MDedge Rheumatology

Key clinical point: Intermetatarsal (IMB) and submetatarsal (SMB) bursitis are associated with and specific for early rheumatoid arthritis (RA), with IMB having the highest sensitivity.

Major finding: IMB (adjusted odds ratio [aOR], 4.5; P less than .001) and SMB (aOR, 2.2; P = .041) were associated with RA. Sensitivity for RA of IMB and SMB was 69% and 25%, respectively. Specificity of IMB vs. other arthritides and healthy controls was 70% and 84%, respectively. Specificity for SMB was 94% (vs. other arthritides) and 97% (vs. healthy controls).

Study details: The findings are based on a large case-controlled magnetic resonance imaging study of 157 patients presenting with early RA, 284 other arthritides, and 193 healthy controls.

Disclosures: The study was supported by the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Dakkak Y et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02359-w.

Key clinical point: Intermetatarsal (IMB) and submetatarsal (SMB) bursitis are associated with and specific for early rheumatoid arthritis (RA), with IMB having the highest sensitivity.

Major finding: IMB (adjusted odds ratio [aOR], 4.5; P less than .001) and SMB (aOR, 2.2; P = .041) were associated with RA. Sensitivity for RA of IMB and SMB was 69% and 25%, respectively. Specificity of IMB vs. other arthritides and healthy controls was 70% and 84%, respectively. Specificity for SMB was 94% (vs. other arthritides) and 97% (vs. healthy controls).

Study details: The findings are based on a large case-controlled magnetic resonance imaging study of 157 patients presenting with early RA, 284 other arthritides, and 193 healthy controls.

Disclosures: The study was supported by the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Dakkak Y et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02359-w.

Key clinical point: Intermetatarsal (IMB) and submetatarsal (SMB) bursitis are associated with and specific for early rheumatoid arthritis (RA), with IMB having the highest sensitivity.

Major finding: IMB (adjusted odds ratio [aOR], 4.5; P less than .001) and SMB (aOR, 2.2; P = .041) were associated with RA. Sensitivity for RA of IMB and SMB was 69% and 25%, respectively. Specificity of IMB vs. other arthritides and healthy controls was 70% and 84%, respectively. Specificity for SMB was 94% (vs. other arthritides) and 97% (vs. healthy controls).

Study details: The findings are based on a large case-controlled magnetic resonance imaging study of 157 patients presenting with early RA, 284 other arthritides, and 193 healthy controls.

Disclosures: The study was supported by the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Dakkak Y et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02359-w.

Key clinical point: Depression was associated with greater short-term disease activity and more severe and persistent pain in US veterans with early rheumatoid arthritis (RA) receiving methotrexate.

Major finding: Depression was associated with significantly higher 28-joint count disease activity scores at 6 months (β, 0.345; P = .045) but not at 1- (P = .477) and 2- (P = .804) year follow-up. Moreover, depression was significantly associated with higher patient-reported pain at 6 months (β, 0.385; P = .029) and 1 year (β, 0.396; P = .028).

Study details: The study included 268 US veterans (89.2% males) with early RA (duration less than 2 years) prescribed methotrexate, identified from the Veterans Affairs Rheumatoid Arthritis Registry.

Disclosures: The study was supported by the Rheumatology Research Foundation’s Scientist Development Award, the National Institute on Ageing, VA Clinical Science Research and Development Service, and the National Institute of General Medical Sciences. The authors reported receiving grants from various organizations and/or pharmaceutical companies.

Source: Rathbun AM et al. J Rheumatol. 2020 Nov 15. doi: 10.3899/jrheum.200743.

Key clinical point: Depression was associated with greater short-term disease activity and more severe and persistent pain in US veterans with early rheumatoid arthritis (RA) receiving methotrexate.

Major finding: Depression was associated with significantly higher 28-joint count disease activity scores at 6 months (β, 0.345; P = .045) but not at 1- (P = .477) and 2- (P = .804) year follow-up. Moreover, depression was significantly associated with higher patient-reported pain at 6 months (β, 0.385; P = .029) and 1 year (β, 0.396; P = .028).

Study details: The study included 268 US veterans (89.2% males) with early RA (duration less than 2 years) prescribed methotrexate, identified from the Veterans Affairs Rheumatoid Arthritis Registry.

Disclosures: The study was supported by the Rheumatology Research Foundation’s Scientist Development Award, the National Institute on Ageing, VA Clinical Science Research and Development Service, and the National Institute of General Medical Sciences. The authors reported receiving grants from various organizations and/or pharmaceutical companies.

Source: Rathbun AM et al. J Rheumatol. 2020 Nov 15. doi: 10.3899/jrheum.200743.

Key clinical point: Depression was associated with greater short-term disease activity and more severe and persistent pain in US veterans with early rheumatoid arthritis (RA) receiving methotrexate.

Major finding: Depression was associated with significantly higher 28-joint count disease activity scores at 6 months (β, 0.345; P = .045) but not at 1- (P = .477) and 2- (P = .804) year follow-up. Moreover, depression was significantly associated with higher patient-reported pain at 6 months (β, 0.385; P = .029) and 1 year (β, 0.396; P = .028).

Study details: The study included 268 US veterans (89.2% males) with early RA (duration less than 2 years) prescribed methotrexate, identified from the Veterans Affairs Rheumatoid Arthritis Registry.

Disclosures: The study was supported by the Rheumatology Research Foundation’s Scientist Development Award, the National Institute on Ageing, VA Clinical Science Research and Development Service, and the National Institute of General Medical Sciences. The authors reported receiving grants from various organizations and/or pharmaceutical companies.

Source: Rathbun AM et al. J Rheumatol. 2020 Nov 15. doi: 10.3899/jrheum.200743.

Key clinical point: The concomitant use of oral glucocorticoids and proton pump inhibitors (PPIs) is associated with a higher risk of osteoporotic fractures in patients with rheumatoid arthritis (RA).

Major finding: The risk of osteoporotic fractures was significantly higher in concomitant users of oral glucocorticoids and PPIs (adjusted hazard ratio [aHR] 1.60; 95% confidence interval [CI] 1.35-1.89). Among current concomitant users, an increased risk was observed for fractures of the hip (aHR, 1.45; 95% CI, 1.11-1.91), clinical vertebrae (aHR, 2.84; 95% CI, 1.87-4.32), pelvis (aHR, 2.47; 95% CI, 1.41-4.34), and ribs (aHR, 4.03; 95% CI, 2.13-7.63).

Study details: The data come from a retrospective study of 12,351 patients with RA aged 50 years or older in the United Kingdom.

Disclosures: Two of the authors reported receiving research grants and speakers’ fees from various pharmaceutical companies. The others reported no conflicts of interest.

Source: Abtahi S et al. Ann Rheum Dis. 2020 Dec 11. doi: 10.1136/annrheumdis-2020-218758.

Key clinical point: The concomitant use of oral glucocorticoids and proton pump inhibitors (PPIs) is associated with a higher risk of osteoporotic fractures in patients with rheumatoid arthritis (RA).

Major finding: The risk of osteoporotic fractures was significantly higher in concomitant users of oral glucocorticoids and PPIs (adjusted hazard ratio [aHR] 1.60; 95% confidence interval [CI] 1.35-1.89). Among current concomitant users, an increased risk was observed for fractures of the hip (aHR, 1.45; 95% CI, 1.11-1.91), clinical vertebrae (aHR, 2.84; 95% CI, 1.87-4.32), pelvis (aHR, 2.47; 95% CI, 1.41-4.34), and ribs (aHR, 4.03; 95% CI, 2.13-7.63).

Study details: The data come from a retrospective study of 12,351 patients with RA aged 50 years or older in the United Kingdom.

Disclosures: Two of the authors reported receiving research grants and speakers’ fees from various pharmaceutical companies. The others reported no conflicts of interest.

Source: Abtahi S et al. Ann Rheum Dis. 2020 Dec 11. doi: 10.1136/annrheumdis-2020-218758.

Key clinical point: The concomitant use of oral glucocorticoids and proton pump inhibitors (PPIs) is associated with a higher risk of osteoporotic fractures in patients with rheumatoid arthritis (RA).

Major finding: The risk of osteoporotic fractures was significantly higher in concomitant users of oral glucocorticoids and PPIs (adjusted hazard ratio [aHR] 1.60; 95% confidence interval [CI] 1.35-1.89). Among current concomitant users, an increased risk was observed for fractures of the hip (aHR, 1.45; 95% CI, 1.11-1.91), clinical vertebrae (aHR, 2.84; 95% CI, 1.87-4.32), pelvis (aHR, 2.47; 95% CI, 1.41-4.34), and ribs (aHR, 4.03; 95% CI, 2.13-7.63).

Study details: The data come from a retrospective study of 12,351 patients with RA aged 50 years or older in the United Kingdom.

Disclosures: Two of the authors reported receiving research grants and speakers’ fees from various pharmaceutical companies. The others reported no conflicts of interest.

Source: Abtahi S et al. Ann Rheum Dis. 2020 Dec 11. doi: 10.1136/annrheumdis-2020-218758.

Key clinical point: Tocilizumab (TCZ) and methotrexate (MTX) combination therapy was generally more effective than TCZ monotherapy in preventing radiographic progression in patients with early and established rheumatoid arthritis. However, effect modifiers were more joint damage or lower disease activity score (DAS) in early RA and longer disease duration in established RA.

Major finding: Overall, TCZ monotherapy was less effective in preventing radiographic progression (relative risk; 95% confidence interval) than TCZ+MTX combination therapy in patients with early (0.96; 0.90 to –1.03) and established (0.96; 0.87 to –1.07) RA. These effects were modified by baseline joint damage (P less than .01), DAS assessing 28 joints (P = .04) in early RA, and disease duration (P = .04) in established RA.

Study details: Analysis of individual patient data from randomized controlled trials comparing TCZ monotherapy and TCZ+MTX combination therapy in patients with early (n=1,089) and established (n=417) RA.

Disclosures: No study sponsor was identified. Some of the investigators reported ties with various pharmaceutical companies.

Source: Verhoeven MMA et al. Arthritis Care Res (Hoboken). 2020 Nov 30. doi: 10.1002/acr.24524. 

Key clinical point: Tocilizumab (TCZ) and methotrexate (MTX) combination therapy was generally more effective than TCZ monotherapy in preventing radiographic progression in patients with early and established rheumatoid arthritis. However, effect modifiers were more joint damage or lower disease activity score (DAS) in early RA and longer disease duration in established RA.

Major finding: Overall, TCZ monotherapy was less effective in preventing radiographic progression (relative risk; 95% confidence interval) than TCZ+MTX combination therapy in patients with early (0.96; 0.90 to –1.03) and established (0.96; 0.87 to –1.07) RA. These effects were modified by baseline joint damage (P less than .01), DAS assessing 28 joints (P = .04) in early RA, and disease duration (P = .04) in established RA.

Study details: Analysis of individual patient data from randomized controlled trials comparing TCZ monotherapy and TCZ+MTX combination therapy in patients with early (n=1,089) and established (n=417) RA.

Disclosures: No study sponsor was identified. Some of the investigators reported ties with various pharmaceutical companies.

Source: Verhoeven MMA et al. Arthritis Care Res (Hoboken). 2020 Nov 30. doi: 10.1002/acr.24524. 

Key clinical point: Tocilizumab (TCZ) and methotrexate (MTX) combination therapy was generally more effective than TCZ monotherapy in preventing radiographic progression in patients with early and established rheumatoid arthritis. However, effect modifiers were more joint damage or lower disease activity score (DAS) in early RA and longer disease duration in established RA.

Major finding: Overall, TCZ monotherapy was less effective in preventing radiographic progression (relative risk; 95% confidence interval) than TCZ+MTX combination therapy in patients with early (0.96; 0.90 to –1.03) and established (0.96; 0.87 to –1.07) RA. These effects were modified by baseline joint damage (P less than .01), DAS assessing 28 joints (P = .04) in early RA, and disease duration (P = .04) in established RA.

Study details: Analysis of individual patient data from randomized controlled trials comparing TCZ monotherapy and TCZ+MTX combination therapy in patients with early (n=1,089) and established (n=417) RA.

Disclosures: No study sponsor was identified. Some of the investigators reported ties with various pharmaceutical companies.

Source: Verhoeven MMA et al. Arthritis Care Res (Hoboken). 2020 Nov 30. doi: 10.1002/acr.24524. 

Key clinical point: Nonuse of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), high updated Charlson’s comorbidity index (CCI), elevated acute physiology and chronic health evaluation (APACHE) II score, and coagulation abnormalities predicted poorer prognosis in patients with rheumatoid arthritis admitted to the intensive care unit (ICU).

Major finding: The 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. Factors associated with an increased mortality risk after ICU admission were nonuse of csDMARDs (hazard ratio [HR], 0.413; P = .0229), elevated updated CCI (HR, 1.522; P = .0007), high APACHE II score (HR, 1.045; P = .0008), and extended prothrombin time-international normalized ratio (HR, 2.670; P = .0051). The liver (P = .0004) and renal (P = .0009) disease scores were significantly higher in nonsurvivors vs. survivors.

Study details: The findings are based on a single-center retrospective study of 67 patients (mean age at admission, 68±13 years) with RA (median duration, 14±15 years) admitted to the ICU.

Disclosures: The study was supported by grants from JSPS KAKENHI. The authors declared no conflicts of interest.

Source: Fujiwara T et al. BMC Rheumatol. 2020 Dec 4. doi: 10.1186/s41927-020-00164-1.

Key clinical point: Nonuse of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), high updated Charlson’s comorbidity index (CCI), elevated acute physiology and chronic health evaluation (APACHE) II score, and coagulation abnormalities predicted poorer prognosis in patients with rheumatoid arthritis admitted to the intensive care unit (ICU).

Major finding: The 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. Factors associated with an increased mortality risk after ICU admission were nonuse of csDMARDs (hazard ratio [HR], 0.413; P = .0229), elevated updated CCI (HR, 1.522; P = .0007), high APACHE II score (HR, 1.045; P = .0008), and extended prothrombin time-international normalized ratio (HR, 2.670; P = .0051). The liver (P = .0004) and renal (P = .0009) disease scores were significantly higher in nonsurvivors vs. survivors.

Study details: The findings are based on a single-center retrospective study of 67 patients (mean age at admission, 68±13 years) with RA (median duration, 14±15 years) admitted to the ICU.

Disclosures: The study was supported by grants from JSPS KAKENHI. The authors declared no conflicts of interest.

Source: Fujiwara T et al. BMC Rheumatol. 2020 Dec 4. doi: 10.1186/s41927-020-00164-1.

Key clinical point: Nonuse of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), high updated Charlson’s comorbidity index (CCI), elevated acute physiology and chronic health evaluation (APACHE) II score, and coagulation abnormalities predicted poorer prognosis in patients with rheumatoid arthritis admitted to the intensive care unit (ICU).

Major finding: The 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. Factors associated with an increased mortality risk after ICU admission were nonuse of csDMARDs (hazard ratio [HR], 0.413; P = .0229), elevated updated CCI (HR, 1.522; P = .0007), high APACHE II score (HR, 1.045; P = .0008), and extended prothrombin time-international normalized ratio (HR, 2.670; P = .0051). The liver (P = .0004) and renal (P = .0009) disease scores were significantly higher in nonsurvivors vs. survivors.

Study details: The findings are based on a single-center retrospective study of 67 patients (mean age at admission, 68±13 years) with RA (median duration, 14±15 years) admitted to the ICU.

Disclosures: The study was supported by grants from JSPS KAKENHI. The authors declared no conflicts of interest.

Source: Fujiwara T et al. BMC Rheumatol. 2020 Dec 4. doi: 10.1186/s41927-020-00164-1.

Key clinical point: Nonresponse to methotrexate (MTX) therapy can be predicted based on the gut microbiome of an individual patient newly diagnosed with rheumatoid arthritis.

Major finding: A model developed using machine learning predicted 83.3% of patients who did not respond to MTX and 78% of MTX responders.

Study details: An analysis of DNA from fecal samples obtained from a training cohort of 26 patients with new-onset RA (NORA), a validation cohort of 21 patients with NORA, and a control group of 20 patients with RA.

Disclosures: This study was funded by the National Institutes of Health, the Rheumatology Research Foundation, the Searle Scholars Program, various funds from the Spanish government, the UCSF Breakthrough Program for Rheumatoid Arthritis-related Research, and the Arthritis Foundation Center for Excellence. Four authors report consultancies and memberships on scientific advisory boards with pharmaceutical and biotechnology companies that do not overlap with the current study.

Source: Artacho A et al. Arthritis Rheumatol. 2020 Dec 13. doi: 10.1002/art.41622.

Key clinical point: Nonresponse to methotrexate (MTX) therapy can be predicted based on the gut microbiome of an individual patient newly diagnosed with rheumatoid arthritis.

Major finding: A model developed using machine learning predicted 83.3% of patients who did not respond to MTX and 78% of MTX responders.

Study details: An analysis of DNA from fecal samples obtained from a training cohort of 26 patients with new-onset RA (NORA), a validation cohort of 21 patients with NORA, and a control group of 20 patients with RA.

Disclosures: This study was funded by the National Institutes of Health, the Rheumatology Research Foundation, the Searle Scholars Program, various funds from the Spanish government, the UCSF Breakthrough Program for Rheumatoid Arthritis-related Research, and the Arthritis Foundation Center for Excellence. Four authors report consultancies and memberships on scientific advisory boards with pharmaceutical and biotechnology companies that do not overlap with the current study.

Source: Artacho A et al. Arthritis Rheumatol. 2020 Dec 13. doi: 10.1002/art.41622.

Key clinical point: Nonresponse to methotrexate (MTX) therapy can be predicted based on the gut microbiome of an individual patient newly diagnosed with rheumatoid arthritis.

Major finding: A model developed using machine learning predicted 83.3% of patients who did not respond to MTX and 78% of MTX responders.

Study details: An analysis of DNA from fecal samples obtained from a training cohort of 26 patients with new-onset RA (NORA), a validation cohort of 21 patients with NORA, and a control group of 20 patients with RA.

Disclosures: This study was funded by the National Institutes of Health, the Rheumatology Research Foundation, the Searle Scholars Program, various funds from the Spanish government, the UCSF Breakthrough Program for Rheumatoid Arthritis-related Research, and the Arthritis Foundation Center for Excellence. Four authors report consultancies and memberships on scientific advisory boards with pharmaceutical and biotechnology companies that do not overlap with the current study.

Source: Artacho A et al. Arthritis Rheumatol. 2020 Dec 13. doi: 10.1002/art.41622.

Key clinical point: Higher perceived distress was associated with elevated risk of developing inflammatory arthritis (IA) in an at-risk population having either positive rheumatoid arthritis (RA)-related autoantibodies or inherent genetic risk based on family history.

Major finding: A 1-point increase in the perceived distress score was significantly associated with a 10% increase in the risk of incident IA (adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.02-1.19). Total perceived stress (aHR, 1.05; 95% CI, 0.99-1.10) and self-efficacy (aHR, 1.04; 95% CI, 0.91-1.18) scores were not significantly associated with the risk of incident IA.

Study details: This prospective cohort study evaluated 448 participants at an increased risk of developing future RA (either first-degree relatives of RA probands or positive for anti-citrullinated protein antibodies) from the Studies of the Etiologies of Rheumatoid Arthritis cohort.

Disclosures: The study was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.

Source: Polinski KJ et al. Arthritis Care Res (Hoboken). 2020 Nov 6. doi: 10.1002/acr.24085.

Key clinical point: Higher perceived distress was associated with elevated risk of developing inflammatory arthritis (IA) in an at-risk population having either positive rheumatoid arthritis (RA)-related autoantibodies or inherent genetic risk based on family history.

Major finding: A 1-point increase in the perceived distress score was significantly associated with a 10% increase in the risk of incident IA (adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.02-1.19). Total perceived stress (aHR, 1.05; 95% CI, 0.99-1.10) and self-efficacy (aHR, 1.04; 95% CI, 0.91-1.18) scores were not significantly associated with the risk of incident IA.

Study details: This prospective cohort study evaluated 448 participants at an increased risk of developing future RA (either first-degree relatives of RA probands or positive for anti-citrullinated protein antibodies) from the Studies of the Etiologies of Rheumatoid Arthritis cohort.

Disclosures: The study was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.

Source: Polinski KJ et al. Arthritis Care Res (Hoboken). 2020 Nov 6. doi: 10.1002/acr.24085.

Key clinical point: Higher perceived distress was associated with elevated risk of developing inflammatory arthritis (IA) in an at-risk population having either positive rheumatoid arthritis (RA)-related autoantibodies or inherent genetic risk based on family history.

Major finding: A 1-point increase in the perceived distress score was significantly associated with a 10% increase in the risk of incident IA (adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.02-1.19). Total perceived stress (aHR, 1.05; 95% CI, 0.99-1.10) and self-efficacy (aHR, 1.04; 95% CI, 0.91-1.18) scores were not significantly associated with the risk of incident IA.

Study details: This prospective cohort study evaluated 448 participants at an increased risk of developing future RA (either first-degree relatives of RA probands or positive for anti-citrullinated protein antibodies) from the Studies of the Etiologies of Rheumatoid Arthritis cohort.

Disclosures: The study was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.

Source: Polinski KJ et al. Arthritis Care Res (Hoboken). 2020 Nov 6. doi: 10.1002/acr.24085.

Key clinical point: The appearance of total antinuclear antibodies (ANA) before administration of TNF-α inhibitors (TNFi) is a risk factor for the appearance of antidrug antibodies (ADrA) and treatment failure.

Major finding: ADrA appeared in 36.8% and 30.2% of patients treated with infliximab (IFX) and adalimumab (ADA), respectively; all being positive for total ANA before TNFi administration. High titers of total ANA before IFX treatment were significantly associated with inefficacy and discontinuation of treatment.

Study details: The data come from observational study of 121 patients with RA newly introduced to 3 classes of TNFi.

Disclosures: The study did not receive any funding. S Kumagai reported ties with various pharmaceutical companies. The other authors reported no conflicts of interest.

Source: Mori A et al. PLoS One. 2020 Dec 14. doi: 10.1371/journal.pone.0243729.

Key clinical point: The appearance of total antinuclear antibodies (ANA) before administration of TNF-α inhibitors (TNFi) is a risk factor for the appearance of antidrug antibodies (ADrA) and treatment failure.

Major finding: ADrA appeared in 36.8% and 30.2% of patients treated with infliximab (IFX) and adalimumab (ADA), respectively; all being positive for total ANA before TNFi administration. High titers of total ANA before IFX treatment were significantly associated with inefficacy and discontinuation of treatment.

Study details: The data come from observational study of 121 patients with RA newly introduced to 3 classes of TNFi.

Disclosures: The study did not receive any funding. S Kumagai reported ties with various pharmaceutical companies. The other authors reported no conflicts of interest.

Source: Mori A et al. PLoS One. 2020 Dec 14. doi: 10.1371/journal.pone.0243729.

Key clinical point: The appearance of total antinuclear antibodies (ANA) before administration of TNF-α inhibitors (TNFi) is a risk factor for the appearance of antidrug antibodies (ADrA) and treatment failure.

Major finding: ADrA appeared in 36.8% and 30.2% of patients treated with infliximab (IFX) and adalimumab (ADA), respectively; all being positive for total ANA before TNFi administration. High titers of total ANA before IFX treatment were significantly associated with inefficacy and discontinuation of treatment.

Study details: The data come from observational study of 121 patients with RA newly introduced to 3 classes of TNFi.

Disclosures: The study did not receive any funding. S Kumagai reported ties with various pharmaceutical companies. The other authors reported no conflicts of interest.

Source: Mori A et al. PLoS One. 2020 Dec 14. doi: 10.1371/journal.pone.0243729.

Key clinical point: Baricitinib 4 mg may be considered for long-term treatment of patients with moderate to severe rheumatoid arthritis (RA) who were either naïve to disease-modifying antirheumatic drugs (DMARDs) or had inadequate response (IR) to methotrexate (MTX).

Major finding: At week 148, low disease activity was achieved in up to 61% of DMARD-naïve patients and 59% of MTX-IR patients initially treated with baricitinib. Baricitinib was well-tolerated.

Study details: Analysis of data from 2 completed (RA-BEGIN [n = 584] and RA-BEAM [n = 1,305]) and 1 ongoing long-term extension (RA-BEYOND) phase 3 trials involving either DMARD-naïve or MTX-IR patients.

Disclosures: The study was supported by Eli Lilly and Company. L Xie, B Jia, A Elias, A Cardoso, R Ortmann and C Walls are full-time employees of Eli Lilly and Company and may own stock or stock options in the company.

Source: Smolen JS et al. Rheumatology (Oxford). 2020 Nov 17. doi: 10.1093/rheumatology/keaa576.

Key clinical point: Baricitinib 4 mg may be considered for long-term treatment of patients with moderate to severe rheumatoid arthritis (RA) who were either naïve to disease-modifying antirheumatic drugs (DMARDs) or had inadequate response (IR) to methotrexate (MTX).

Major finding: At week 148, low disease activity was achieved in up to 61% of DMARD-naïve patients and 59% of MTX-IR patients initially treated with baricitinib. Baricitinib was well-tolerated.

Study details: Analysis of data from 2 completed (RA-BEGIN [n = 584] and RA-BEAM [n = 1,305]) and 1 ongoing long-term extension (RA-BEYOND) phase 3 trials involving either DMARD-naïve or MTX-IR patients.

Disclosures: The study was supported by Eli Lilly and Company. L Xie, B Jia, A Elias, A Cardoso, R Ortmann and C Walls are full-time employees of Eli Lilly and Company and may own stock or stock options in the company.

Source: Smolen JS et al. Rheumatology (Oxford). 2020 Nov 17. doi: 10.1093/rheumatology/keaa576.

Key clinical point: Baricitinib 4 mg may be considered for long-term treatment of patients with moderate to severe rheumatoid arthritis (RA) who were either naïve to disease-modifying antirheumatic drugs (DMARDs) or had inadequate response (IR) to methotrexate (MTX).

Major finding: At week 148, low disease activity was achieved in up to 61% of DMARD-naïve patients and 59% of MTX-IR patients initially treated with baricitinib. Baricitinib was well-tolerated.

Study details: Analysis of data from 2 completed (RA-BEGIN [n = 584] and RA-BEAM [n = 1,305]) and 1 ongoing long-term extension (RA-BEYOND) phase 3 trials involving either DMARD-naïve or MTX-IR patients.

Disclosures: The study was supported by Eli Lilly and Company. L Xie, B Jia, A Elias, A Cardoso, R Ortmann and C Walls are full-time employees of Eli Lilly and Company and may own stock or stock options in the company.

Source: Smolen JS et al. Rheumatology (Oxford). 2020 Nov 17. doi: 10.1093/rheumatology/keaa576.

Key clinical point: In anti-citrullinated protein antibodies (ACPA)-negative rheumatoid arthritis (RA), a significant decline in the disease activity score (DAS) within the first 4 months after diagnosis was associated with a higher probability of achieving sustained disease-modifying anti-rheumatic drugs (DMARDs)-free remission (SDFR).

Major finding: In patients with ACPA-negative RA, the decline in DAS within the first 4 months was stronger in the SDFR vs. non-SDFR group (−1.73 vs. −1.07 units; P less than .001). SDFR incidence was high (70.2%) and rare (7.1%) when absolute DAS level at 4 months was less than 1.6 and 3.6 or greater, respectively.

Study details: The study cohort included 772 consecutive patients with RA promptly treated with conventional DMARDs. Patients were classified into SDFR (n=149) and non-SDFR (n=623) groups.

Disclosures: The study was supported by the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Verstappen M et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02368-9.

Key clinical point: In anti-citrullinated protein antibodies (ACPA)-negative rheumatoid arthritis (RA), a significant decline in the disease activity score (DAS) within the first 4 months after diagnosis was associated with a higher probability of achieving sustained disease-modifying anti-rheumatic drugs (DMARDs)-free remission (SDFR).

Major finding: In patients with ACPA-negative RA, the decline in DAS within the first 4 months was stronger in the SDFR vs. non-SDFR group (−1.73 vs. −1.07 units; P less than .001). SDFR incidence was high (70.2%) and rare (7.1%) when absolute DAS level at 4 months was less than 1.6 and 3.6 or greater, respectively.

Study details: The study cohort included 772 consecutive patients with RA promptly treated with conventional DMARDs. Patients were classified into SDFR (n=149) and non-SDFR (n=623) groups.

Disclosures: The study was supported by the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Verstappen M et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02368-9.

Key clinical point: In anti-citrullinated protein antibodies (ACPA)-negative rheumatoid arthritis (RA), a significant decline in the disease activity score (DAS) within the first 4 months after diagnosis was associated with a higher probability of achieving sustained disease-modifying anti-rheumatic drugs (DMARDs)-free remission (SDFR).

Major finding: In patients with ACPA-negative RA, the decline in DAS within the first 4 months was stronger in the SDFR vs. non-SDFR group (−1.73 vs. −1.07 units; P less than .001). SDFR incidence was high (70.2%) and rare (7.1%) when absolute DAS level at 4 months was less than 1.6 and 3.6 or greater, respectively.

Study details: The study cohort included 772 consecutive patients with RA promptly treated with conventional DMARDs. Patients were classified into SDFR (n=149) and non-SDFR (n=623) groups.

Disclosures: The study was supported by the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation program. The authors declared no conflicts of interest.

Source: Verstappen M et al. Arthritis Res Ther. 2020 Nov 23. doi: 10.1186/s13075-020-02368-9.