Disease outcomes in rheumatoid arthritis (RA) have improved dramatically since the introduction of biologic agents and improved treatment strategies. Nevertheless, the majority of patients still require prolonged, if not lifelong, therapy. Therefore, the ultimate goal would be to prevent RA. This study analyzed the effect of a one-year course of methotrexate in high-risk UA patients (studied in a previous trial) after post-randomization exclusion of patients without a high risk of developing RA…
Articles by Arthritis & Rheumatology
Immune-Related Adverse Events with Use of Checkpoint Inhibitors for Immunotherapy of Cancer
Introduction: Major advances in the past two decades have enhanced our understanding of the complex interactions between the immune system and cancer cells and their environment. Genetic and epigenetic alterations in tumor cells result in the expression of diverse antigens that can elicit an immune response, primarily mediated by T cells. Immune responses are regulated…
Herpes Zoster & the Risk of Stroke in Patients with Autoimmune Diseases
Herpes zoster (HZ) infection, also known as shingles, is caused by reactivation of latent varicella-zoster virus infection generally acquired decades earlier. This study was designed to test the hypothesis that the incidence of stroke immediately following HZ infection is increased in patients with autoimmune diseases compared with the incidence of stroke at later time points. Results: In patients with autoimmune diseases, incident HZ was associated with as much as a twofold increased risk of stroke. Prompt antiviral therapy was associated with lower incidence of subsequent stroke…
Lesinurad with Allopurinol When Allopurinol Alone Is Insufficient
Current guidelines for the long-term management of gout recommend a combination of lifestyle management and/or pharmacotherapy to lower serum UA levels to <6.0 mg/dL in most patients or <5.0 mg/dL in patients with more severe disease. Allopurinol is the most widely used xanthine oxidase inhibitor and is recommended in treatment guidelines as a first-line urate-lowering…
Effect of Diet & Sodium Intake on Serum Uric Acid
Serum uric acid (UA) is an important factor in the causal pathway for gout. It has also been implicated as a potential risk factor and/or mediator of cardiovascular disease outcomes and mortality in a large number of observational studies. Although many of the clinical trials targeting serum UA reduction have focused on pharmacologic interventions, diet…
Pregnancy Outcome in Early Rheumatic Disease
Systemic autoimmune rheumatic diseases are associated with increased rates of adverse pregnancy outcomes, including spontaneous abortion, preeclampsia, fetal growth restriction (FGR) and prematurity. In this study population, preclinical rheumatic disorders were associated with an increased risk of FGR, preeclampsia and small-for-gestational-age infants. The impact of these findings and their utility in screening for fetal growth restriction/preeclampsia need to be confirmed in population studies…
Clazakizumab for Adults with Active PsA
This is the first clinical trial of an IL-6–targeted therapy in PsA. Clazakizumab may be an effective treatment option for musculoskeletal aspects of PsA, but because of the lack of a dose response in this study, further studies are required to confirm the appropriate dose. The safety profile is consistent with the pharmacology of IL-6 blockade and prior clinical experience with this antibody in rheumatoid arthritis…
Secukinumab Inhibits Structural Joint Damage in Active PsA
Psoriatic arthritis (PsA), a chronic inflammatory arthritis characterized by structural damage to the joints, has been associated with reduced health-related quality of life, disability and reduced life expectancy. The joint changes in PsA are characterized radiographically by a combination of erosive and proliferative bone changes, including erosive joint destruction, fluffy periostitis and pencil-in-cup deformities. Radiographic…
Arthritis Prevalence on the Rise, Creating Challenges for Healthcare System
Updated projections suggest that arthritis and arthritis-attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs. By 2040, the number of U.S. adults with doctor-diagnosed arthritis is projected to increase 49% to 78.4 million. Can the healthcare system accommodate these projected increases? Not without changes. By 2025, the expected demand for rheumatologists is expected to exceed supply by 2,576 adult and 33 pediatric rheumatologists…
Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes
A variety of immune and nonimmune pathophysiologic mechanisms causing the disruption of alveolar capillaries with bleeding into the alveolar spaces can lead to diffuse alveolar hemorrhage (DAH). Immune-mediated mechanisms can cause DAH with or without the presence of capillaritis. The antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) syndromes—granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)—are the…