csDMARDs to half-dose had more flares than those continuing therapy, suggesting that reducing csDMARDs to half-dose in RA patients in remission may not be easily accomplished. Whether this changes in patients with prolonged or “deep” remission is as yet unknown.

Finally, with all of these options for tailored therapy, how does our treatment of early RA fare? Combe et al report the 10-year outcomes of a French early RA cohort (ESPOIR), including patients with RA for <6 months recruited from 2003-2005. 521 patients were followed; at year 10, half were in DAS28 remission, and 14% in drug-free remission. Compared to outcomes from an earlier community- based study, patients in the ESPOIR cohort have better outcomes, possibly due to more aggressive treatment for RA, use of bDMARDs, or perhaps even earlier identification of patients for treatment. Due to the sizeable proportion of patients in drug-free remission, the impact of stringency of entry criteria should be considered, and a comparison to a later cohort with patients identified using 2019 ACR/EULAR criteria would be of great interest.

In the approach to treatment of patients with rheumatoid arthritis (RA), methotrexate monotherapy is often followed by addition of a biologic disease modifying anti-rheumatic drugs (bDMARDs) for best disease outcomes. Combination DMARDs therapy with methotrexate, hydroxychloroquine, and sulfasalazine (triple therapy) has been proposed as an alternative to biologic therapy. Combination methotrexate and leflunomide is not as frequently addressed in the literature, perhaps due in part to concerns about hepatotoxicity. Bredemeier et al address safety concerns regarding combination methotrexate and leflunomide in the treatment of patients with RA. In this multicenter Brazilian registry study, they compared adverse events (including infection) among patients receiving bDMARDs or JAK inhibitors. Patients treated with combination methotrexate and leflunomide had comparable rates of adverse effects as patients treated with either medication alone; infectious and serious adverse events were fewer compared to patients treated with bDMARDs or JAK inhibitors. Given this reassuring information, further study of the efficacy and durability of combination methotrexate and leflunomide therapy would be helpful to firmly establish its place in treatment of RA, especially among newer biologic choices.

Tofacitinib and tocilizumab, for example, have been under investigation for safety and efficacy, alone and in combination with conventional synthetic DMARDs (csDMARDs). Prior studies have suggested that tofacitinib is more effective in bDMARD-naïve patients than patients who have had inadequate efficacy with one or more bDMARDs. In this multicenter Japanese cohort study, Mori et al examine RA outcomes in new users of tofacitinib and tocilizumab. Clinical disease activity index (CDAI) responses and remission rates were significantly better among bDMARD-naïve patients receiving tofacitinib compared to those receiving tocilizumab; interestingly, this difference was not seen in patients who had previously received bDMARDs. Interpretation of these results is somewhat hampered by the use of the lower every-other-week tocilizimab injection dose, but they still raise the question as to whether timing and sequence of biologics can affect future response to therapy.

The role of conventional DMARDs has also been questioned in the converse role: tapering of therapy. Lillegraven et al compare tapering of csDMARDs to continuing therapy in this randomized multicenter Norwegian study. The possibility of biologic tapering in RA has previously been addressed with some evidence of success in the form of reduced frequency of administration. Unfortunately, despite being in stable remission, patients assigned to reduce csDMARDs to half-dose had more flares than those continuing therapy, suggesting that reducing csDMARDs to half-dose in RA patients in remission may not be easily accomplished. Whether this changes in patients with prolonged or “deep” remission is as yet unknown.

Finally, with all of these options for tailored therapy, how does our treatment of early RA fare? Combe et al report the 10-year outcomes of a French early RA cohort (ESPOIR), including patients with RA for <6 months recruited from 2003-2005. 521 patients were followed; at year 10, half were in DAS28 remission, and 14% in drug-free remission. Compared to outcomes from an earlier community- based study, patients in the ESPOIR cohort have better outcomes, possibly due to more aggressive treatment for RA, use of bDMARDs, or perhaps even earlier identification of patients for treatment. Due to the sizeable proportion of patients in drug-free remission, the impact of stringency of entry criteria should be considered, and a comparison to a later cohort with patients identified using 2019 ACR/EULAR criteria would be of great interest.

Key clinical point: Rheumatologists mostly preferred tumor necrosis factor inhibitors (TNFi) for the management of patients with rheumatoid arthritis (RA) with an inadequate response to methotrexate. Abatacept seemed to be the more preferred option for patients with pulmonary involvement or a high risk for infection.

Major finding: TNFi was the preferred strategy in 80% of vignettes, except in cases with a history of infection and pulmonary comorbidity where abatacept was the first choice (global BW score: TNFi, 0.53 and abatacept, 0.38). Tocilizumab was the third most preferred strategy, chosen in 83% of the cases (global BW score: 0.11).

Study details: This was a noninterventional multicenter study involving 64 hypothetical clinical vignettes of patients with RA with an inadequate response to methotrexate. These case vignettes were presented to 211 French rheumatologists to elicit their therapeutic preferences.

Disclosures: The study was funded by Eli Lilly and Company, Indianapolis, IN, USA. Some of the authors declared receiving research grants, consultancy fees, and/or being employees and/or shareholders of Eli Lilly and Company and FAST4.

Source: Senbel E et al. Rheumatol Ther. 2021 May 3. doi: 10.1007/s40744-021-00311-1.

Key clinical point: Rheumatologists mostly preferred tumor necrosis factor inhibitors (TNFi) for the management of patients with rheumatoid arthritis (RA) with an inadequate response to methotrexate. Abatacept seemed to be the more preferred option for patients with pulmonary involvement or a high risk for infection.

Major finding: TNFi was the preferred strategy in 80% of vignettes, except in cases with a history of infection and pulmonary comorbidity where abatacept was the first choice (global BW score: TNFi, 0.53 and abatacept, 0.38). Tocilizumab was the third most preferred strategy, chosen in 83% of the cases (global BW score: 0.11).

Study details: This was a noninterventional multicenter study involving 64 hypothetical clinical vignettes of patients with RA with an inadequate response to methotrexate. These case vignettes were presented to 211 French rheumatologists to elicit their therapeutic preferences.

Disclosures: The study was funded by Eli Lilly and Company, Indianapolis, IN, USA. Some of the authors declared receiving research grants, consultancy fees, and/or being employees and/or shareholders of Eli Lilly and Company and FAST4.

Source: Senbel E et al. Rheumatol Ther. 2021 May 3. doi: 10.1007/s40744-021-00311-1.

Key clinical point: Rheumatologists mostly preferred tumor necrosis factor inhibitors (TNFi) for the management of patients with rheumatoid arthritis (RA) with an inadequate response to methotrexate. Abatacept seemed to be the more preferred option for patients with pulmonary involvement or a high risk for infection.

Major finding: TNFi was the preferred strategy in 80% of vignettes, except in cases with a history of infection and pulmonary comorbidity where abatacept was the first choice (global BW score: TNFi, 0.53 and abatacept, 0.38). Tocilizumab was the third most preferred strategy, chosen in 83% of the cases (global BW score: 0.11).

Study details: This was a noninterventional multicenter study involving 64 hypothetical clinical vignettes of patients with RA with an inadequate response to methotrexate. These case vignettes were presented to 211 French rheumatologists to elicit their therapeutic preferences.

Disclosures: The study was funded by Eli Lilly and Company, Indianapolis, IN, USA. Some of the authors declared receiving research grants, consultancy fees, and/or being employees and/or shareholders of Eli Lilly and Company and FAST4.

Source: Senbel E et al. Rheumatol Ther. 2021 May 3. doi: 10.1007/s40744-021-00311-1.

Key clinical point: Patients with rheumatoid arthritis (RA) have distinct clinical and biomechanical factors that place them at an increased risk for falls.

Major finding: The fallers vs. nonfallers were older (P = .05), had significantly higher pain scores (P less than .01), experienced dizziness (P less than .01), and were taking psychotropic medications (P = .02). The fallers vs. nonfallers had significantly higher anteroposterior sway (P = .03) and sway range (P = .02) and medial-lateral sway (P = .01) and sway range (P = .02) when standing with eyes open and a greater asymmetry during isometric extension at 90° (P = .05) and 60° (P = .02).

Study details: This was a nested case-control biomechanical analysis of 436 patients (aged 60 years or older) with RA who completed a 1-year prospective survey of falls.

Disclosures: This work was supported by the National Institute for Health Research, Research for Patient Benefit, and NIHR Manchester Biomedical Research Centre. The authors declared no conflicts of interest.

Source: Smith TO et al. Rheumatology (Oxford). 2021 Apr 26. doi:10.1093/rheumatology/keab388.

Key clinical point: Patients with rheumatoid arthritis (RA) have distinct clinical and biomechanical factors that place them at an increased risk for falls.

Major finding: The fallers vs. nonfallers were older (P = .05), had significantly higher pain scores (P less than .01), experienced dizziness (P less than .01), and were taking psychotropic medications (P = .02). The fallers vs. nonfallers had significantly higher anteroposterior sway (P = .03) and sway range (P = .02) and medial-lateral sway (P = .01) and sway range (P = .02) when standing with eyes open and a greater asymmetry during isometric extension at 90° (P = .05) and 60° (P = .02).

Study details: This was a nested case-control biomechanical analysis of 436 patients (aged 60 years or older) with RA who completed a 1-year prospective survey of falls.

Disclosures: This work was supported by the National Institute for Health Research, Research for Patient Benefit, and NIHR Manchester Biomedical Research Centre. The authors declared no conflicts of interest.

Source: Smith TO et al. Rheumatology (Oxford). 2021 Apr 26. doi:10.1093/rheumatology/keab388.

Key clinical point: Patients with rheumatoid arthritis (RA) have distinct clinical and biomechanical factors that place them at an increased risk for falls.

Major finding: The fallers vs. nonfallers were older (P = .05), had significantly higher pain scores (P less than .01), experienced dizziness (P less than .01), and were taking psychotropic medications (P = .02). The fallers vs. nonfallers had significantly higher anteroposterior sway (P = .03) and sway range (P = .02) and medial-lateral sway (P = .01) and sway range (P = .02) when standing with eyes open and a greater asymmetry during isometric extension at 90° (P = .05) and 60° (P = .02).

Study details: This was a nested case-control biomechanical analysis of 436 patients (aged 60 years or older) with RA who completed a 1-year prospective survey of falls.

Disclosures: This work was supported by the National Institute for Health Research, Research for Patient Benefit, and NIHR Manchester Biomedical Research Centre. The authors declared no conflicts of interest.

Source: Smith TO et al. Rheumatology (Oxford). 2021 Apr 26. doi:10.1093/rheumatology/keab388.

Key clinical point: Obese patients with established rheumatoid arthritis (RA) were less likely to achieve remission and more likely to experience intensive exposure to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) than patients with normal body mass index (BMI).

Major finding: At 6 months, obese patients vs. those with normal BMI were less likely to achieve disease activity score 28 remission (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.28-0.69) and more likely to be treated with combination csDMARD therapy than monotherapy (OR, 1.59; 95% CI, 1.03-2.45).

Study details: The findings are from a real-world analysis of 1,313 patients diagnosed with RA collected from the METEOR database.

Disclosures: No funding was received for this study. The authors declared no conflicts of interest.

Source: Dey M et al. Rheumatology (Oxford). 2021 Apr 30. doi: 10.1093/rheumatology/keab389.

Key clinical point: Obese patients with established rheumatoid arthritis (RA) were less likely to achieve remission and more likely to experience intensive exposure to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) than patients with normal body mass index (BMI).

Major finding: At 6 months, obese patients vs. those with normal BMI were less likely to achieve disease activity score 28 remission (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.28-0.69) and more likely to be treated with combination csDMARD therapy than monotherapy (OR, 1.59; 95% CI, 1.03-2.45).

Study details: The findings are from a real-world analysis of 1,313 patients diagnosed with RA collected from the METEOR database.

Disclosures: No funding was received for this study. The authors declared no conflicts of interest.

Source: Dey M et al. Rheumatology (Oxford). 2021 Apr 30. doi: 10.1093/rheumatology/keab389.

Key clinical point: Obese patients with established rheumatoid arthritis (RA) were less likely to achieve remission and more likely to experience intensive exposure to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) than patients with normal body mass index (BMI).

Major finding: At 6 months, obese patients vs. those with normal BMI were less likely to achieve disease activity score 28 remission (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.28-0.69) and more likely to be treated with combination csDMARD therapy than monotherapy (OR, 1.59; 95% CI, 1.03-2.45).

Study details: The findings are from a real-world analysis of 1,313 patients diagnosed with RA collected from the METEOR database.

Disclosures: No funding was received for this study. The authors declared no conflicts of interest.

Source: Dey M et al. Rheumatology (Oxford). 2021 Apr 30. doi: 10.1093/rheumatology/keab389.

Key clinical point: Anti-interleukin-6 (aIL-6) receptor antibody was more effective than other biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with knee joint involvement but not in patients without knee joint involvement.

Major finding: At 12 weeks, treatment with aIL-6 significantly increased clinical disease activity index (CDAI) in patients with knee joint involvement compared with other bDMARDs (P = .02). In patients without swollen knee joints, aIL-6 vs. other bDMARDs showed no significant difference in CDAI improvement (P = .61).

Study details: Findings are from a retrospective analysis of 1,059 treatment courses in patients with RA from the ANSWER cohort who were treated with bDMARDs. The patients were categorized into those with (n=275; 323 bDMARDs treatment course) or without (n=561; 736 bDMARDs treatment course) joint knee involvement.

Disclosures: ANSWER Cohort was supported by grants from Abbie G.K., Asahi-Kasei Pharma, AYUMI Pharmaceutical Co., Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Janssen Pharmaceutical K.K., Ono Pharmaceutical Co., Sanofi, UCB Japan Co. Ltd., and Teijin Healthcare Limited. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Maeda Y et al. Rheumatol Int. 2021 Apr 26. doi: 10.1007/s00296-021-04862-y.

Key clinical point: Anti-interleukin-6 (aIL-6) receptor antibody was more effective than other biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with knee joint involvement but not in patients without knee joint involvement.

Major finding: At 12 weeks, treatment with aIL-6 significantly increased clinical disease activity index (CDAI) in patients with knee joint involvement compared with other bDMARDs (P = .02). In patients without swollen knee joints, aIL-6 vs. other bDMARDs showed no significant difference in CDAI improvement (P = .61).

Study details: Findings are from a retrospective analysis of 1,059 treatment courses in patients with RA from the ANSWER cohort who were treated with bDMARDs. The patients were categorized into those with (n=275; 323 bDMARDs treatment course) or without (n=561; 736 bDMARDs treatment course) joint knee involvement.

Disclosures: ANSWER Cohort was supported by grants from Abbie G.K., Asahi-Kasei Pharma, AYUMI Pharmaceutical Co., Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Janssen Pharmaceutical K.K., Ono Pharmaceutical Co., Sanofi, UCB Japan Co. Ltd., and Teijin Healthcare Limited. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Maeda Y et al. Rheumatol Int. 2021 Apr 26. doi: 10.1007/s00296-021-04862-y.

Key clinical point: Anti-interleukin-6 (aIL-6) receptor antibody was more effective than other biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with knee joint involvement but not in patients without knee joint involvement.

Major finding: At 12 weeks, treatment with aIL-6 significantly increased clinical disease activity index (CDAI) in patients with knee joint involvement compared with other bDMARDs (P = .02). In patients without swollen knee joints, aIL-6 vs. other bDMARDs showed no significant difference in CDAI improvement (P = .61).

Study details: Findings are from a retrospective analysis of 1,059 treatment courses in patients with RA from the ANSWER cohort who were treated with bDMARDs. The patients were categorized into those with (n=275; 323 bDMARDs treatment course) or without (n=561; 736 bDMARDs treatment course) joint knee involvement.

Disclosures: ANSWER Cohort was supported by grants from Abbie G.K., Asahi-Kasei Pharma, AYUMI Pharmaceutical Co., Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Janssen Pharmaceutical K.K., Ono Pharmaceutical Co., Sanofi, UCB Japan Co. Ltd., and Teijin Healthcare Limited. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Maeda Y et al. Rheumatol Int. 2021 Apr 26. doi: 10.1007/s00296-021-04862-y.

Key clinical point: Combination of methotrexate (MTX) and leflunomide (LEF) had a good overall safety profile compared with MTX or LEF alone and other regimens involved in advanced therapy for rheumatoid arthritis (RA).

Major finding: The risk for serious adverse events (SAEs; adjusted hazard ratio, [aHR], 1.00; P = .984) was not higher; however, the risk for any adverse events (aHR, 1.22; P = .013) was higher with MTX+LEF vs. MTX or LEF alone. The risk for SAEs (aHR, 0.56; P = .011) and infectious SAEs (aHR, 0.48; P = .031) was lower with MTX+LEF combo vs. biologic disease-modifying antirheumatic drugs (bDMARD)/JAK inhibitor (JAKi) with MTX or LEF.

Study details: Findings are from an analysis of 1,671 patients with RA from BiobadaBrasil, a multicentric, observational study. Included patients initiated the first treatment course with a conventional synthetic-DMARD or first bDMARD/JAKi.

Disclosures: This study was funded by the Brazilian Society of Rheumatology with funds from various pharmaceutical companies marketing biological compounds. The authors declared no conflicts of interest.

Source: Bredemeier M et al. J Rheumatol. 2021 May 1. doi: 10.3899/jrheum.201248.

Key clinical point: Combination of methotrexate (MTX) and leflunomide (LEF) had a good overall safety profile compared with MTX or LEF alone and other regimens involved in advanced therapy for rheumatoid arthritis (RA).

Major finding: The risk for serious adverse events (SAEs; adjusted hazard ratio, [aHR], 1.00; P = .984) was not higher; however, the risk for any adverse events (aHR, 1.22; P = .013) was higher with MTX+LEF vs. MTX or LEF alone. The risk for SAEs (aHR, 0.56; P = .011) and infectious SAEs (aHR, 0.48; P = .031) was lower with MTX+LEF combo vs. biologic disease-modifying antirheumatic drugs (bDMARD)/JAK inhibitor (JAKi) with MTX or LEF.

Study details: Findings are from an analysis of 1,671 patients with RA from BiobadaBrasil, a multicentric, observational study. Included patients initiated the first treatment course with a conventional synthetic-DMARD or first bDMARD/JAKi.

Disclosures: This study was funded by the Brazilian Society of Rheumatology with funds from various pharmaceutical companies marketing biological compounds. The authors declared no conflicts of interest.

Source: Bredemeier M et al. J Rheumatol. 2021 May 1. doi: 10.3899/jrheum.201248.

Key clinical point: Combination of methotrexate (MTX) and leflunomide (LEF) had a good overall safety profile compared with MTX or LEF alone and other regimens involved in advanced therapy for rheumatoid arthritis (RA).

Major finding: The risk for serious adverse events (SAEs; adjusted hazard ratio, [aHR], 1.00; P = .984) was not higher; however, the risk for any adverse events (aHR, 1.22; P = .013) was higher with MTX+LEF vs. MTX or LEF alone. The risk for SAEs (aHR, 0.56; P = .011) and infectious SAEs (aHR, 0.48; P = .031) was lower with MTX+LEF combo vs. biologic disease-modifying antirheumatic drugs (bDMARD)/JAK inhibitor (JAKi) with MTX or LEF.

Study details: Findings are from an analysis of 1,671 patients with RA from BiobadaBrasil, a multicentric, observational study. Included patients initiated the first treatment course with a conventional synthetic-DMARD or first bDMARD/JAKi.

Disclosures: This study was funded by the Brazilian Society of Rheumatology with funds from various pharmaceutical companies marketing biological compounds. The authors declared no conflicts of interest.

Source: Bredemeier M et al. J Rheumatol. 2021 May 1. doi: 10.3899/jrheum.201248.

Key clinical point: Rheumatoid meningitis should be considered in adult patients with or without a diagnosis of rheumatoid arthritis (RA). This would help in timely diagnosis and treatment, thus improving its outcomes.

Major finding: Common clinical manifestations of rheumatoid meningitis were transient focal neurologic signs (64.28%), systemic symptoms (51.78%), episodic headaches (50.00%), and neuropsychiatric changes (47.32%). Brain imaging indicated frontal (82.69%) and parietal (77.88%) lobes as the most common lesion location. Laboratory findings included high levels of rheumatoid factor (89.71%), anticyclic citrulline peptide (89.47%), C-reactive protein (82.54%), and erythrocyte deposition rate (81.81%).

Study details: Findings are from a meta-analysis of 103 studies involving 130 cases of rheumatoid meningitis. RA was diagnosed previously in 83% of cases, whereas the remaining 17% of patients were diagnosed with RA during or after the first diagnosis of rheumatoid meningitis.

Disclosures: No outside funding was provided for this study. The authors did not report any conflicts of interest.

Source: Villa E et al. Eur J Neurol. 2021 May 9. doi: 10.1111/ene.14904.

Key clinical point: Rheumatoid meningitis should be considered in adult patients with or without a diagnosis of rheumatoid arthritis (RA). This would help in timely diagnosis and treatment, thus improving its outcomes.

Major finding: Common clinical manifestations of rheumatoid meningitis were transient focal neurologic signs (64.28%), systemic symptoms (51.78%), episodic headaches (50.00%), and neuropsychiatric changes (47.32%). Brain imaging indicated frontal (82.69%) and parietal (77.88%) lobes as the most common lesion location. Laboratory findings included high levels of rheumatoid factor (89.71%), anticyclic citrulline peptide (89.47%), C-reactive protein (82.54%), and erythrocyte deposition rate (81.81%).

Study details: Findings are from a meta-analysis of 103 studies involving 130 cases of rheumatoid meningitis. RA was diagnosed previously in 83% of cases, whereas the remaining 17% of patients were diagnosed with RA during or after the first diagnosis of rheumatoid meningitis.

Disclosures: No outside funding was provided for this study. The authors did not report any conflicts of interest.

Source: Villa E et al. Eur J Neurol. 2021 May 9. doi: 10.1111/ene.14904.

Key clinical point: Rheumatoid meningitis should be considered in adult patients with or without a diagnosis of rheumatoid arthritis (RA). This would help in timely diagnosis and treatment, thus improving its outcomes.

Major finding: Common clinical manifestations of rheumatoid meningitis were transient focal neurologic signs (64.28%), systemic symptoms (51.78%), episodic headaches (50.00%), and neuropsychiatric changes (47.32%). Brain imaging indicated frontal (82.69%) and parietal (77.88%) lobes as the most common lesion location. Laboratory findings included high levels of rheumatoid factor (89.71%), anticyclic citrulline peptide (89.47%), C-reactive protein (82.54%), and erythrocyte deposition rate (81.81%).

Study details: Findings are from a meta-analysis of 103 studies involving 130 cases of rheumatoid meningitis. RA was diagnosed previously in 83% of cases, whereas the remaining 17% of patients were diagnosed with RA during or after the first diagnosis of rheumatoid meningitis.

Disclosures: No outside funding was provided for this study. The authors did not report any conflicts of interest.

Source: Villa E et al. Eur J Neurol. 2021 May 9. doi: 10.1111/ene.14904.

Key clinical point: A recent large cohort of patients with early rheumatoid arthritis (RA) revealed favorable 10-year outcomes, significantly better than the outcomes observed in a previous cohort of patients studied in 1993.

Major finding: At 10 years, disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate remission, DAS28 sustained remission, and drug-free remission were achieved by 52.4%, 40.1%, and 14.1% of patients, respectively. Half of the patients did not have a serious functional disability. Mortality rates were lower than that in the 1993 cohort (4.5% vs. 11.0%) and similar to that in the general population.

Study details: The data come from an analysis of 521 patients from the ESPOIR cohort who were diagnosed with early arthritis between 2003 and 2005 with a probable or certain diagnosis of RA and had never been prescribed disease-modifying antirheumatic drugs or glucocorticoids.

Disclosures: This work was supported by the Merck Sharp and Dohme, INSERM, French Society of Rheumatology, AbbVie, Pfizer, Lilly, Fresenius, and Galapagos. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Combe B et al. Rheumatology (Oxford). 2021 May 7. doi: 10.1093/rheumatology/keab398.

Key clinical point: A recent large cohort of patients with early rheumatoid arthritis (RA) revealed favorable 10-year outcomes, significantly better than the outcomes observed in a previous cohort of patients studied in 1993.

Major finding: At 10 years, disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate remission, DAS28 sustained remission, and drug-free remission were achieved by 52.4%, 40.1%, and 14.1% of patients, respectively. Half of the patients did not have a serious functional disability. Mortality rates were lower than that in the 1993 cohort (4.5% vs. 11.0%) and similar to that in the general population.

Study details: The data come from an analysis of 521 patients from the ESPOIR cohort who were diagnosed with early arthritis between 2003 and 2005 with a probable or certain diagnosis of RA and had never been prescribed disease-modifying antirheumatic drugs or glucocorticoids.

Disclosures: This work was supported by the Merck Sharp and Dohme, INSERM, French Society of Rheumatology, AbbVie, Pfizer, Lilly, Fresenius, and Galapagos. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Combe B et al. Rheumatology (Oxford). 2021 May 7. doi: 10.1093/rheumatology/keab398.

Key clinical point: A recent large cohort of patients with early rheumatoid arthritis (RA) revealed favorable 10-year outcomes, significantly better than the outcomes observed in a previous cohort of patients studied in 1993.

Major finding: At 10 years, disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate remission, DAS28 sustained remission, and drug-free remission were achieved by 52.4%, 40.1%, and 14.1% of patients, respectively. Half of the patients did not have a serious functional disability. Mortality rates were lower than that in the 1993 cohort (4.5% vs. 11.0%) and similar to that in the general population.

Study details: The data come from an analysis of 521 patients from the ESPOIR cohort who were diagnosed with early arthritis between 2003 and 2005 with a probable or certain diagnosis of RA and had never been prescribed disease-modifying antirheumatic drugs or glucocorticoids.

Disclosures: This work was supported by the Merck Sharp and Dohme, INSERM, French Society of Rheumatology, AbbVie, Pfizer, Lilly, Fresenius, and Galapagos. The authors including the lead author reported receiving grants, consulting fees, speaker fees, and/or honoraria from various sources.

Source: Combe B et al. Rheumatology (Oxford). 2021 May 7. doi: 10.1093/rheumatology/keab398.

Key clinical point: Tofacitinib vs. tocilizumab was more likely to induce and maintain improvement in clinical disease activity index (CDAI) and remission during the first 12 months of therapy in biological disease-modifying antirheumatic drugs (bDMARD)-naïve patients with methotrexate-refractory rheumatoid arthritis (RA).

Major finding: Likelihood of achieving and maintaining 85% or more (adjusted odds ratio [aOR], 3.88; P less than .001), 70% or more (aOR, 2.89; P = .003) improvement in CDAI, and remission (aOR, 3.31; P less than .001) in the first 12 months was higher with tofacitinib vs. tocilizumab in bDMARD-naïve patients but not in patients with previous bDMARD failure.

Study details: This was a multicenter cohort study of 464 patients with methotrexate-refractory RA who had high to moderate CDAI and initiated treatment with tofacitinib (n=247) or tocilizumab (n=217).

Disclosures: This study was supported by research funds from the National Hospital Organization, Japan. The authors including the leading author reported receiving lecture fees from various sources.

Source: Mori S et al. RMD Open. 2021 May 6. doi: 10.1136/rmdopen-2021-001601.

Key clinical point: Tofacitinib vs. tocilizumab was more likely to induce and maintain improvement in clinical disease activity index (CDAI) and remission during the first 12 months of therapy in biological disease-modifying antirheumatic drugs (bDMARD)-naïve patients with methotrexate-refractory rheumatoid arthritis (RA).

Major finding: Likelihood of achieving and maintaining 85% or more (adjusted odds ratio [aOR], 3.88; P less than .001), 70% or more (aOR, 2.89; P = .003) improvement in CDAI, and remission (aOR, 3.31; P less than .001) in the first 12 months was higher with tofacitinib vs. tocilizumab in bDMARD-naïve patients but not in patients with previous bDMARD failure.

Study details: This was a multicenter cohort study of 464 patients with methotrexate-refractory RA who had high to moderate CDAI and initiated treatment with tofacitinib (n=247) or tocilizumab (n=217).

Disclosures: This study was supported by research funds from the National Hospital Organization, Japan. The authors including the leading author reported receiving lecture fees from various sources.

Source: Mori S et al. RMD Open. 2021 May 6. doi: 10.1136/rmdopen-2021-001601.

Key clinical point: Tofacitinib vs. tocilizumab was more likely to induce and maintain improvement in clinical disease activity index (CDAI) and remission during the first 12 months of therapy in biological disease-modifying antirheumatic drugs (bDMARD)-naïve patients with methotrexate-refractory rheumatoid arthritis (RA).

Major finding: Likelihood of achieving and maintaining 85% or more (adjusted odds ratio [aOR], 3.88; P less than .001), 70% or more (aOR, 2.89; P = .003) improvement in CDAI, and remission (aOR, 3.31; P less than .001) in the first 12 months was higher with tofacitinib vs. tocilizumab in bDMARD-naïve patients but not in patients with previous bDMARD failure.

Study details: This was a multicenter cohort study of 464 patients with methotrexate-refractory RA who had high to moderate CDAI and initiated treatment with tofacitinib (n=247) or tocilizumab (n=217).

Disclosures: This study was supported by research funds from the National Hospital Organization, Japan. The authors including the leading author reported receiving lecture fees from various sources.

Source: Mori S et al. RMD Open. 2021 May 6. doi: 10.1136/rmdopen-2021-001601.

Key clinical point: A 3-dose regimen of intravenous tranexamic acid (IV-TXA) was more effective than a single dose in reducing postoperative blood loss in patients with rheumatoid arthritis (RA) who underwent primary unilateral total knee arthroplasty (TKA).

Major finding: Decrease in total blood loss (P = .038), hidden blood loss (P = .036), and maximum hemoglobin drop (P less than .001) was significantly lower with 3 vs. a single dose of postoperative IV-TXA. Additionally, levels of D-dimer on postoperative day 1 were significantly lower with 3 vs. a single dose of IV-TXA (P less than .001). Incidences of thromboembolic events were similar between groups.

Study details: This was a single-center, randomized controlled trial of 104 patients who underwent primary unilateral TKA for RA and were randomly allocated to receive either a single dose of IV-TXA (1 g; n=52) 3 hours postoperatively or 3 doses of IV-TXA (1 g; n=52) 3, 6, and 12 hours postoperatively.

Disclosures: This study was supported by the Foundation of Health and Family planning Commission of Shanghai, China. The authors declared no conflicts of interest.

Source: Kang BX et al. BMC Musculoskelet Disord. 2021 May 7. doi: 10.1186/s12891-021-04307-4.

Key clinical point: A 3-dose regimen of intravenous tranexamic acid (IV-TXA) was more effective than a single dose in reducing postoperative blood loss in patients with rheumatoid arthritis (RA) who underwent primary unilateral total knee arthroplasty (TKA).

Major finding: Decrease in total blood loss (P = .038), hidden blood loss (P = .036), and maximum hemoglobin drop (P less than .001) was significantly lower with 3 vs. a single dose of postoperative IV-TXA. Additionally, levels of D-dimer on postoperative day 1 were significantly lower with 3 vs. a single dose of IV-TXA (P less than .001). Incidences of thromboembolic events were similar between groups.

Study details: This was a single-center, randomized controlled trial of 104 patients who underwent primary unilateral TKA for RA and were randomly allocated to receive either a single dose of IV-TXA (1 g; n=52) 3 hours postoperatively or 3 doses of IV-TXA (1 g; n=52) 3, 6, and 12 hours postoperatively.

Disclosures: This study was supported by the Foundation of Health and Family planning Commission of Shanghai, China. The authors declared no conflicts of interest.

Source: Kang BX et al. BMC Musculoskelet Disord. 2021 May 7. doi: 10.1186/s12891-021-04307-4.

Key clinical point: A 3-dose regimen of intravenous tranexamic acid (IV-TXA) was more effective than a single dose in reducing postoperative blood loss in patients with rheumatoid arthritis (RA) who underwent primary unilateral total knee arthroplasty (TKA).

Major finding: Decrease in total blood loss (P = .038), hidden blood loss (P = .036), and maximum hemoglobin drop (P less than .001) was significantly lower with 3 vs. a single dose of postoperative IV-TXA. Additionally, levels of D-dimer on postoperative day 1 were significantly lower with 3 vs. a single dose of IV-TXA (P less than .001). Incidences of thromboembolic events were similar between groups.

Study details: This was a single-center, randomized controlled trial of 104 patients who underwent primary unilateral TKA for RA and were randomly allocated to receive either a single dose of IV-TXA (1 g; n=52) 3 hours postoperatively or 3 doses of IV-TXA (1 g; n=52) 3, 6, and 12 hours postoperatively.

Disclosures: This study was supported by the Foundation of Health and Family planning Commission of Shanghai, China. The authors declared no conflicts of interest.

Source: Kang BX et al. BMC Musculoskelet Disord. 2021 May 7. doi: 10.1186/s12891-021-04307-4.