MDedge Rheumatology

Key clinical point: High-resolution peripheral quantitative computed tomography (HR-pQCT) of 2 metacarpophalangeal joints and conventional radiography (CR) of 44 joints had comparable diagnostic accuracy for classifying patients with established rheumatoid arthritis (RA) as having erosive disease.

Major finding: Using CR as reference, the sensitivity and specificity of HR-pQCT for classifying patients having erosive RA was 89% (95% confidence interval [CI], 84%-92%) and 30% (95% Cl, 20%-43%), respectively. In contrast, the sensitivity and specificity of CR of 44 joints was 85% (95% Cl, 80%-89%) and 38% (95% Cl, 25%-52%), respectively, when HR-pQCT was used as reference. There was no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or CR (2.14; P = .177).

Study details: Data come from a single-center cross-sectional study of 353 patients with established RA.

Disclosures: The study received support from the Aarhus University Research Foundation, Danish Rheumatism Association, Novo Nordic Foundation, and A.P. Møller Fonden. E M Hauge and B Langdahl reported receiving grants and personal fees from various sources. All the other authors reported no conflicts of interest.

Source: Klose-Jensen R et al. Rheumatology (Oxford). 2021 May 20. doi: 10.1093/rheumatology/keab446.

Key clinical point: High-resolution peripheral quantitative computed tomography (HR-pQCT) of 2 metacarpophalangeal joints and conventional radiography (CR) of 44 joints had comparable diagnostic accuracy for classifying patients with established rheumatoid arthritis (RA) as having erosive disease.

Major finding: Using CR as reference, the sensitivity and specificity of HR-pQCT for classifying patients having erosive RA was 89% (95% confidence interval [CI], 84%-92%) and 30% (95% Cl, 20%-43%), respectively. In contrast, the sensitivity and specificity of CR of 44 joints was 85% (95% Cl, 80%-89%) and 38% (95% Cl, 25%-52%), respectively, when HR-pQCT was used as reference. There was no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or CR (2.14; P = .177).

Study details: Data come from a single-center cross-sectional study of 353 patients with established RA.

Disclosures: The study received support from the Aarhus University Research Foundation, Danish Rheumatism Association, Novo Nordic Foundation, and A.P. Møller Fonden. E M Hauge and B Langdahl reported receiving grants and personal fees from various sources. All the other authors reported no conflicts of interest.

Source: Klose-Jensen R et al. Rheumatology (Oxford). 2021 May 20. doi: 10.1093/rheumatology/keab446.

Key clinical point: High-resolution peripheral quantitative computed tomography (HR-pQCT) of 2 metacarpophalangeal joints and conventional radiography (CR) of 44 joints had comparable diagnostic accuracy for classifying patients with established rheumatoid arthritis (RA) as having erosive disease.

Major finding: Using CR as reference, the sensitivity and specificity of HR-pQCT for classifying patients having erosive RA was 89% (95% confidence interval [CI], 84%-92%) and 30% (95% Cl, 20%-43%), respectively. In contrast, the sensitivity and specificity of CR of 44 joints was 85% (95% Cl, 80%-89%) and 38% (95% Cl, 25%-52%), respectively, when HR-pQCT was used as reference. There was no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or CR (2.14; P = .177).

Study details: Data come from a single-center cross-sectional study of 353 patients with established RA.

Disclosures: The study received support from the Aarhus University Research Foundation, Danish Rheumatism Association, Novo Nordic Foundation, and A.P. Møller Fonden. E M Hauge and B Langdahl reported receiving grants and personal fees from various sources. All the other authors reported no conflicts of interest.

Source: Klose-Jensen R et al. Rheumatology (Oxford). 2021 May 20. doi: 10.1093/rheumatology/keab446.

Key clinical point: Initial treatment with methotrexate (MTX) and glucocorticoids (GC) bridging reduced chronic use of the nonsteroidal anti-inflammatory drug (NSAID) and analgesics compared with MTX treatment alone in patients with early rheumatoid arthritis (eRA) considered to have a favorable prognosis.

Major finding: The number of patients with a daily chronic intake of NSAIDs was significantly lower in MTX monotherapy along with step-down GC vs. MTX monotherapy without oral GC group (14% vs. 40%; P less than .01). Even after correcting for previous chronic analgesic use and baseline pain, patients treated with MTX and step-down GCs had an 83% lower hazard of chronic use of NSAID or analgesic (P less than .001).

Study details: Findings are from a post hoc analysis of the CareRA trial of 90 patients with eRA and favorable risk profile. Patients were randomly allocated to either MTX monotherapy without oral GC (n=47) or MTX monotherapy along with step-down GC (n=43).

Disclosures: The CareRA trial was funded by a Flemish governmental grant. All the authors declared no conflicts of interest.

Source: Pazmino S et al. RMD Open. 2021 May 24. doi: 10.1136/rmdopen-2021-001615.

Key clinical point: Initial treatment with methotrexate (MTX) and glucocorticoids (GC) bridging reduced chronic use of the nonsteroidal anti-inflammatory drug (NSAID) and analgesics compared with MTX treatment alone in patients with early rheumatoid arthritis (eRA) considered to have a favorable prognosis.

Major finding: The number of patients with a daily chronic intake of NSAIDs was significantly lower in MTX monotherapy along with step-down GC vs. MTX monotherapy without oral GC group (14% vs. 40%; P less than .01). Even after correcting for previous chronic analgesic use and baseline pain, patients treated with MTX and step-down GCs had an 83% lower hazard of chronic use of NSAID or analgesic (P less than .001).

Study details: Findings are from a post hoc analysis of the CareRA trial of 90 patients with eRA and favorable risk profile. Patients were randomly allocated to either MTX monotherapy without oral GC (n=47) or MTX monotherapy along with step-down GC (n=43).

Disclosures: The CareRA trial was funded by a Flemish governmental grant. All the authors declared no conflicts of interest.

Source: Pazmino S et al. RMD Open. 2021 May 24. doi: 10.1136/rmdopen-2021-001615.

Key clinical point: Initial treatment with methotrexate (MTX) and glucocorticoids (GC) bridging reduced chronic use of the nonsteroidal anti-inflammatory drug (NSAID) and analgesics compared with MTX treatment alone in patients with early rheumatoid arthritis (eRA) considered to have a favorable prognosis.

Major finding: The number of patients with a daily chronic intake of NSAIDs was significantly lower in MTX monotherapy along with step-down GC vs. MTX monotherapy without oral GC group (14% vs. 40%; P less than .01). Even after correcting for previous chronic analgesic use and baseline pain, patients treated with MTX and step-down GCs had an 83% lower hazard of chronic use of NSAID or analgesic (P less than .001).

Study details: Findings are from a post hoc analysis of the CareRA trial of 90 patients with eRA and favorable risk profile. Patients were randomly allocated to either MTX monotherapy without oral GC (n=47) or MTX monotherapy along with step-down GC (n=43).

Disclosures: The CareRA trial was funded by a Flemish governmental grant. All the authors declared no conflicts of interest.

Source: Pazmino S et al. RMD Open. 2021 May 24. doi: 10.1136/rmdopen-2021-001615.

Key clinical point: Early rheumatoid arthritis (RA) strategies have different risk profiles. Moreover, the use of early steroid-based regimens did not emerge as more harmful.

Major finding: The risk for serious adverse events was higher with biologic monotherapy vs. methotrexate (MTX)+steroid therapy (rate ratio [RR], 3.22; 95% confidence interval [CI], 1.47-7.07) and with biological monotherapy vs. MTX monotherapy (RR, 1.39; 95% CI, 1.12-1.73) and MTX+biologic disease-modifying antirheumatic drugs (DMARD; RR, 1.26; 95% CI, 1.02-1.54).

Study details: Findings are from a network meta-analysis of 20 double-blind randomized clinical trials involving 9,202 adult patients with RA who were initiated on DMARD therapy.

Disclosures: This study received no external funding. The authors received speaker’s fees and honoraria from various pharmaceutical companies including AbbVie. None of the authors reported any conflict of interest.

Source: Adas MA et al. Rheumatology (Oxford). 2021 May 18. doi: 10.1093/rheumatology/keab429.

Key clinical point: Early rheumatoid arthritis (RA) strategies have different risk profiles. Moreover, the use of early steroid-based regimens did not emerge as more harmful.

Major finding: The risk for serious adverse events was higher with biologic monotherapy vs. methotrexate (MTX)+steroid therapy (rate ratio [RR], 3.22; 95% confidence interval [CI], 1.47-7.07) and with biological monotherapy vs. MTX monotherapy (RR, 1.39; 95% CI, 1.12-1.73) and MTX+biologic disease-modifying antirheumatic drugs (DMARD; RR, 1.26; 95% CI, 1.02-1.54).

Study details: Findings are from a network meta-analysis of 20 double-blind randomized clinical trials involving 9,202 adult patients with RA who were initiated on DMARD therapy.

Disclosures: This study received no external funding. The authors received speaker’s fees and honoraria from various pharmaceutical companies including AbbVie. None of the authors reported any conflict of interest.

Source: Adas MA et al. Rheumatology (Oxford). 2021 May 18. doi: 10.1093/rheumatology/keab429.

Key clinical point: Early rheumatoid arthritis (RA) strategies have different risk profiles. Moreover, the use of early steroid-based regimens did not emerge as more harmful.

Major finding: The risk for serious adverse events was higher with biologic monotherapy vs. methotrexate (MTX)+steroid therapy (rate ratio [RR], 3.22; 95% confidence interval [CI], 1.47-7.07) and with biological monotherapy vs. MTX monotherapy (RR, 1.39; 95% CI, 1.12-1.73) and MTX+biologic disease-modifying antirheumatic drugs (DMARD; RR, 1.26; 95% CI, 1.02-1.54).

Study details: Findings are from a network meta-analysis of 20 double-blind randomized clinical trials involving 9,202 adult patients with RA who were initiated on DMARD therapy.

Disclosures: This study received no external funding. The authors received speaker’s fees and honoraria from various pharmaceutical companies including AbbVie. None of the authors reported any conflict of interest.

Source: Adas MA et al. Rheumatology (Oxford). 2021 May 18. doi: 10.1093/rheumatology/keab429.

Key clinical point: Tocilizumab (TCZ) was associated with an increased risk for diverticulitis and gastrointestinal (GI) perforation related to diverticulitis compared with rituximab (RTX) and abatacept (ABA) in patients with rheumatoid arthritis (RA).

Major finding: TCZ vs. RTX or ABA was associated with an increased risk for diverticulitis (hazard ratio [HR], 3.1; P = .002) and GI perforation because of diverticulitis (HR, 2.9; P = .03).

Study details: Data come from an analysis of a real-life cohort of 4,501 patients with RA from 3 observational registries of the French Society of Rheumatology who received RTX (n=1,986), ABA (n=1,019), or TCZ (n=1,496).

Disclosures: The French Society of Rheumatology received unrestricted grants from Bristol Myers Squibb, Roche, and Roche-Chugai. Some of the authors including the lead author declared receiving grants and consulting/speaker/personal fees from various sources including Bristol Myers Squibb. C Rempenault, A Herrero, and I Pane declared no conflicts of interest.

Source: Rempenault C et al. Rheumatology (Oxford). 2021 May 16. doi: 10.1093/rheumatology/keab438.

Key clinical point: Tocilizumab (TCZ) was associated with an increased risk for diverticulitis and gastrointestinal (GI) perforation related to diverticulitis compared with rituximab (RTX) and abatacept (ABA) in patients with rheumatoid arthritis (RA).

Major finding: TCZ vs. RTX or ABA was associated with an increased risk for diverticulitis (hazard ratio [HR], 3.1; P = .002) and GI perforation because of diverticulitis (HR, 2.9; P = .03).

Study details: Data come from an analysis of a real-life cohort of 4,501 patients with RA from 3 observational registries of the French Society of Rheumatology who received RTX (n=1,986), ABA (n=1,019), or TCZ (n=1,496).

Disclosures: The French Society of Rheumatology received unrestricted grants from Bristol Myers Squibb, Roche, and Roche-Chugai. Some of the authors including the lead author declared receiving grants and consulting/speaker/personal fees from various sources including Bristol Myers Squibb. C Rempenault, A Herrero, and I Pane declared no conflicts of interest.

Source: Rempenault C et al. Rheumatology (Oxford). 2021 May 16. doi: 10.1093/rheumatology/keab438.

Key clinical point: Tocilizumab (TCZ) was associated with an increased risk for diverticulitis and gastrointestinal (GI) perforation related to diverticulitis compared with rituximab (RTX) and abatacept (ABA) in patients with rheumatoid arthritis (RA).

Major finding: TCZ vs. RTX or ABA was associated with an increased risk for diverticulitis (hazard ratio [HR], 3.1; P = .002) and GI perforation because of diverticulitis (HR, 2.9; P = .03).

Study details: Data come from an analysis of a real-life cohort of 4,501 patients with RA from 3 observational registries of the French Society of Rheumatology who received RTX (n=1,986), ABA (n=1,019), or TCZ (n=1,496).

Disclosures: The French Society of Rheumatology received unrestricted grants from Bristol Myers Squibb, Roche, and Roche-Chugai. Some of the authors including the lead author declared receiving grants and consulting/speaker/personal fees from various sources including Bristol Myers Squibb. C Rempenault, A Herrero, and I Pane declared no conflicts of interest.

Source: Rempenault C et al. Rheumatology (Oxford). 2021 May 16. doi: 10.1093/rheumatology/keab438.

Key clinical point: Use of methotrexate significantly reduced the risk for cardiovascular disease (CVD) events, particularly heart failure (HF)-related hospitalizations in patients with rheumatoid arthritis (RA).

Major finding: Use of methotrexate was associated with a significant 24% reduced risk for composite CVD events (hazard ratio [HR], 0.76; P = .04), including a 57% lower risk for HF hospitalizations (HR, 0.43; P = .005).

Study details: The data come from a prospective cohort study of 2,044 US veterans with RA.

Disclosures: The work was supported by Centre of Excellence for Suicide Prevention and Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository—National Death Index. MD George reported receiving grant support from Bristol Myers Squibb for unrelated work.

Source: Johnson TM et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220125.

Key clinical point: Use of methotrexate significantly reduced the risk for cardiovascular disease (CVD) events, particularly heart failure (HF)-related hospitalizations in patients with rheumatoid arthritis (RA).

Major finding: Use of methotrexate was associated with a significant 24% reduced risk for composite CVD events (hazard ratio [HR], 0.76; P = .04), including a 57% lower risk for HF hospitalizations (HR, 0.43; P = .005).

Study details: The data come from a prospective cohort study of 2,044 US veterans with RA.

Disclosures: The work was supported by Centre of Excellence for Suicide Prevention and Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository—National Death Index. MD George reported receiving grant support from Bristol Myers Squibb for unrelated work.

Source: Johnson TM et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220125.

Key clinical point: Use of methotrexate significantly reduced the risk for cardiovascular disease (CVD) events, particularly heart failure (HF)-related hospitalizations in patients with rheumatoid arthritis (RA).

Major finding: Use of methotrexate was associated with a significant 24% reduced risk for composite CVD events (hazard ratio [HR], 0.76; P = .04), including a 57% lower risk for HF hospitalizations (HR, 0.43; P = .005).

Study details: The data come from a prospective cohort study of 2,044 US veterans with RA.

Disclosures: The work was supported by Centre of Excellence for Suicide Prevention and Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository—National Death Index. MD George reported receiving grant support from Bristol Myers Squibb for unrelated work.

Source: Johnson TM et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220125.

Key clinical point: Patients with rheumatoid arthritis (RA) treated with rituximab or Janus kinase inhibitors (JAKi) at onset of COVID-19 were more likely to have poor COVID-19 outcomes compared with those treated with tumor necrosis factor inhibitors (TNFi).

Major finding: Odds of worse COVID-19 severity were 4.15 and 2.06 greater in patients on rituximab (odds ratio [OR], 4.15) and JAKi (OR, 2.06; both P less than .01) vs. those on TNFi. Patients on rituximab and JAKi therapy vs. TNFi were more susceptible to hospitalization (OR, 4.53 and 2.40, respectively; P less than .01) and death (OR, 4.57 and 2.04, respectively; P less than .01).

Study details: The data come from the analysis of 2,869 patients with RA and COVID-19 who were on abatacept (n=237), rituximab (n=364), interleukin 6 inhibitors (n=317), Janus kinase inhibitors (n=563), or TNFi (n=1,388) at the time of clinical COVID-19 onset.

Disclosures: The study received support from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. The authors reported receiving research support, grants, and speaker’s/consultancy/personal fees from various sources.

Source: Sparks JA et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220418.

Key clinical point: Patients with rheumatoid arthritis (RA) treated with rituximab or Janus kinase inhibitors (JAKi) at onset of COVID-19 were more likely to have poor COVID-19 outcomes compared with those treated with tumor necrosis factor inhibitors (TNFi).

Major finding: Odds of worse COVID-19 severity were 4.15 and 2.06 greater in patients on rituximab (odds ratio [OR], 4.15) and JAKi (OR, 2.06; both P less than .01) vs. those on TNFi. Patients on rituximab and JAKi therapy vs. TNFi were more susceptible to hospitalization (OR, 4.53 and 2.40, respectively; P less than .01) and death (OR, 4.57 and 2.04, respectively; P less than .01).

Study details: The data come from the analysis of 2,869 patients with RA and COVID-19 who were on abatacept (n=237), rituximab (n=364), interleukin 6 inhibitors (n=317), Janus kinase inhibitors (n=563), or TNFi (n=1,388) at the time of clinical COVID-19 onset.

Disclosures: The study received support from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. The authors reported receiving research support, grants, and speaker’s/consultancy/personal fees from various sources.

Source: Sparks JA et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220418.

Key clinical point: Patients with rheumatoid arthritis (RA) treated with rituximab or Janus kinase inhibitors (JAKi) at onset of COVID-19 were more likely to have poor COVID-19 outcomes compared with those treated with tumor necrosis factor inhibitors (TNFi).

Major finding: Odds of worse COVID-19 severity were 4.15 and 2.06 greater in patients on rituximab (odds ratio [OR], 4.15) and JAKi (OR, 2.06; both P less than .01) vs. those on TNFi. Patients on rituximab and JAKi therapy vs. TNFi were more susceptible to hospitalization (OR, 4.53 and 2.40, respectively; P less than .01) and death (OR, 4.57 and 2.04, respectively; P less than .01).

Study details: The data come from the analysis of 2,869 patients with RA and COVID-19 who were on abatacept (n=237), rituximab (n=364), interleukin 6 inhibitors (n=317), Janus kinase inhibitors (n=563), or TNFi (n=1,388) at the time of clinical COVID-19 onset.

Disclosures: The study received support from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. The authors reported receiving research support, grants, and speaker’s/consultancy/personal fees from various sources.

Source: Sparks JA et al. Ann Rheum Dis. 2021 May 28. doi: 10.1136/annrheumdis-2021-220418.

Key clinical point: ORAL Shift demonstrates safety and efficacy of tofacitinib modified-release 11 mg once daily (OD) plus methotrexate in a global population of patients with rheumatoid arthritis (RA).

Major finding: All efficacy outcomes improved from baseline to week 12 including Disease Activity Score in 28 joints, erythrocyte sedimentation rate (mean change [MC], −2.0), Clinical Disease Activity Index (CDAI; MC, −19.6), Simplified Disease Activity Index (MC, −20.3), and other patient-reported outcomes, which continued to improve through week 24. At week 24, 84.5% of patients achieved CDAI-defined low disease activity. Most adverse events were mild or moderate in severity and no deaths were reported.

Study details: ORAL Shift, a 48-week phase 3b/4 withdrawal study included patients with moderate to severe RA and an inadequate response to methotrexate who received open-label tofacitinib modified-release 11 mg OD and methotrexate.

Disclosures: This study was sponsored by Pfizer Inc. Some of the authors declared receiving research support and honoraria and serving as consultant or on speaker’s bureau for various sources including Pfizer. Seven of the authors declared being employees and shareholders at Pfizer Inc.

Source: Cohen SB et al. RMD Open. 2021 Jun 7. doi: 10.1136/rmdopen-2021-001673.

Key clinical point: ORAL Shift demonstrates safety and efficacy of tofacitinib modified-release 11 mg once daily (OD) plus methotrexate in a global population of patients with rheumatoid arthritis (RA).

Major finding: All efficacy outcomes improved from baseline to week 12 including Disease Activity Score in 28 joints, erythrocyte sedimentation rate (mean change [MC], −2.0), Clinical Disease Activity Index (CDAI; MC, −19.6), Simplified Disease Activity Index (MC, −20.3), and other patient-reported outcomes, which continued to improve through week 24. At week 24, 84.5% of patients achieved CDAI-defined low disease activity. Most adverse events were mild or moderate in severity and no deaths were reported.

Study details: ORAL Shift, a 48-week phase 3b/4 withdrawal study included patients with moderate to severe RA and an inadequate response to methotrexate who received open-label tofacitinib modified-release 11 mg OD and methotrexate.

Disclosures: This study was sponsored by Pfizer Inc. Some of the authors declared receiving research support and honoraria and serving as consultant or on speaker’s bureau for various sources including Pfizer. Seven of the authors declared being employees and shareholders at Pfizer Inc.

Source: Cohen SB et al. RMD Open. 2021 Jun 7. doi: 10.1136/rmdopen-2021-001673.

Key clinical point: ORAL Shift demonstrates safety and efficacy of tofacitinib modified-release 11 mg once daily (OD) plus methotrexate in a global population of patients with rheumatoid arthritis (RA).

Major finding: All efficacy outcomes improved from baseline to week 12 including Disease Activity Score in 28 joints, erythrocyte sedimentation rate (mean change [MC], −2.0), Clinical Disease Activity Index (CDAI; MC, −19.6), Simplified Disease Activity Index (MC, −20.3), and other patient-reported outcomes, which continued to improve through week 24. At week 24, 84.5% of patients achieved CDAI-defined low disease activity. Most adverse events were mild or moderate in severity and no deaths were reported.

Study details: ORAL Shift, a 48-week phase 3b/4 withdrawal study included patients with moderate to severe RA and an inadequate response to methotrexate who received open-label tofacitinib modified-release 11 mg OD and methotrexate.

Disclosures: This study was sponsored by Pfizer Inc. Some of the authors declared receiving research support and honoraria and serving as consultant or on speaker’s bureau for various sources including Pfizer. Seven of the authors declared being employees and shareholders at Pfizer Inc.

Source: Cohen SB et al. RMD Open. 2021 Jun 7. doi: 10.1136/rmdopen-2021-001673.

Psoriasis patients treated with biological disease-modifying antirheumatic drugs had a significantly lower incidence of psoriatic arthritis (PsA) compared with those treated with phototherapy, in a study of 464 adults.

Epidemiologic data show that PsA may be diagnosed as long as 5-10 years after a diagnosis of plaque psoriasis, but PsA ultimately occurs in up to 25% of cases, wrote the study investigators, Paolo Gisondi, MD, of the section of dermatology and venereology, department of medicine, at Università degli Studi di Verona, Italy, and colleagues.

“The delay between the onset of skin manifestations of psoriasis and joint disease may provide a therapeutic window of clinical opportunity for preventing the progression from psoriasis to PsA,” but the impact of continuous systemic treatment with biological disease-modifying antirheumatic drugs (DMARDs) has not been well studied, the researchers said.

In the retrospective, nonrandomized study published in Annals of the Rheumatic Diseases, the researchers reviewed data from adults with moderate to severe plaque psoriasis who received continuous treatment with biologic DMARDs, compared with those who received narrow-band ultraviolet light B (nb-UVB) phototherapy, between January 2012 and September 2020.

Patients with a past or present PsA diagnosis were excluded from the study. A total of 234 patients were treated with biologic DMARDs for at least 5 years and 230 were treated with at least three courses of nb-UVB phototherapy; all patients were followed for an average of 7 years.

PsA was determined based on the Classification for Psoriatic Arthritis criteria. Incidence was defined in terms of cases per 100 patients per year.

During the follow-up period, 51 patients (11%) developed incident PsA: 19 (8%) in the biologic DMARDs group and 32 (14%) in the nb-UVB phototherapy group. The annual incidence rate of PsA was 1.20 cases per 100 patients per year in the biologic DMARDs group compared with 2.17 cases per 100 patients per year in the phototherapy group (P = .006).

In a multivariate analysis, independent risk factors for PsA were older age (adjusted hazard ratio, 1.04; P < .001), nail psoriasis (aHR 3.15; P = .001), and psoriasis duration greater than 10 years (aHR, 2.02; P = .001). Most other baseline demographics, including smoking status, baseline Psoriasis Area and Severity Index (PASI) scores, and comorbidities, were similar in patients who did and did not develop PsA.

Of the patients taking biologic DMARDs, 39 (17%) were treated with infliximab, 17 (7%) with etanercept, 67 (29%) with adalimumab, 50 (21%) with ustekinumab, and 61 (26%) with secukinumab; 35 of these patients switched biologics during the study period.

The study findings were limited by several factors including the retrospective design and the resulting potential for biases, notably the potential confounding bias by indication because of the lack of randomization, the researchers noted. Another limitation was the inability to perform a subgroup analysis of biologic DMARD classes because of the small sample size, the authors said. However, they added, the findings were strengthened by the complete database and accurate PsA diagnoses supported by an expert rheumatologist.

Larger prospective and intervention studies are needed to validate the results, the researchers emphasized. However, data from the current study suggest that continued treatment with biologic DMARDs “may reduce the risk of incident PsA in patients with moderate to severe chronic plaque psoriasis,” they concluded.

The study was supported by the European Union’s Horizon 2020 Research and Innovation Program. Dr. Gisondi and several coauthors disclosed relationships with Abbvie, Almirall, Amgen, Janssen, Leo Pharma, Eli Lilly, Novartis, Pierre Fabre, Sandoz, Sanofi, and UCB. The study was supported by the European Union’s Horizon 2020 Research and Innovation Program.

Psoriasis patients treated with biological disease-modifying antirheumatic drugs had a significantly lower incidence of psoriatic arthritis (PsA) compared with those treated with phototherapy, in a study of 464 adults.

Epidemiologic data show that PsA may be diagnosed as long as 5-10 years after a diagnosis of plaque psoriasis, but PsA ultimately occurs in up to 25% of cases, wrote the study investigators, Paolo Gisondi, MD, of the section of dermatology and venereology, department of medicine, at Università degli Studi di Verona, Italy, and colleagues.

“The delay between the onset of skin manifestations of psoriasis and joint disease may provide a therapeutic window of clinical opportunity for preventing the progression from psoriasis to PsA,” but the impact of continuous systemic treatment with biological disease-modifying antirheumatic drugs (DMARDs) has not been well studied, the researchers said.

In the retrospective, nonrandomized study published in Annals of the Rheumatic Diseases, the researchers reviewed data from adults with moderate to severe plaque psoriasis who received continuous treatment with biologic DMARDs, compared with those who received narrow-band ultraviolet light B (nb-UVB) phototherapy, between January 2012 and September 2020.

Patients with a past or present PsA diagnosis were excluded from the study. A total of 234 patients were treated with biologic DMARDs for at least 5 years and 230 were treated with at least three courses of nb-UVB phototherapy; all patients were followed for an average of 7 years.

PsA was determined based on the Classification for Psoriatic Arthritis criteria. Incidence was defined in terms of cases per 100 patients per year.

During the follow-up period, 51 patients (11%) developed incident PsA: 19 (8%) in the biologic DMARDs group and 32 (14%) in the nb-UVB phototherapy group. The annual incidence rate of PsA was 1.20 cases per 100 patients per year in the biologic DMARDs group compared with 2.17 cases per 100 patients per year in the phototherapy group (P = .006).

In a multivariate analysis, independent risk factors for PsA were older age (adjusted hazard ratio, 1.04; P < .001), nail psoriasis (aHR 3.15; P = .001), and psoriasis duration greater than 10 years (aHR, 2.02; P = .001). Most other baseline demographics, including smoking status, baseline Psoriasis Area and Severity Index (PASI) scores, and comorbidities, were similar in patients who did and did not develop PsA.

Of the patients taking biologic DMARDs, 39 (17%) were treated with infliximab, 17 (7%) with etanercept, 67 (29%) with adalimumab, 50 (21%) with ustekinumab, and 61 (26%) with secukinumab; 35 of these patients switched biologics during the study period.

The study findings were limited by several factors including the retrospective design and the resulting potential for biases, notably the potential confounding bias by indication because of the lack of randomization, the researchers noted. Another limitation was the inability to perform a subgroup analysis of biologic DMARD classes because of the small sample size, the authors said. However, they added, the findings were strengthened by the complete database and accurate PsA diagnoses supported by an expert rheumatologist.

Larger prospective and intervention studies are needed to validate the results, the researchers emphasized. However, data from the current study suggest that continued treatment with biologic DMARDs “may reduce the risk of incident PsA in patients with moderate to severe chronic plaque psoriasis,” they concluded.

The study was supported by the European Union’s Horizon 2020 Research and Innovation Program. Dr. Gisondi and several coauthors disclosed relationships with Abbvie, Almirall, Amgen, Janssen, Leo Pharma, Eli Lilly, Novartis, Pierre Fabre, Sandoz, Sanofi, and UCB. The study was supported by the European Union’s Horizon 2020 Research and Innovation Program.

Psoriasis patients treated with biological disease-modifying antirheumatic drugs had a significantly lower incidence of psoriatic arthritis (PsA) compared with those treated with phototherapy, in a study of 464 adults.

Epidemiologic data show that PsA may be diagnosed as long as 5-10 years after a diagnosis of plaque psoriasis, but PsA ultimately occurs in up to 25% of cases, wrote the study investigators, Paolo Gisondi, MD, of the section of dermatology and venereology, department of medicine, at Università degli Studi di Verona, Italy, and colleagues.

“The delay between the onset of skin manifestations of psoriasis and joint disease may provide a therapeutic window of clinical opportunity for preventing the progression from psoriasis to PsA,” but the impact of continuous systemic treatment with biological disease-modifying antirheumatic drugs (DMARDs) has not been well studied, the researchers said.

In the retrospective, nonrandomized study published in Annals of the Rheumatic Diseases, the researchers reviewed data from adults with moderate to severe plaque psoriasis who received continuous treatment with biologic DMARDs, compared with those who received narrow-band ultraviolet light B (nb-UVB) phototherapy, between January 2012 and September 2020.

Patients with a past or present PsA diagnosis were excluded from the study. A total of 234 patients were treated with biologic DMARDs for at least 5 years and 230 were treated with at least three courses of nb-UVB phototherapy; all patients were followed for an average of 7 years.

PsA was determined based on the Classification for Psoriatic Arthritis criteria. Incidence was defined in terms of cases per 100 patients per year.

During the follow-up period, 51 patients (11%) developed incident PsA: 19 (8%) in the biologic DMARDs group and 32 (14%) in the nb-UVB phototherapy group. The annual incidence rate of PsA was 1.20 cases per 100 patients per year in the biologic DMARDs group compared with 2.17 cases per 100 patients per year in the phototherapy group (P = .006).

In a multivariate analysis, independent risk factors for PsA were older age (adjusted hazard ratio, 1.04; P < .001), nail psoriasis (aHR 3.15; P = .001), and psoriasis duration greater than 10 years (aHR, 2.02; P = .001). Most other baseline demographics, including smoking status, baseline Psoriasis Area and Severity Index (PASI) scores, and comorbidities, were similar in patients who did and did not develop PsA.

Of the patients taking biologic DMARDs, 39 (17%) were treated with infliximab, 17 (7%) with etanercept, 67 (29%) with adalimumab, 50 (21%) with ustekinumab, and 61 (26%) with secukinumab; 35 of these patients switched biologics during the study period.

The study findings were limited by several factors including the retrospective design and the resulting potential for biases, notably the potential confounding bias by indication because of the lack of randomization, the researchers noted. Another limitation was the inability to perform a subgroup analysis of biologic DMARD classes because of the small sample size, the authors said. However, they added, the findings were strengthened by the complete database and accurate PsA diagnoses supported by an expert rheumatologist.

Larger prospective and intervention studies are needed to validate the results, the researchers emphasized. However, data from the current study suggest that continued treatment with biologic DMARDs “may reduce the risk of incident PsA in patients with moderate to severe chronic plaque psoriasis,” they concluded.

The study was supported by the European Union’s Horizon 2020 Research and Innovation Program. Dr. Gisondi and several coauthors disclosed relationships with Abbvie, Almirall, Amgen, Janssen, Leo Pharma, Eli Lilly, Novartis, Pierre Fabre, Sandoz, Sanofi, and UCB. The study was supported by the European Union’s Horizon 2020 Research and Innovation Program.

Newly updated COVID-19 vaccination guidance from the American College of Rheumatology offers detailed insight into how clinicians should proceed with use, timing, and prioritization of COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases (RMDs).

“The task force advised health care providers to avoid being overly dogmatic in following these recommendations,” Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham, and colleagues wrote. “The attempt to optimize vaccine response in relation to the use and timing of immunosuppressive medications should not compromise a willing patient’s ability to undergo vaccination in a timely manner and risk a missed vaccination opportunity.” The guidelines were published in Arthritis & Rheumatology.

To review the published literature and determine the safety and efficacy of the available COVID-19 vaccines for patients with RMDs, a task force made up of nine rheumatologists/immunologists, two infectious disease specialists, and two public health physicians was formed. The ACR COVID-19 Vaccine Guidance Task Force considered vaccine clinical trial data and overall COVID-19 risk and outcomes among RMD patients, along with the immunogenicity of other vaccines in patients on immunomodulatory therapies and the safety profile of non-COVID vaccines in RMD patients.

Using a 9-point numeric scoring system, the task force developed 74 draft guidance statements that were rated with a median score of 7, 8, or 9. Consensus was deemed strong for 16 of the statements and moderate for the remaining 58.

Of the general considerations related to COVID-19 vaccination, the only statement to achieve strong consensus called for the rheumatology health care provider to take responsibility for assessing their patients’ COVID-19 vaccination status. Other notable statements asserted that patients with autoimmune inflammatory rheumatic diseases (AIIRDs) are at higher risk for hospitalized COVID-19, compared with the general population, and should be prioritized for vaccination accordingly, even though a risk for disease flare or worsening exists and the expected vaccine response for patients on systemic immunomodulatory therapies is “likely to be blunted in its magnitude and duration.”
 

Takeaway advice

When asked about a top-line takeaway for rheumatologists, Dr. Curtis replied: “Make sure that your patients are getting vaccinated. Even though the vaccine in patients with compromised immune systems might not work quite as well and might not last quite as long, they still should get vaccinated. And vaccine hesitancy is a real thing.”

Citing unpublished survey data, he estimated that roughly 25% of people with rheumatic conditions remain unvaccinated, and more than half of them said they had no vaccination plans. “That’s a pretty important message when up to a quarter of your higher-risk people take a pass,” he said. “You’d expect it to be better in people at risk who are on steroids or immune medications. That’s something rheumatologists can help with the most.”

Regarding vaccine use, the task force strongly recommended that RMD patients be offered COVID-19 vaccinations consistent with the emergency use authorization’s current age restrictions and/or Food and Drug Administration approval. They also strongly recommended patients with AIIRDs receive the second dose of a multidose vaccine, even if the first dose led to nonserious adverse events, and that health care providers avoid ordering lab testing to assess COVID-19 immunity in vaccinated and unvaccinated patients.

The issues around testing for immunity are ample, Dr. Curtis said. For starters, “there are different antibodies, and one of them wouldn’t be expected to go up after vaccination.” And even if you are testing for the correct antibodies, “now I get a number. Is my number high enough that says that I’m protected? That’s what clinicians want, that’s what patients want. Unfortunately, we don’t have that test. There’s an antibody test; you can test against the spike protein and get a number, but whether that number has clinical relevance that says you’re protected, and how much, and for how long, we definitely don’t have that information. You could be falsely reassured or falsely alarmed by the results.”

This statement, he added, has been particularly divisive. “A bunch of rheumatologists have said to me: ‘Look, we’re doing this routinely for our patients.’ My rejoinder was: ‘That’s great to know; what’s the evidence base for what you’re doing there? Because I haven’t read that paper.’ I fully acknowledge that, in groups of patients on certain therapies, the antibody response seems somewhat lower. But doctors don’t treat groups of patients; we treat patients one at a time. And I want to know how to help the patient in front of me, and I want to know what to tell him or her if I get the results of an antibody test.”

Finally, the task force emphasized that all AIIRD patients should receive the COVID-19 vaccinations, exempting only those with life-threatening disease, and they stated no preference for one COVID-19 vaccine over the other.
 

Vaccine choice

“Should you prefer one vaccine or vaccine platform to another? That’s been incredibly controversial,” Dr. Curtis said. Though the efficacy of the mRNA vaccines is often cited at 90%, compared with the roughly 60%-70% efficacy of the Johnson and & Johnson single-dose vaccine, “they’re not head-to-head studies. They weren’t done in the same countries; they weren’t done with the same viral variants. They’re not being evaluated under similar conditions; it’s not fair to hold them up and say: ‘Apples to apples, this one is better than that one.’ ”

“On the other hand,” he added, “if you were choosing, which would you want? If you are given a choice, you’re probably going to have a preference. The downside for a public health group – this group, which is trying to help rheumatologists and their patients make prudent decisions in light of very imperfect and evolving evidence – is that most people don’t have a choice. So if you send the message that one vaccine might be better than another, if that makes people wait for the one that supposedly might be better, you’ve probably done something bad. They’re delaying for what may be a marginal reason, and some vaccine protection is better than no vaccine protection.”

Regarding vaccination timing in patients who are on immunomodulatory therapies, the task force strongly recommended not delaying or adjusting the timing for anyone on hydroxychloroquine, sulfasalazine, leflunomide, apremilast, or intravenous immunoglobulin. They moderately recommended the same for patients on numerous drugs, including methotrexate, tumor necrosis factor inhibitors, Janus kinase inhibitors, abatacept, and glucocorticoids. Patients on rituximab with a low COVID-19 risk were recommended to schedule their vaccination so that the vaccine series is initiated roughly 4 weeks before their next scheduled rituximab cycle.

Regarding the use and timing of immunomodulatory therapies in relation to vaccination, they strongly recommended no modifications for patients on hydroxychloroquine, apremilast, intravenous immunoglobulin, or glucocorticoids. They also moderately recommended no modifications for patients on numerous drugs, including sulfasalazine, leflunomide, azathioprine, oral cyclophosphamide, and TNF inhibitors.

Regarding limitations, the researchers noted that there is no direct evidence about COVID-19 vaccine safety and efficacy yet in this subset of patients. They also acknowledged that they did not follow the rigorous methodology typically used by the ACR in developing formal clinical practice guidelines, calling it an “expected limitation” given the need to issue timely and potentially lifesaving guidance for the rheumatology community.

The authors acknowledged several potential conflicts of interest, including receiving consulting fees, speaking fees, and research grants from various pharmaceutical companies.

Newly updated COVID-19 vaccination guidance from the American College of Rheumatology offers detailed insight into how clinicians should proceed with use, timing, and prioritization of COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases (RMDs).

“The task force advised health care providers to avoid being overly dogmatic in following these recommendations,” Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham, and colleagues wrote. “The attempt to optimize vaccine response in relation to the use and timing of immunosuppressive medications should not compromise a willing patient’s ability to undergo vaccination in a timely manner and risk a missed vaccination opportunity.” The guidelines were published in Arthritis & Rheumatology.

To review the published literature and determine the safety and efficacy of the available COVID-19 vaccines for patients with RMDs, a task force made up of nine rheumatologists/immunologists, two infectious disease specialists, and two public health physicians was formed. The ACR COVID-19 Vaccine Guidance Task Force considered vaccine clinical trial data and overall COVID-19 risk and outcomes among RMD patients, along with the immunogenicity of other vaccines in patients on immunomodulatory therapies and the safety profile of non-COVID vaccines in RMD patients.

Using a 9-point numeric scoring system, the task force developed 74 draft guidance statements that were rated with a median score of 7, 8, or 9. Consensus was deemed strong for 16 of the statements and moderate for the remaining 58.

Of the general considerations related to COVID-19 vaccination, the only statement to achieve strong consensus called for the rheumatology health care provider to take responsibility for assessing their patients’ COVID-19 vaccination status. Other notable statements asserted that patients with autoimmune inflammatory rheumatic diseases (AIIRDs) are at higher risk for hospitalized COVID-19, compared with the general population, and should be prioritized for vaccination accordingly, even though a risk for disease flare or worsening exists and the expected vaccine response for patients on systemic immunomodulatory therapies is “likely to be blunted in its magnitude and duration.”
 

Takeaway advice

When asked about a top-line takeaway for rheumatologists, Dr. Curtis replied: “Make sure that your patients are getting vaccinated. Even though the vaccine in patients with compromised immune systems might not work quite as well and might not last quite as long, they still should get vaccinated. And vaccine hesitancy is a real thing.”

Citing unpublished survey data, he estimated that roughly 25% of people with rheumatic conditions remain unvaccinated, and more than half of them said they had no vaccination plans. “That’s a pretty important message when up to a quarter of your higher-risk people take a pass,” he said. “You’d expect it to be better in people at risk who are on steroids or immune medications. That’s something rheumatologists can help with the most.”

Regarding vaccine use, the task force strongly recommended that RMD patients be offered COVID-19 vaccinations consistent with the emergency use authorization’s current age restrictions and/or Food and Drug Administration approval. They also strongly recommended patients with AIIRDs receive the second dose of a multidose vaccine, even if the first dose led to nonserious adverse events, and that health care providers avoid ordering lab testing to assess COVID-19 immunity in vaccinated and unvaccinated patients.

The issues around testing for immunity are ample, Dr. Curtis said. For starters, “there are different antibodies, and one of them wouldn’t be expected to go up after vaccination.” And even if you are testing for the correct antibodies, “now I get a number. Is my number high enough that says that I’m protected? That’s what clinicians want, that’s what patients want. Unfortunately, we don’t have that test. There’s an antibody test; you can test against the spike protein and get a number, but whether that number has clinical relevance that says you’re protected, and how much, and for how long, we definitely don’t have that information. You could be falsely reassured or falsely alarmed by the results.”

This statement, he added, has been particularly divisive. “A bunch of rheumatologists have said to me: ‘Look, we’re doing this routinely for our patients.’ My rejoinder was: ‘That’s great to know; what’s the evidence base for what you’re doing there? Because I haven’t read that paper.’ I fully acknowledge that, in groups of patients on certain therapies, the antibody response seems somewhat lower. But doctors don’t treat groups of patients; we treat patients one at a time. And I want to know how to help the patient in front of me, and I want to know what to tell him or her if I get the results of an antibody test.”

Finally, the task force emphasized that all AIIRD patients should receive the COVID-19 vaccinations, exempting only those with life-threatening disease, and they stated no preference for one COVID-19 vaccine over the other.
 

Vaccine choice

“Should you prefer one vaccine or vaccine platform to another? That’s been incredibly controversial,” Dr. Curtis said. Though the efficacy of the mRNA vaccines is often cited at 90%, compared with the roughly 60%-70% efficacy of the Johnson and & Johnson single-dose vaccine, “they’re not head-to-head studies. They weren’t done in the same countries; they weren’t done with the same viral variants. They’re not being evaluated under similar conditions; it’s not fair to hold them up and say: ‘Apples to apples, this one is better than that one.’ ”

“On the other hand,” he added, “if you were choosing, which would you want? If you are given a choice, you’re probably going to have a preference. The downside for a public health group – this group, which is trying to help rheumatologists and their patients make prudent decisions in light of very imperfect and evolving evidence – is that most people don’t have a choice. So if you send the message that one vaccine might be better than another, if that makes people wait for the one that supposedly might be better, you’ve probably done something bad. They’re delaying for what may be a marginal reason, and some vaccine protection is better than no vaccine protection.”

Regarding vaccination timing in patients who are on immunomodulatory therapies, the task force strongly recommended not delaying or adjusting the timing for anyone on hydroxychloroquine, sulfasalazine, leflunomide, apremilast, or intravenous immunoglobulin. They moderately recommended the same for patients on numerous drugs, including methotrexate, tumor necrosis factor inhibitors, Janus kinase inhibitors, abatacept, and glucocorticoids. Patients on rituximab with a low COVID-19 risk were recommended to schedule their vaccination so that the vaccine series is initiated roughly 4 weeks before their next scheduled rituximab cycle.

Regarding the use and timing of immunomodulatory therapies in relation to vaccination, they strongly recommended no modifications for patients on hydroxychloroquine, apremilast, intravenous immunoglobulin, or glucocorticoids. They also moderately recommended no modifications for patients on numerous drugs, including sulfasalazine, leflunomide, azathioprine, oral cyclophosphamide, and TNF inhibitors.

Regarding limitations, the researchers noted that there is no direct evidence about COVID-19 vaccine safety and efficacy yet in this subset of patients. They also acknowledged that they did not follow the rigorous methodology typically used by the ACR in developing formal clinical practice guidelines, calling it an “expected limitation” given the need to issue timely and potentially lifesaving guidance for the rheumatology community.

The authors acknowledged several potential conflicts of interest, including receiving consulting fees, speaking fees, and research grants from various pharmaceutical companies.

Newly updated COVID-19 vaccination guidance from the American College of Rheumatology offers detailed insight into how clinicians should proceed with use, timing, and prioritization of COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases (RMDs).

“The task force advised health care providers to avoid being overly dogmatic in following these recommendations,” Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham, and colleagues wrote. “The attempt to optimize vaccine response in relation to the use and timing of immunosuppressive medications should not compromise a willing patient’s ability to undergo vaccination in a timely manner and risk a missed vaccination opportunity.” The guidelines were published in Arthritis & Rheumatology.

To review the published literature and determine the safety and efficacy of the available COVID-19 vaccines for patients with RMDs, a task force made up of nine rheumatologists/immunologists, two infectious disease specialists, and two public health physicians was formed. The ACR COVID-19 Vaccine Guidance Task Force considered vaccine clinical trial data and overall COVID-19 risk and outcomes among RMD patients, along with the immunogenicity of other vaccines in patients on immunomodulatory therapies and the safety profile of non-COVID vaccines in RMD patients.

Using a 9-point numeric scoring system, the task force developed 74 draft guidance statements that were rated with a median score of 7, 8, or 9. Consensus was deemed strong for 16 of the statements and moderate for the remaining 58.

Of the general considerations related to COVID-19 vaccination, the only statement to achieve strong consensus called for the rheumatology health care provider to take responsibility for assessing their patients’ COVID-19 vaccination status. Other notable statements asserted that patients with autoimmune inflammatory rheumatic diseases (AIIRDs) are at higher risk for hospitalized COVID-19, compared with the general population, and should be prioritized for vaccination accordingly, even though a risk for disease flare or worsening exists and the expected vaccine response for patients on systemic immunomodulatory therapies is “likely to be blunted in its magnitude and duration.”
 

Takeaway advice

When asked about a top-line takeaway for rheumatologists, Dr. Curtis replied: “Make sure that your patients are getting vaccinated. Even though the vaccine in patients with compromised immune systems might not work quite as well and might not last quite as long, they still should get vaccinated. And vaccine hesitancy is a real thing.”

Citing unpublished survey data, he estimated that roughly 25% of people with rheumatic conditions remain unvaccinated, and more than half of them said they had no vaccination plans. “That’s a pretty important message when up to a quarter of your higher-risk people take a pass,” he said. “You’d expect it to be better in people at risk who are on steroids or immune medications. That’s something rheumatologists can help with the most.”

Regarding vaccine use, the task force strongly recommended that RMD patients be offered COVID-19 vaccinations consistent with the emergency use authorization’s current age restrictions and/or Food and Drug Administration approval. They also strongly recommended patients with AIIRDs receive the second dose of a multidose vaccine, even if the first dose led to nonserious adverse events, and that health care providers avoid ordering lab testing to assess COVID-19 immunity in vaccinated and unvaccinated patients.

The issues around testing for immunity are ample, Dr. Curtis said. For starters, “there are different antibodies, and one of them wouldn’t be expected to go up after vaccination.” And even if you are testing for the correct antibodies, “now I get a number. Is my number high enough that says that I’m protected? That’s what clinicians want, that’s what patients want. Unfortunately, we don’t have that test. There’s an antibody test; you can test against the spike protein and get a number, but whether that number has clinical relevance that says you’re protected, and how much, and for how long, we definitely don’t have that information. You could be falsely reassured or falsely alarmed by the results.”

This statement, he added, has been particularly divisive. “A bunch of rheumatologists have said to me: ‘Look, we’re doing this routinely for our patients.’ My rejoinder was: ‘That’s great to know; what’s the evidence base for what you’re doing there? Because I haven’t read that paper.’ I fully acknowledge that, in groups of patients on certain therapies, the antibody response seems somewhat lower. But doctors don’t treat groups of patients; we treat patients one at a time. And I want to know how to help the patient in front of me, and I want to know what to tell him or her if I get the results of an antibody test.”

Finally, the task force emphasized that all AIIRD patients should receive the COVID-19 vaccinations, exempting only those with life-threatening disease, and they stated no preference for one COVID-19 vaccine over the other.
 

Vaccine choice

“Should you prefer one vaccine or vaccine platform to another? That’s been incredibly controversial,” Dr. Curtis said. Though the efficacy of the mRNA vaccines is often cited at 90%, compared with the roughly 60%-70% efficacy of the Johnson and & Johnson single-dose vaccine, “they’re not head-to-head studies. They weren’t done in the same countries; they weren’t done with the same viral variants. They’re not being evaluated under similar conditions; it’s not fair to hold them up and say: ‘Apples to apples, this one is better than that one.’ ”

“On the other hand,” he added, “if you were choosing, which would you want? If you are given a choice, you’re probably going to have a preference. The downside for a public health group – this group, which is trying to help rheumatologists and their patients make prudent decisions in light of very imperfect and evolving evidence – is that most people don’t have a choice. So if you send the message that one vaccine might be better than another, if that makes people wait for the one that supposedly might be better, you’ve probably done something bad. They’re delaying for what may be a marginal reason, and some vaccine protection is better than no vaccine protection.”

Regarding vaccination timing in patients who are on immunomodulatory therapies, the task force strongly recommended not delaying or adjusting the timing for anyone on hydroxychloroquine, sulfasalazine, leflunomide, apremilast, or intravenous immunoglobulin. They moderately recommended the same for patients on numerous drugs, including methotrexate, tumor necrosis factor inhibitors, Janus kinase inhibitors, abatacept, and glucocorticoids. Patients on rituximab with a low COVID-19 risk were recommended to schedule their vaccination so that the vaccine series is initiated roughly 4 weeks before their next scheduled rituximab cycle.

Regarding the use and timing of immunomodulatory therapies in relation to vaccination, they strongly recommended no modifications for patients on hydroxychloroquine, apremilast, intravenous immunoglobulin, or glucocorticoids. They also moderately recommended no modifications for patients on numerous drugs, including sulfasalazine, leflunomide, azathioprine, oral cyclophosphamide, and TNF inhibitors.

Regarding limitations, the researchers noted that there is no direct evidence about COVID-19 vaccine safety and efficacy yet in this subset of patients. They also acknowledged that they did not follow the rigorous methodology typically used by the ACR in developing formal clinical practice guidelines, calling it an “expected limitation” given the need to issue timely and potentially lifesaving guidance for the rheumatology community.

The authors acknowledged several potential conflicts of interest, including receiving consulting fees, speaking fees, and research grants from various pharmaceutical companies.

Goodbye stress, goodbye gray hair

Last year was a doozy, so it wouldn’t be too surprising if we all had a few new gray strands in our hair. But what if we told you that you don’t need to start dying them or plucking them out? What if they could magically go back to the way they were? Well, it may be possible, sans magic and sans stress.

Investigators recently discovered that the age-old belief that stress will permanently turn your hair gray may not be true after all. There’s a strong possibility that it could turn back to its original color once the stressful agent is eliminated.

“Understanding the mechanisms that allow ‘old’ gray hairs to return to their ‘young’ pigmented states could yield new clues about the malleability of human aging in general and how it is influenced by stress,” said senior author Martin Picard, PhD, of Columbia University, New York.

NomeVisualizzato/Pixabay

One small step for squid

Space does a number on the human body. Forget the obvious like going for a walk outside without a spacesuit, or even the well-known risks like the degradation of bone in microgravity; there are numerous smaller but still important changes to the body during spaceflight, like the disruption of the symbiotic relationship between gut bacteria and the human body. This causes the immune system to lose the ability to recognize threats, and illnesses spread more easily.

Naturally, if astronauts are going to undertake years-long journeys to Mars and beyond, a thorough understanding of this disturbance is necessary, and that’s why NASA has sent a bunch of squid to the International Space Station.

When it comes to animal studies, squid aren’t the usual culprits, but there’s a reason NASA chose calamari over the alternatives: The Hawaiian bobtail squid has a symbiotic relationship with bacteria that regulate their bioluminescence in much the same way that we have a symbiotic relationship with our gut bacteria, but the squid is a much simpler animal. If the bioluminescence-regulating bacteria are disturbed during their time in space, it will be much easier to figure out what’s going wrong.

PxHere

Less plastic, more vanilla

Have you been racked by guilt over the number of plastic water bottles you use? What about the amount of ice cream you eat? Well, this one’s for you.

Plastic isn’t the first thing you think about when you open up a pint of vanilla ice cream and catch the sweet, spicy vanilla scent, or when you smell those fresh vanilla scones coming out of the oven at the coffee shop, but a new study shows that the flavor of vanilla can come from water bottles.

Here’s the deal. A compound called vanillin is responsible for the scent of vanilla, and it can come naturally from the bean or it can be made synthetically. Believe it or not, 85% of vanillin is made synthetically from fossil fuels!

We’ve definitely grown accustomed to our favorite vanilla scents, foods, and cosmetics. In 2018, the global demand for vanillin was about 40,800 tons and is expected to grow to 65,000 tons by 2025, which far exceeds the supply of natural vanilla.

So what can we do? Well, we can use genetically engineered bacteria to turn plastic water bottles into vanillin, according to a study published in the journal Green Chemistry.

tezzstock/Thinkstock

No withdrawals from this bank

Into each life, some milestones must fall: High school graduation, birth of a child, first house, 50th wedding anniversary, COVID-19. One LOTME staffer got really excited – way too excited, actually – when his Nissan Sentra reached 300,000 miles.

Well, there are milestones, and then there are milestones. “1,000 Reasons for Hope” is a report celebrating the first 1,000 brains donated to the VA-BU-CLF Brain Bank. For those of you keeping score at home, that would be the Department of Veterans Affairs, Boston University, and the Concussion Legacy Foundation.

The Brain Bank, created in 2008 to study concussions and chronic traumatic encephalopathy, is the brainchild – yes, we went there – of Chris Nowinski, PhD, a former professional wrestler, and Ann McKee, MD, an expert on neurogenerative disease. “Our discoveries have already inspired changes to sports that will prevent many future cases of CTE in the next generation of athletes,” Dr. Nowinski, the CEO of CLF, said in a written statement.

Jana Blaková/Thinkstock

Goodbye stress, goodbye gray hair

Last year was a doozy, so it wouldn’t be too surprising if we all had a few new gray strands in our hair. But what if we told you that you don’t need to start dying them or plucking them out? What if they could magically go back to the way they were? Well, it may be possible, sans magic and sans stress.

Investigators recently discovered that the age-old belief that stress will permanently turn your hair gray may not be true after all. There’s a strong possibility that it could turn back to its original color once the stressful agent is eliminated.

“Understanding the mechanisms that allow ‘old’ gray hairs to return to their ‘young’ pigmented states could yield new clues about the malleability of human aging in general and how it is influenced by stress,” said senior author Martin Picard, PhD, of Columbia University, New York.

NomeVisualizzato/Pixabay

One small step for squid

Space does a number on the human body. Forget the obvious like going for a walk outside without a spacesuit, or even the well-known risks like the degradation of bone in microgravity; there are numerous smaller but still important changes to the body during spaceflight, like the disruption of the symbiotic relationship between gut bacteria and the human body. This causes the immune system to lose the ability to recognize threats, and illnesses spread more easily.

Naturally, if astronauts are going to undertake years-long journeys to Mars and beyond, a thorough understanding of this disturbance is necessary, and that’s why NASA has sent a bunch of squid to the International Space Station.

When it comes to animal studies, squid aren’t the usual culprits, but there’s a reason NASA chose calamari over the alternatives: The Hawaiian bobtail squid has a symbiotic relationship with bacteria that regulate their bioluminescence in much the same way that we have a symbiotic relationship with our gut bacteria, but the squid is a much simpler animal. If the bioluminescence-regulating bacteria are disturbed during their time in space, it will be much easier to figure out what’s going wrong.

PxHere

Less plastic, more vanilla

Have you been racked by guilt over the number of plastic water bottles you use? What about the amount of ice cream you eat? Well, this one’s for you.

Plastic isn’t the first thing you think about when you open up a pint of vanilla ice cream and catch the sweet, spicy vanilla scent, or when you smell those fresh vanilla scones coming out of the oven at the coffee shop, but a new study shows that the flavor of vanilla can come from water bottles.

Here’s the deal. A compound called vanillin is responsible for the scent of vanilla, and it can come naturally from the bean or it can be made synthetically. Believe it or not, 85% of vanillin is made synthetically from fossil fuels!

We’ve definitely grown accustomed to our favorite vanilla scents, foods, and cosmetics. In 2018, the global demand for vanillin was about 40,800 tons and is expected to grow to 65,000 tons by 2025, which far exceeds the supply of natural vanilla.

So what can we do? Well, we can use genetically engineered bacteria to turn plastic water bottles into vanillin, according to a study published in the journal Green Chemistry.

tezzstock/Thinkstock

No withdrawals from this bank

Into each life, some milestones must fall: High school graduation, birth of a child, first house, 50th wedding anniversary, COVID-19. One LOTME staffer got really excited – way too excited, actually – when his Nissan Sentra reached 300,000 miles.

Well, there are milestones, and then there are milestones. “1,000 Reasons for Hope” is a report celebrating the first 1,000 brains donated to the VA-BU-CLF Brain Bank. For those of you keeping score at home, that would be the Department of Veterans Affairs, Boston University, and the Concussion Legacy Foundation.

The Brain Bank, created in 2008 to study concussions and chronic traumatic encephalopathy, is the brainchild – yes, we went there – of Chris Nowinski, PhD, a former professional wrestler, and Ann McKee, MD, an expert on neurogenerative disease. “Our discoveries have already inspired changes to sports that will prevent many future cases of CTE in the next generation of athletes,” Dr. Nowinski, the CEO of CLF, said in a written statement.

Jana Blaková/Thinkstock

Goodbye stress, goodbye gray hair

Last year was a doozy, so it wouldn’t be too surprising if we all had a few new gray strands in our hair. But what if we told you that you don’t need to start dying them or plucking them out? What if they could magically go back to the way they were? Well, it may be possible, sans magic and sans stress.

Investigators recently discovered that the age-old belief that stress will permanently turn your hair gray may not be true after all. There’s a strong possibility that it could turn back to its original color once the stressful agent is eliminated.

“Understanding the mechanisms that allow ‘old’ gray hairs to return to their ‘young’ pigmented states could yield new clues about the malleability of human aging in general and how it is influenced by stress,” said senior author Martin Picard, PhD, of Columbia University, New York.

NomeVisualizzato/Pixabay

One small step for squid

Space does a number on the human body. Forget the obvious like going for a walk outside without a spacesuit, or even the well-known risks like the degradation of bone in microgravity; there are numerous smaller but still important changes to the body during spaceflight, like the disruption of the symbiotic relationship between gut bacteria and the human body. This causes the immune system to lose the ability to recognize threats, and illnesses spread more easily.

Naturally, if astronauts are going to undertake years-long journeys to Mars and beyond, a thorough understanding of this disturbance is necessary, and that’s why NASA has sent a bunch of squid to the International Space Station.

When it comes to animal studies, squid aren’t the usual culprits, but there’s a reason NASA chose calamari over the alternatives: The Hawaiian bobtail squid has a symbiotic relationship with bacteria that regulate their bioluminescence in much the same way that we have a symbiotic relationship with our gut bacteria, but the squid is a much simpler animal. If the bioluminescence-regulating bacteria are disturbed during their time in space, it will be much easier to figure out what’s going wrong.

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Less plastic, more vanilla

Have you been racked by guilt over the number of plastic water bottles you use? What about the amount of ice cream you eat? Well, this one’s for you.

Plastic isn’t the first thing you think about when you open up a pint of vanilla ice cream and catch the sweet, spicy vanilla scent, or when you smell those fresh vanilla scones coming out of the oven at the coffee shop, but a new study shows that the flavor of vanilla can come from water bottles.

Here’s the deal. A compound called vanillin is responsible for the scent of vanilla, and it can come naturally from the bean or it can be made synthetically. Believe it or not, 85% of vanillin is made synthetically from fossil fuels!

We’ve definitely grown accustomed to our favorite vanilla scents, foods, and cosmetics. In 2018, the global demand for vanillin was about 40,800 tons and is expected to grow to 65,000 tons by 2025, which far exceeds the supply of natural vanilla.

So what can we do? Well, we can use genetically engineered bacteria to turn plastic water bottles into vanillin, according to a study published in the journal Green Chemistry.

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No withdrawals from this bank

Into each life, some milestones must fall: High school graduation, birth of a child, first house, 50th wedding anniversary, COVID-19. One LOTME staffer got really excited – way too excited, actually – when his Nissan Sentra reached 300,000 miles.

Well, there are milestones, and then there are milestones. “1,000 Reasons for Hope” is a report celebrating the first 1,000 brains donated to the VA-BU-CLF Brain Bank. For those of you keeping score at home, that would be the Department of Veterans Affairs, Boston University, and the Concussion Legacy Foundation.

The Brain Bank, created in 2008 to study concussions and chronic traumatic encephalopathy, is the brainchild – yes, we went there – of Chris Nowinski, PhD, a former professional wrestler, and Ann McKee, MD, an expert on neurogenerative disease. “Our discoveries have already inspired changes to sports that will prevent many future cases of CTE in the next generation of athletes,” Dr. Nowinski, the CEO of CLF, said in a written statement.

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