Clinical Edge Journal Scan

The safety of vaginal breech delivery has been controversial since the Term Breech Trial in 2000 suggested increased neonatal mortality and short-term morbidity associated with vaginal breech delivery. The stance against breech delivery has softened since that time. Fruscalzo and colleagues provide yet more evidence supporting the safety of vaginal breech deliveries with their single-center, retrospective study, which included 804 singleton pregnant women who underwent vaginal breech vs emergency cesarean section vs elective cesarean section in Coesfeld, Germany. They found no significant differences between the vaginal breech–delivery group vs the other two groups in regard to umbilical artery pH < 7, low Apgar scores, or neonatal intensive care unit admissions. The only significant difference noted was umbilical artery pH < 7.1. This suggests that in experienced hands (each of the candidates was referred to a senior obstetrician for consultation), vaginal breech delivery can be safe, including for nulliparous women (67% were nulliparous), showing that even the short-term morbidity associated with vaginal breech delivery approaches that of planned cesarean section.

Two other articles raise caution regarding SD and increased risk for fetal death and PPH. Linde and colleagues used data from The Medical Birth Registry of Norway and Statistics Norway to examine recurrence risk for PPH associated with various causes. PPH associated with SD led the way: The recurrence risk adjusted odds ratio (aOR) was 6.8 for SD vs 5.9 for retained products of conception, 4.0 for uterine atony, 3.9 for obstetric trauma, and 2.2 for PPH of undefined cause. This study suggests that the risks for SD recurrence should be focused not just on SD, but also on PPH. Another concern regarding shoulder dystocia is raised by Davidesko and colleagues in their analysis of risk factors for intrapartum fetal death. Using a generalized estimation equation model to help identify independent risk factors for intrapartum fetal death, they examined 344,536 deliveries from 1991 to 2016 at Soroka University Medical Center in Israel and noted that SD again led the way: aOR was 23.8 for SD vs 19.0 for uterine rupture, 11.9 for preterm birth, 6.2 for placental abruption, and 3.6 for fetal malpresentation. This high risk for intrapartum fetal death associated with SD suggests a need for even more robust SD drills to help deal with this dreaded and often unpredictable obstetric emergency.

The safety of vaginal breech delivery has been controversial since the Term Breech Trial in 2000 suggested increased neonatal mortality and short-term morbidity associated with vaginal breech delivery. The stance against breech delivery has softened since that time. Fruscalzo and colleagues provide yet more evidence supporting the safety of vaginal breech deliveries with their single-center, retrospective study, which included 804 singleton pregnant women who underwent vaginal breech vs emergency cesarean section vs elective cesarean section in Coesfeld, Germany. They found no significant differences between the vaginal breech–delivery group vs the other two groups in regard to umbilical artery pH < 7, low Apgar scores, or neonatal intensive care unit admissions. The only significant difference noted was umbilical artery pH < 7.1. This suggests that in experienced hands (each of the candidates was referred to a senior obstetrician for consultation), vaginal breech delivery can be safe, including for nulliparous women (67% were nulliparous), showing that even the short-term morbidity associated with vaginal breech delivery approaches that of planned cesarean section.

Two other articles raise caution regarding SD and increased risk for fetal death and PPH. Linde and colleagues used data from The Medical Birth Registry of Norway and Statistics Norway to examine recurrence risk for PPH associated with various causes. PPH associated with SD led the way: The recurrence risk adjusted odds ratio (aOR) was 6.8 for SD vs 5.9 for retained products of conception, 4.0 for uterine atony, 3.9 for obstetric trauma, and 2.2 for PPH of undefined cause. This study suggests that the risks for SD recurrence should be focused not just on SD, but also on PPH. Another concern regarding shoulder dystocia is raised by Davidesko and colleagues in their analysis of risk factors for intrapartum fetal death. Using a generalized estimation equation model to help identify independent risk factors for intrapartum fetal death, they examined 344,536 deliveries from 1991 to 2016 at Soroka University Medical Center in Israel and noted that SD again led the way: aOR was 23.8 for SD vs 19.0 for uterine rupture, 11.9 for preterm birth, 6.2 for placental abruption, and 3.6 for fetal malpresentation. This high risk for intrapartum fetal death associated with SD suggests a need for even more robust SD drills to help deal with this dreaded and often unpredictable obstetric emergency.

The safety of vaginal breech delivery has been controversial since the Term Breech Trial in 2000 suggested increased neonatal mortality and short-term morbidity associated with vaginal breech delivery. The stance against breech delivery has softened since that time. Fruscalzo and colleagues provide yet more evidence supporting the safety of vaginal breech deliveries with their single-center, retrospective study, which included 804 singleton pregnant women who underwent vaginal breech vs emergency cesarean section vs elective cesarean section in Coesfeld, Germany. They found no significant differences between the vaginal breech–delivery group vs the other two groups in regard to umbilical artery pH < 7, low Apgar scores, or neonatal intensive care unit admissions. The only significant difference noted was umbilical artery pH < 7.1. This suggests that in experienced hands (each of the candidates was referred to a senior obstetrician for consultation), vaginal breech delivery can be safe, including for nulliparous women (67% were nulliparous), showing that even the short-term morbidity associated with vaginal breech delivery approaches that of planned cesarean section.

Two other articles raise caution regarding SD and increased risk for fetal death and PPH. Linde and colleagues used data from The Medical Birth Registry of Norway and Statistics Norway to examine recurrence risk for PPH associated with various causes. PPH associated with SD led the way: The recurrence risk adjusted odds ratio (aOR) was 6.8 for SD vs 5.9 for retained products of conception, 4.0 for uterine atony, 3.9 for obstetric trauma, and 2.2 for PPH of undefined cause. This study suggests that the risks for SD recurrence should be focused not just on SD, but also on PPH. Another concern regarding shoulder dystocia is raised by Davidesko and colleagues in their analysis of risk factors for intrapartum fetal death. Using a generalized estimation equation model to help identify independent risk factors for intrapartum fetal death, they examined 344,536 deliveries from 1991 to 2016 at Soroka University Medical Center in Israel and noted that SD again led the way: aOR was 23.8 for SD vs 19.0 for uterine rupture, 11.9 for preterm birth, 6.2 for placental abruption, and 3.6 for fetal malpresentation. This high risk for intrapartum fetal death associated with SD suggests a need for even more robust SD drills to help deal with this dreaded and often unpredictable obstetric emergency.

As usual, several provocative additions to the colorectal cancer literature were published last month, but I will review only one today: the NordICC trial. This trial evaluated the use of screening colonoscopy to reduce the incidence of colorectal cancer, death from colorectal cancer, and all-cause mortality.

We have long accepted that colonoscopy is the gold standard for detection of colorectal cancer, but until the publication of this study there has never been a prospective, randomized controlled clinical trial to evaluate the efficacy of the test. Nearly 85,000 men and women from Nordic nations were randomly assigned to receive an invitation for either screening colonoscopy or usual care (ie, no colonoscopy). In the intention-to-screen analysis, colonoscopy reduced the risk for colorectal cancer over a period of 10 years by 18% (relative risk [RR] 0.82; 95% CI 0.70-0.93). However, the reduction in risk for death from colorectal cancer failed to reach statistical significance (RR 0.90; 95% CI 0.64-1.16).

These results were especially disappointing because sigmoidoscopy, a test that evaluates only the rectum and left colon, has been shown in multiple studies to reduce risk for colorectal cancer death and all-cause mortality. It is difficult for me to think of a biologically plausible explanation for colonoscopy to be less effective than sigmoidoscopy in the prevention of cause-specific and all-cause death. However, potential explanations are hidden in the study data. Most glaringly, only 42% of the colonoscopy invitees received a colonoscopy as compared with a much larger percentage of patients (58%-87%) in the sigmoidoscopy trials. While this might be an important real-world data point, it is far less than the estimated 60% of patients in the United States who adhere to the recommendation for screening colonoscopy from ages 45 to 55. Additionally, the study had only 10 years of follow-up. It is possible that this is just not long enough for the benefits of screening colonoscopy to be fully realized. Finally, 29% of endoscopists had an adenoma detection below the recommended threshold of 25%, suggesting that poor colonoscopic technique may have played a role in the limited efficacy of colonoscopy found in the study.

Regardless of what we think of these results, the study was generally well designed and, therefore, very important. Studies like this give us critical information that we, as a nation, need to determine how best to allot our limited healthcare resources. While this study does not change my perception of the efficacy of colonoscopy, it makes me think twice about its societal utility.

As usual, several provocative additions to the colorectal cancer literature were published last month, but I will review only one today: the NordICC trial. This trial evaluated the use of screening colonoscopy to reduce the incidence of colorectal cancer, death from colorectal cancer, and all-cause mortality.

We have long accepted that colonoscopy is the gold standard for detection of colorectal cancer, but until the publication of this study there has never been a prospective, randomized controlled clinical trial to evaluate the efficacy of the test. Nearly 85,000 men and women from Nordic nations were randomly assigned to receive an invitation for either screening colonoscopy or usual care (ie, no colonoscopy). In the intention-to-screen analysis, colonoscopy reduced the risk for colorectal cancer over a period of 10 years by 18% (relative risk [RR] 0.82; 95% CI 0.70-0.93). However, the reduction in risk for death from colorectal cancer failed to reach statistical significance (RR 0.90; 95% CI 0.64-1.16).

These results were especially disappointing because sigmoidoscopy, a test that evaluates only the rectum and left colon, has been shown in multiple studies to reduce risk for colorectal cancer death and all-cause mortality. It is difficult for me to think of a biologically plausible explanation for colonoscopy to be less effective than sigmoidoscopy in the prevention of cause-specific and all-cause death. However, potential explanations are hidden in the study data. Most glaringly, only 42% of the colonoscopy invitees received a colonoscopy as compared with a much larger percentage of patients (58%-87%) in the sigmoidoscopy trials. While this might be an important real-world data point, it is far less than the estimated 60% of patients in the United States who adhere to the recommendation for screening colonoscopy from ages 45 to 55. Additionally, the study had only 10 years of follow-up. It is possible that this is just not long enough for the benefits of screening colonoscopy to be fully realized. Finally, 29% of endoscopists had an adenoma detection below the recommended threshold of 25%, suggesting that poor colonoscopic technique may have played a role in the limited efficacy of colonoscopy found in the study.

Regardless of what we think of these results, the study was generally well designed and, therefore, very important. Studies like this give us critical information that we, as a nation, need to determine how best to allot our limited healthcare resources. While this study does not change my perception of the efficacy of colonoscopy, it makes me think twice about its societal utility.

As usual, several provocative additions to the colorectal cancer literature were published last month, but I will review only one today: the NordICC trial. This trial evaluated the use of screening colonoscopy to reduce the incidence of colorectal cancer, death from colorectal cancer, and all-cause mortality.

We have long accepted that colonoscopy is the gold standard for detection of colorectal cancer, but until the publication of this study there has never been a prospective, randomized controlled clinical trial to evaluate the efficacy of the test. Nearly 85,000 men and women from Nordic nations were randomly assigned to receive an invitation for either screening colonoscopy or usual care (ie, no colonoscopy). In the intention-to-screen analysis, colonoscopy reduced the risk for colorectal cancer over a period of 10 years by 18% (relative risk [RR] 0.82; 95% CI 0.70-0.93). However, the reduction in risk for death from colorectal cancer failed to reach statistical significance (RR 0.90; 95% CI 0.64-1.16).

These results were especially disappointing because sigmoidoscopy, a test that evaluates only the rectum and left colon, has been shown in multiple studies to reduce risk for colorectal cancer death and all-cause mortality. It is difficult for me to think of a biologically plausible explanation for colonoscopy to be less effective than sigmoidoscopy in the prevention of cause-specific and all-cause death. However, potential explanations are hidden in the study data. Most glaringly, only 42% of the colonoscopy invitees received a colonoscopy as compared with a much larger percentage of patients (58%-87%) in the sigmoidoscopy trials. While this might be an important real-world data point, it is far less than the estimated 60% of patients in the United States who adhere to the recommendation for screening colonoscopy from ages 45 to 55. Additionally, the study had only 10 years of follow-up. It is possible that this is just not long enough for the benefits of screening colonoscopy to be fully realized. Finally, 29% of endoscopists had an adenoma detection below the recommended threshold of 25%, suggesting that poor colonoscopic technique may have played a role in the limited efficacy of colonoscopy found in the study.

Regardless of what we think of these results, the study was generally well designed and, therefore, very important. Studies like this give us critical information that we, as a nation, need to determine how best to allot our limited healthcare resources. While this study does not change my perception of the efficacy of colonoscopy, it makes me think twice about its societal utility.

Key clinical point: Overall, COVID-19 vaccines were well tolerated in patients with rheumatoid arthritis (RA), with the adverse event (AE) profile being comparable to that in control individuals; patients receiving methotrexate and hydroxychloroquine vs other immunosuppressants reporting fewer minor AE.

Major finding: At 7 days after vaccination, 76.9% of patients with RA reported AE, all being minor and comparable to those in the control group and similar between patients with active and inactive disease. Major AE were reported by 4.2% of patients with RA. Patients receiving methotrexate or hydroxychloroquine vs other immunosuppressants reported fewer minor AE (all P ≤ .05).

Study details: This was a cross-sectional survey-based study of 9462 respondents of an online self-reported questionnaire, including patients with RA (n = 1347), other autoimmune rheumatic diseases (n = 2305), non-rheumatic autoimmune diseases (n = 1079), and the control group (n = 4741) who received at least one dose of any COVID-19 vaccine.

Disclosures: This study did not receive any specific funding. Several authors reported receiving advisory board or speaker honoraria, consulting fees, research grant, or funding from various sources.

Source: Naveen R et al. COVID-19 vaccination in autoimmune diseases (COVAD) Study: Vaccine safety and tolerance in rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 31). Doi: 10.1093/rheumatology/keac624

Key clinical point: Overall, COVID-19 vaccines were well tolerated in patients with rheumatoid arthritis (RA), with the adverse event (AE) profile being comparable to that in control individuals; patients receiving methotrexate and hydroxychloroquine vs other immunosuppressants reporting fewer minor AE.

Major finding: At 7 days after vaccination, 76.9% of patients with RA reported AE, all being minor and comparable to those in the control group and similar between patients with active and inactive disease. Major AE were reported by 4.2% of patients with RA. Patients receiving methotrexate or hydroxychloroquine vs other immunosuppressants reported fewer minor AE (all P ≤ .05).

Study details: This was a cross-sectional survey-based study of 9462 respondents of an online self-reported questionnaire, including patients with RA (n = 1347), other autoimmune rheumatic diseases (n = 2305), non-rheumatic autoimmune diseases (n = 1079), and the control group (n = 4741) who received at least one dose of any COVID-19 vaccine.

Disclosures: This study did not receive any specific funding. Several authors reported receiving advisory board or speaker honoraria, consulting fees, research grant, or funding from various sources.

Source: Naveen R et al. COVID-19 vaccination in autoimmune diseases (COVAD) Study: Vaccine safety and tolerance in rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 31). Doi: 10.1093/rheumatology/keac624

Key clinical point: Overall, COVID-19 vaccines were well tolerated in patients with rheumatoid arthritis (RA), with the adverse event (AE) profile being comparable to that in control individuals; patients receiving methotrexate and hydroxychloroquine vs other immunosuppressants reporting fewer minor AE.

Major finding: At 7 days after vaccination, 76.9% of patients with RA reported AE, all being minor and comparable to those in the control group and similar between patients with active and inactive disease. Major AE were reported by 4.2% of patients with RA. Patients receiving methotrexate or hydroxychloroquine vs other immunosuppressants reported fewer minor AE (all P ≤ .05).

Study details: This was a cross-sectional survey-based study of 9462 respondents of an online self-reported questionnaire, including patients with RA (n = 1347), other autoimmune rheumatic diseases (n = 2305), non-rheumatic autoimmune diseases (n = 1079), and the control group (n = 4741) who received at least one dose of any COVID-19 vaccine.

Disclosures: This study did not receive any specific funding. Several authors reported receiving advisory board or speaker honoraria, consulting fees, research grant, or funding from various sources.

Source: Naveen R et al. COVID-19 vaccination in autoimmune diseases (COVAD) Study: Vaccine safety and tolerance in rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 31). Doi: 10.1093/rheumatology/keac624

Key clinical point: Filgotinib vs placebo, both with background methotrexate, significantly improved disease activity and suppressed radiographic progression in patients with rheumatoid arthritis (RA) who were methotrexate inadequate responders (IR) and had ≤4 poor prognostic factors (PPF).

Major finding: Doses of 100 and 200 mg filgotinib vs placebo led to higher American College of Rheumatology 20, 50, and 70 response rates among patients with ≤4 PPF at week 12 (all P < .05) and significantly reduced the change from baseline in modified total Sharp score at week 24 among patients with 4 PPF (both P < .01) along with similar tolerability.

Study details: This post hoc analysis of FINCH 1 included 1755 patients with RA who were methotrexate-IR and were randomly assigned to receive filgotinib, adalimumab, or placebo, all with background methotrexate.

Disclosures: This study was funded by Gilead Sciences, Inc., with support from Eisai Co., Ltd., and Gilead Sciences K.K. Seven authors declared being current or former employees of Gilead Sciences/Galapagos BV or shareholders of various sources. Several authors reported ties with various sources.

Source: Combe BG et al. Efficacy and safety of filgotinib in patients with high risk of poor prognosis who showed inadequate response to MTX: A post hoc analysis of the FINCH 1 study. Rheumatol Ther. 2022 (Oct 9). Doi: 10.1007/s40744-022-00498-x

Key clinical point: Filgotinib vs placebo, both with background methotrexate, significantly improved disease activity and suppressed radiographic progression in patients with rheumatoid arthritis (RA) who were methotrexate inadequate responders (IR) and had ≤4 poor prognostic factors (PPF).

Major finding: Doses of 100 and 200 mg filgotinib vs placebo led to higher American College of Rheumatology 20, 50, and 70 response rates among patients with ≤4 PPF at week 12 (all P < .05) and significantly reduced the change from baseline in modified total Sharp score at week 24 among patients with 4 PPF (both P < .01) along with similar tolerability.

Study details: This post hoc analysis of FINCH 1 included 1755 patients with RA who were methotrexate-IR and were randomly assigned to receive filgotinib, adalimumab, or placebo, all with background methotrexate.

Disclosures: This study was funded by Gilead Sciences, Inc., with support from Eisai Co., Ltd., and Gilead Sciences K.K. Seven authors declared being current or former employees of Gilead Sciences/Galapagos BV or shareholders of various sources. Several authors reported ties with various sources.

Source: Combe BG et al. Efficacy and safety of filgotinib in patients with high risk of poor prognosis who showed inadequate response to MTX: A post hoc analysis of the FINCH 1 study. Rheumatol Ther. 2022 (Oct 9). Doi: 10.1007/s40744-022-00498-x

Key clinical point: Filgotinib vs placebo, both with background methotrexate, significantly improved disease activity and suppressed radiographic progression in patients with rheumatoid arthritis (RA) who were methotrexate inadequate responders (IR) and had ≤4 poor prognostic factors (PPF).

Major finding: Doses of 100 and 200 mg filgotinib vs placebo led to higher American College of Rheumatology 20, 50, and 70 response rates among patients with ≤4 PPF at week 12 (all P < .05) and significantly reduced the change from baseline in modified total Sharp score at week 24 among patients with 4 PPF (both P < .01) along with similar tolerability.

Study details: This post hoc analysis of FINCH 1 included 1755 patients with RA who were methotrexate-IR and were randomly assigned to receive filgotinib, adalimumab, or placebo, all with background methotrexate.

Disclosures: This study was funded by Gilead Sciences, Inc., with support from Eisai Co., Ltd., and Gilead Sciences K.K. Seven authors declared being current or former employees of Gilead Sciences/Galapagos BV or shareholders of various sources. Several authors reported ties with various sources.

Source: Combe BG et al. Efficacy and safety of filgotinib in patients with high risk of poor prognosis who showed inadequate response to MTX: A post hoc analysis of the FINCH 1 study. Rheumatol Ther. 2022 (Oct 9). Doi: 10.1007/s40744-022-00498-x

Key clinical point: Presence of autoantibodies for cyclic citrullinated peptide (anti-CCP2), load of anticitrullinated protein antibody (ACPA) fine-specificities, and immunoglobulin M (IgM) rheumatoid factor (RF) at diagnosis of rheumatoid arthritis (RA) increased the risk for incident venous thromboembolic events (VTE) in patients with RA.

Major finding: Positivity for IgG anti-CCP2 (hazard ratio [HR] 1.33; 95% CI 1.00-1.78) and IgM RF (HR 1.38; 95% CI 1.04-1.83) increased the risk for incident VTE. Additionally, the risk increased with the number of ACPA fine-specificities expressed (P_trend = .033).

Study details: This prospective cohort study analyzed 2782 patients with newly diagnosed RA who reported 213 first-ever VTE.

Disclosures: This study was supported by the Swedish Research Council, NordForsk, and others. Four authors declared being employees or part-time employees, paid advisors, or founders of different companies. Two authors reported owning patents for peptides and their use for diagnostic purpose.

Source: Westerlind H et al. The association between autoantibodies and risk for venous thromboembolic events among patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 18). Doi: 10.1093/rheumatology/keac601

Key clinical point: Presence of autoantibodies for cyclic citrullinated peptide (anti-CCP2), load of anticitrullinated protein antibody (ACPA) fine-specificities, and immunoglobulin M (IgM) rheumatoid factor (RF) at diagnosis of rheumatoid arthritis (RA) increased the risk for incident venous thromboembolic events (VTE) in patients with RA.

Major finding: Positivity for IgG anti-CCP2 (hazard ratio [HR] 1.33; 95% CI 1.00-1.78) and IgM RF (HR 1.38; 95% CI 1.04-1.83) increased the risk for incident VTE. Additionally, the risk increased with the number of ACPA fine-specificities expressed (P_trend = .033).

Study details: This prospective cohort study analyzed 2782 patients with newly diagnosed RA who reported 213 first-ever VTE.

Disclosures: This study was supported by the Swedish Research Council, NordForsk, and others. Four authors declared being employees or part-time employees, paid advisors, or founders of different companies. Two authors reported owning patents for peptides and their use for diagnostic purpose.

Source: Westerlind H et al. The association between autoantibodies and risk for venous thromboembolic events among patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 18). Doi: 10.1093/rheumatology/keac601

Key clinical point: Presence of autoantibodies for cyclic citrullinated peptide (anti-CCP2), load of anticitrullinated protein antibody (ACPA) fine-specificities, and immunoglobulin M (IgM) rheumatoid factor (RF) at diagnosis of rheumatoid arthritis (RA) increased the risk for incident venous thromboembolic events (VTE) in patients with RA.

Major finding: Positivity for IgG anti-CCP2 (hazard ratio [HR] 1.33; 95% CI 1.00-1.78) and IgM RF (HR 1.38; 95% CI 1.04-1.83) increased the risk for incident VTE. Additionally, the risk increased with the number of ACPA fine-specificities expressed (P_trend = .033).

Study details: This prospective cohort study analyzed 2782 patients with newly diagnosed RA who reported 213 first-ever VTE.

Disclosures: This study was supported by the Swedish Research Council, NordForsk, and others. Four authors declared being employees or part-time employees, paid advisors, or founders of different companies. Two authors reported owning patents for peptides and their use for diagnostic purpose.

Source: Westerlind H et al. The association between autoantibodies and risk for venous thromboembolic events among patients with rheumatoid arthritis. Rheumatology (Oxford). 2022 (Oct 18). Doi: 10.1093/rheumatology/keac601

Key clinical point: Concomitant methotrexate significantly reduced humoral response to the third SARS-CoV-2 mRNA vaccine in older (age ≥ 64.5 years) but not younger (age < 64.5 years) patients with rheumatoid arthritis (RA).

Major finding: Patients aged ≥ 64.5 years receiving methotrexate plus biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) vs methotrexate monotherapy or b/tsDMARD monotherapy had significantly lower serum levels of immunoglobulin G antibody for SARS-CoV-2 spike protein receptor binding domain (64.8 vs 1743.8 or 1106.0 binding antibody units/mL, respectively; Kruskal-Wallis Test, P < .001), whereas patients aged < 64.5 years showed no significant difference (Kruskal-Wallis Test, P = .334).

Study details: Findings are from a retrospective analysis including 136 patients with RA treated with conventional synthetic DMARD or b/ts DMARD with or without methotrexate who received the third dose of SARS-CoV-2 mRNA vaccines BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna).

Disclosures: This study did not declare any specific source of funding. No conflict of interests was declared.

Source: Stahl D et al. Reduced humoral response to a third dose (booster) of SARS-CoV-2 mRNA vaccines by concomitant methotrexate therapy in elderly patients with rheumatoid arthritis. RMD Open. 2022;8(2):e002632 (Oct 10). Doi: 10.1136/rmdopen-2022-002632

Key clinical point: Concomitant methotrexate significantly reduced humoral response to the third SARS-CoV-2 mRNA vaccine in older (age ≥ 64.5 years) but not younger (age < 64.5 years) patients with rheumatoid arthritis (RA).

Major finding: Patients aged ≥ 64.5 years receiving methotrexate plus biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) vs methotrexate monotherapy or b/tsDMARD monotherapy had significantly lower serum levels of immunoglobulin G antibody for SARS-CoV-2 spike protein receptor binding domain (64.8 vs 1743.8 or 1106.0 binding antibody units/mL, respectively; Kruskal-Wallis Test, P < .001), whereas patients aged < 64.5 years showed no significant difference (Kruskal-Wallis Test, P = .334).

Study details: Findings are from a retrospective analysis including 136 patients with RA treated with conventional synthetic DMARD or b/ts DMARD with or without methotrexate who received the third dose of SARS-CoV-2 mRNA vaccines BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna).

Disclosures: This study did not declare any specific source of funding. No conflict of interests was declared.

Source: Stahl D et al. Reduced humoral response to a third dose (booster) of SARS-CoV-2 mRNA vaccines by concomitant methotrexate therapy in elderly patients with rheumatoid arthritis. RMD Open. 2022;8(2):e002632 (Oct 10). Doi: 10.1136/rmdopen-2022-002632

Key clinical point: Concomitant methotrexate significantly reduced humoral response to the third SARS-CoV-2 mRNA vaccine in older (age ≥ 64.5 years) but not younger (age < 64.5 years) patients with rheumatoid arthritis (RA).

Major finding: Patients aged ≥ 64.5 years receiving methotrexate plus biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) vs methotrexate monotherapy or b/tsDMARD monotherapy had significantly lower serum levels of immunoglobulin G antibody for SARS-CoV-2 spike protein receptor binding domain (64.8 vs 1743.8 or 1106.0 binding antibody units/mL, respectively; Kruskal-Wallis Test, P < .001), whereas patients aged < 64.5 years showed no significant difference (Kruskal-Wallis Test, P = .334).

Study details: Findings are from a retrospective analysis including 136 patients with RA treated with conventional synthetic DMARD or b/ts DMARD with or without methotrexate who received the third dose of SARS-CoV-2 mRNA vaccines BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna).

Disclosures: This study did not declare any specific source of funding. No conflict of interests was declared.

Source: Stahl D et al. Reduced humoral response to a third dose (booster) of SARS-CoV-2 mRNA vaccines by concomitant methotrexate therapy in elderly patients with rheumatoid arthritis. RMD Open. 2022;8(2):e002632 (Oct 10). Doi: 10.1136/rmdopen-2022-002632

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk of developing all types of thyroid dysfunctions, with the risk being the highest for hypothyroidism, followed by subclinical hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism.

Major finding: Patients with RA vs non-RA control individuals were at a higher risk of developing thyroid dysfunctions such as hypothyroidism (pooled OR [pOR] 2.25; 95% CI 1.78-2.84), subclinical hypothyroidism (pOR 2.18; 95% CI 1.32-3.61), subclinical hyperthyroidism (pOR 2.13; 95% CI 1.25-3.63), and hyperthyroidism (OR 1.65; 95% CI 1.24-2.19).

Study details: Findings are from a systematic review and meta-analysis of 29 studies that evaluated thyroid dysfunction in patients with RA (n = 35,708) and non-RA control individuals (n = 149,421).

Disclosures: This study was supported by grants from the Science and Technology Bureau of Quanzhou and the Natural Science Foundation of Fujian Province. The authors declared no conflict of interests.

Source: Liu Y-j et al. Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review. Front Endocrinol. 2022;13:1015516 (Oct 13). Doi: 10.3389/fendo.2022.1015516

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk of developing all types of thyroid dysfunctions, with the risk being the highest for hypothyroidism, followed by subclinical hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism.

Major finding: Patients with RA vs non-RA control individuals were at a higher risk of developing thyroid dysfunctions such as hypothyroidism (pooled OR [pOR] 2.25; 95% CI 1.78-2.84), subclinical hypothyroidism (pOR 2.18; 95% CI 1.32-3.61), subclinical hyperthyroidism (pOR 2.13; 95% CI 1.25-3.63), and hyperthyroidism (OR 1.65; 95% CI 1.24-2.19).

Study details: Findings are from a systematic review and meta-analysis of 29 studies that evaluated thyroid dysfunction in patients with RA (n = 35,708) and non-RA control individuals (n = 149,421).

Disclosures: This study was supported by grants from the Science and Technology Bureau of Quanzhou and the Natural Science Foundation of Fujian Province. The authors declared no conflict of interests.

Source: Liu Y-j et al. Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review. Front Endocrinol. 2022;13:1015516 (Oct 13). Doi: 10.3389/fendo.2022.1015516

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk of developing all types of thyroid dysfunctions, with the risk being the highest for hypothyroidism, followed by subclinical hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism.

Major finding: Patients with RA vs non-RA control individuals were at a higher risk of developing thyroid dysfunctions such as hypothyroidism (pooled OR [pOR] 2.25; 95% CI 1.78-2.84), subclinical hypothyroidism (pOR 2.18; 95% CI 1.32-3.61), subclinical hyperthyroidism (pOR 2.13; 95% CI 1.25-3.63), and hyperthyroidism (OR 1.65; 95% CI 1.24-2.19).

Study details: Findings are from a systematic review and meta-analysis of 29 studies that evaluated thyroid dysfunction in patients with RA (n = 35,708) and non-RA control individuals (n = 149,421).

Disclosures: This study was supported by grants from the Science and Technology Bureau of Quanzhou and the Natural Science Foundation of Fujian Province. The authors declared no conflict of interests.

Source: Liu Y-j et al. Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review. Front Endocrinol. 2022;13:1015516 (Oct 13). Doi: 10.3389/fendo.2022.1015516

Key clinical point: Red blood cell distribution width could serve as a useful biomarker and successfully differentiate between patients with rheumatoid arthritis (RA) and control individuals.

Major finding: Patients with RA vs. control individuals had significantly higher values for red blood cell distribution width (standardized mean difference, 0.96; P < .001); however, the mean platelet volume (P = .515) and platelet distribution width (P = .222) were not significantly different between the 2 groups.

Study details: This was a systematic review and meta-analysis of 23 studies, of which 11 studies reported data on red blood cell distribution width and included 1,221 patients with RA and 983 control individuals.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zinellu A and Mangoni AA et al. Platelet and red blood cell volume indices in patients with rheumatoid arthritis: A systematic review and meta-analysis. Diagnostics. 2022;12(11):2633 (Oct 30). Doi: 10.3390/diagnostics12112633.

Key clinical point: Red blood cell distribution width could serve as a useful biomarker and successfully differentiate between patients with rheumatoid arthritis (RA) and control individuals.

Major finding: Patients with RA vs. control individuals had significantly higher values for red blood cell distribution width (standardized mean difference, 0.96; P < .001); however, the mean platelet volume (P = .515) and platelet distribution width (P = .222) were not significantly different between the 2 groups.

Study details: This was a systematic review and meta-analysis of 23 studies, of which 11 studies reported data on red blood cell distribution width and included 1,221 patients with RA and 983 control individuals.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zinellu A and Mangoni AA et al. Platelet and red blood cell volume indices in patients with rheumatoid arthritis: A systematic review and meta-analysis. Diagnostics. 2022;12(11):2633 (Oct 30). Doi: 10.3390/diagnostics12112633.

Key clinical point: Red blood cell distribution width could serve as a useful biomarker and successfully differentiate between patients with rheumatoid arthritis (RA) and control individuals.

Major finding: Patients with RA vs. control individuals had significantly higher values for red blood cell distribution width (standardized mean difference, 0.96; P < .001); however, the mean platelet volume (P = .515) and platelet distribution width (P = .222) were not significantly different between the 2 groups.

Study details: This was a systematic review and meta-analysis of 23 studies, of which 11 studies reported data on red blood cell distribution width and included 1,221 patients with RA and 983 control individuals.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zinellu A and Mangoni AA et al. Platelet and red blood cell volume indices in patients with rheumatoid arthritis: A systematic review and meta-analysis. Diagnostics. 2022;12(11):2633 (Oct 30). Doi: 10.3390/diagnostics12112633.

Key clinical point: Age is an independent contributor to seronegative rheumatoid arthritis (RA), with the effect being prominent in females but not in males.

Major finding: Rates of rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) positivity and RF/anti-CCP double positivity declined significantly with an increase in age at RA diagnosis (all P < .001). The age at disease onset was independently associated with RF (odds ratio [OR] 0.980; P < .001) and anti-CCP (OR 0.976; P < .001) positivity in patients with RA, with both the associations being significant in women (RF positivity: OR 0.979; P < .001; anti-CCP positivity: OR 0.970; P < .001) but not in men.

Study details: This was a cohort study including 1685 patients with RA (mean age at diagnosis, 51.9 years), of which 83.4% were women.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Takanashi S et al. Impacts of ageing on rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity in patients with rheumatoid arthritis. J Rheumatol. 2022 (Nov 1). Doi: 10.3899/jrheum.220526

Key clinical point: Age is an independent contributor to seronegative rheumatoid arthritis (RA), with the effect being prominent in females but not in males.

Major finding: Rates of rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) positivity and RF/anti-CCP double positivity declined significantly with an increase in age at RA diagnosis (all P < .001). The age at disease onset was independently associated with RF (odds ratio [OR] 0.980; P < .001) and anti-CCP (OR 0.976; P < .001) positivity in patients with RA, with both the associations being significant in women (RF positivity: OR 0.979; P < .001; anti-CCP positivity: OR 0.970; P < .001) but not in men.

Study details: This was a cohort study including 1685 patients with RA (mean age at diagnosis, 51.9 years), of which 83.4% were women.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Takanashi S et al. Impacts of ageing on rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity in patients with rheumatoid arthritis. J Rheumatol. 2022 (Nov 1). Doi: 10.3899/jrheum.220526

Key clinical point: Age is an independent contributor to seronegative rheumatoid arthritis (RA), with the effect being prominent in females but not in males.

Major finding: Rates of rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) positivity and RF/anti-CCP double positivity declined significantly with an increase in age at RA diagnosis (all P < .001). The age at disease onset was independently associated with RF (odds ratio [OR] 0.980; P < .001) and anti-CCP (OR 0.976; P < .001) positivity in patients with RA, with both the associations being significant in women (RF positivity: OR 0.979; P < .001; anti-CCP positivity: OR 0.970; P < .001) but not in men.

Study details: This was a cohort study including 1685 patients with RA (mean age at diagnosis, 51.9 years), of which 83.4% were women.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Takanashi S et al. Impacts of ageing on rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity in patients with rheumatoid arthritis. J Rheumatol. 2022 (Nov 1). Doi: 10.3899/jrheum.220526

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk for lung cancer compared with the general population, with seropositivity being a strong and independent risk factor above what can be explained by smoking.

Major finding: Patients with RA vs. general population were at increased risk for lung cancer (adjusted hazard ratio [aHR] 1.70; 95% CI 1.54-1.87), with the risk being even higher among ever smokers (aHR 1.82; 95% CI 1.06-3.17) or current smokers (aHR 2.73; 95% CI 1.21-6.16) and double seropositivity being a strong and independent risk factor (aHR 6.21; 95% CI 1.47-26.33).

Study details: This was a population-based matched cohort study including 44,101 patients with RA who were individually matched with 216,495 control individuals from the general population and prospectively followed for the occurrence of lung cancer.

Disclosures: This study was funded by the Swedish Research Council and other sources. K Chatzidionysiou declared receiving consulting fees from various sources. J Askling declared serving as principal investigator and having ties with various sources.

Source: Chatzidionysiou K et al. Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking. RMD Open. 2022;8(2):e002465 (Oct 21). Doi: 10.1136/rmdopen-2022-002465

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk for lung cancer compared with the general population, with seropositivity being a strong and independent risk factor above what can be explained by smoking.

Major finding: Patients with RA vs. general population were at increased risk for lung cancer (adjusted hazard ratio [aHR] 1.70; 95% CI 1.54-1.87), with the risk being even higher among ever smokers (aHR 1.82; 95% CI 1.06-3.17) or current smokers (aHR 2.73; 95% CI 1.21-6.16) and double seropositivity being a strong and independent risk factor (aHR 6.21; 95% CI 1.47-26.33).

Study details: This was a population-based matched cohort study including 44,101 patients with RA who were individually matched with 216,495 control individuals from the general population and prospectively followed for the occurrence of lung cancer.

Disclosures: This study was funded by the Swedish Research Council and other sources. K Chatzidionysiou declared receiving consulting fees from various sources. J Askling declared serving as principal investigator and having ties with various sources.

Source: Chatzidionysiou K et al. Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking. RMD Open. 2022;8(2):e002465 (Oct 21). Doi: 10.1136/rmdopen-2022-002465

Key clinical point: Patients with rheumatoid arthritis (RA) were at an increased risk for lung cancer compared with the general population, with seropositivity being a strong and independent risk factor above what can be explained by smoking.

Major finding: Patients with RA vs. general population were at increased risk for lung cancer (adjusted hazard ratio [aHR] 1.70; 95% CI 1.54-1.87), with the risk being even higher among ever smokers (aHR 1.82; 95% CI 1.06-3.17) or current smokers (aHR 2.73; 95% CI 1.21-6.16) and double seropositivity being a strong and independent risk factor (aHR 6.21; 95% CI 1.47-26.33).

Study details: This was a population-based matched cohort study including 44,101 patients with RA who were individually matched with 216,495 control individuals from the general population and prospectively followed for the occurrence of lung cancer.

Disclosures: This study was funded by the Swedish Research Council and other sources. K Chatzidionysiou declared receiving consulting fees from various sources. J Askling declared serving as principal investigator and having ties with various sources.

Source: Chatzidionysiou K et al. Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking. RMD Open. 2022;8(2):e002465 (Oct 21). Doi: 10.1136/rmdopen-2022-002465