Rheumatoid Arthritis

Salliot et al examine the relationship between female sex hormone exposure and risk of RA in a large cohort of French women. Based on a biannual questionnaire, 698 RA cases were diagnosed among 78,452 women and examined for association with endogenous and exogenous sex hormone exposure (e.g., age at menarche, parity, age at menopause, use of oral contraceptives, and use of hormone replacement therapy). Early age at menopause (≤45 vs >53 years) and early age at first pregnancy (<22 vs ≥27 years) were associated with increased risk of incident RA. Among exogenous hormone exposure, duration of perimenopausal progestogen use >24 months was inversely associated with risk of RA (HR 0.77). The results of this study are difficult to fit into a simple narrative regarding cumulative hormonal exposure or lifetime reproductive events, and the hazard ratios in question are relatively low. Even taking into account the fact that the study only looked at RA incidence after menopause, a larger cohort size may be necessary to determine whether type and timing of hormone exposure influences RA risk.

New biomarkers remain of high interest in RA in order to better predict severity and tailor treatment. ACPA positivity is known to be associated with joint damage in RA; however, ACPA-negative RA patients have similar outcomes in terms of pain and fatigue. Lamachia et al analyze the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies in identifying patients at risk of severe RA outcomes. Anti-PAD3, but not anti-CarP, positivity was associated with higher baseline swollen joint counts and DAS28-ESR, as well as higher overall disease activity and joint damage scores, but not radiographic progression. While there was significant overlap between RF- and ACPA-positive and anti-PAD3 positive RA patients, the existence of a subset of nearly 20% of anti-PAD3 positive patients who were anti-CCP3 negative suggests that anti-PAD3 could have diagnostic in addition to predictive utility.

In addition to risk of joint damage, people with RA also have an increased risk of fracture due to low bone density, glucocorticoid use, and other factors. While we may recognize this in older patients, the risk in younger patients may be less frequently recognized. In this retrospective cohort study, Erwin et al examined risk of fracture and risk of first fracture before age 50 in RA patients compared to matched controls. Overall, fracture risk was higher in RA patients even after adjusting for age at diagnosis, gender, glucocorticoid risk, smoking, and alcohol use. Women in particular had a higher risk of first fracture before age 50 compared to women without RA; men did not have a similar risk. Hopefully awareness of this increased risk among younger RA patients will lead to better preventative strategies as well.

Salliot et al examine the relationship between female sex hormone exposure and risk of RA in a large cohort of French women. Based on a biannual questionnaire, 698 RA cases were diagnosed among 78,452 women and examined for association with endogenous and exogenous sex hormone exposure (e.g., age at menarche, parity, age at menopause, use of oral contraceptives, and use of hormone replacement therapy). Early age at menopause (≤45 vs >53 years) and early age at first pregnancy (<22 vs ≥27 years) were associated with increased risk of incident RA. Among exogenous hormone exposure, duration of perimenopausal progestogen use >24 months was inversely associated with risk of RA (HR 0.77). The results of this study are difficult to fit into a simple narrative regarding cumulative hormonal exposure or lifetime reproductive events, and the hazard ratios in question are relatively low. Even taking into account the fact that the study only looked at RA incidence after menopause, a larger cohort size may be necessary to determine whether type and timing of hormone exposure influences RA risk.

New biomarkers remain of high interest in RA in order to better predict severity and tailor treatment. ACPA positivity is known to be associated with joint damage in RA; however, ACPA-negative RA patients have similar outcomes in terms of pain and fatigue. Lamachia et al analyze the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies in identifying patients at risk of severe RA outcomes. Anti-PAD3, but not anti-CarP, positivity was associated with higher baseline swollen joint counts and DAS28-ESR, as well as higher overall disease activity and joint damage scores, but not radiographic progression. While there was significant overlap between RF- and ACPA-positive and anti-PAD3 positive RA patients, the existence of a subset of nearly 20% of anti-PAD3 positive patients who were anti-CCP3 negative suggests that anti-PAD3 could have diagnostic in addition to predictive utility.

In addition to risk of joint damage, people with RA also have an increased risk of fracture due to low bone density, glucocorticoid use, and other factors. While we may recognize this in older patients, the risk in younger patients may be less frequently recognized. In this retrospective cohort study, Erwin et al examined risk of fracture and risk of first fracture before age 50 in RA patients compared to matched controls. Overall, fracture risk was higher in RA patients even after adjusting for age at diagnosis, gender, glucocorticoid risk, smoking, and alcohol use. Women in particular had a higher risk of first fracture before age 50 compared to women without RA; men did not have a similar risk. Hopefully awareness of this increased risk among younger RA patients will lead to better preventative strategies as well.

Salliot et al examine the relationship between female sex hormone exposure and risk of RA in a large cohort of French women. Based on a biannual questionnaire, 698 RA cases were diagnosed among 78,452 women and examined for association with endogenous and exogenous sex hormone exposure (e.g., age at menarche, parity, age at menopause, use of oral contraceptives, and use of hormone replacement therapy). Early age at menopause (≤45 vs >53 years) and early age at first pregnancy (<22 vs ≥27 years) were associated with increased risk of incident RA. Among exogenous hormone exposure, duration of perimenopausal progestogen use >24 months was inversely associated with risk of RA (HR 0.77). The results of this study are difficult to fit into a simple narrative regarding cumulative hormonal exposure or lifetime reproductive events, and the hazard ratios in question are relatively low. Even taking into account the fact that the study only looked at RA incidence after menopause, a larger cohort size may be necessary to determine whether type and timing of hormone exposure influences RA risk.

New biomarkers remain of high interest in RA in order to better predict severity and tailor treatment. ACPA positivity is known to be associated with joint damage in RA; however, ACPA-negative RA patients have similar outcomes in terms of pain and fatigue. Lamachia et al analyze the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies in identifying patients at risk of severe RA outcomes. Anti-PAD3, but not anti-CarP, positivity was associated with higher baseline swollen joint counts and DAS28-ESR, as well as higher overall disease activity and joint damage scores, but not radiographic progression. While there was significant overlap between RF- and ACPA-positive and anti-PAD3 positive RA patients, the existence of a subset of nearly 20% of anti-PAD3 positive patients who were anti-CCP3 negative suggests that anti-PAD3 could have diagnostic in addition to predictive utility.

In addition to risk of joint damage, people with RA also have an increased risk of fracture due to low bone density, glucocorticoid use, and other factors. While we may recognize this in older patients, the risk in younger patients may be less frequently recognized. In this retrospective cohort study, Erwin et al examined risk of fracture and risk of first fracture before age 50 in RA patients compared to matched controls. Overall, fracture risk was higher in RA patients even after adjusting for age at diagnosis, gender, glucocorticoid risk, smoking, and alcohol use. Women in particular had a higher risk of first fracture before age 50 compared to women without RA; men did not have a similar risk. Hopefully awareness of this increased risk among younger RA patients will lead to better preventative strategies as well.

Key clinical point: Patients with rheumatoid arthritis (RA) have a higher risk for peritonsillar abscess (PTA) and longer hospital stay than those without RA.

Major finding: The RA cohort had a significantly higher PTA incidence (incidence rate ratio, 1.73, P = .017) and cumulative incidence (P = .016) than the non-RA cohort. PTA was also associated with a significantly longer length of hospital stay in the RA cohort vs. the non-RA cohort (6.5 ± 4.5 days vs. 4.6 ± 2.8 days; P = .045).

Study details: The data come from a real-world evidence study of 30,328 patients with RA (RA cohort) matched to 121,312 individuals without RA (non-RA cohort).

Disclosures: The study was financially supported by grants from the Chang Gung Memorial Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Ding M-C et al. Eur Arch Otorhinolaryngol. 2021 Feb 3. doi: 10.1007/s00405-021-06638-3.

Key clinical point: Patients with rheumatoid arthritis (RA) have a higher risk for peritonsillar abscess (PTA) and longer hospital stay than those without RA.

Major finding: The RA cohort had a significantly higher PTA incidence (incidence rate ratio, 1.73, P = .017) and cumulative incidence (P = .016) than the non-RA cohort. PTA was also associated with a significantly longer length of hospital stay in the RA cohort vs. the non-RA cohort (6.5 ± 4.5 days vs. 4.6 ± 2.8 days; P = .045).

Study details: The data come from a real-world evidence study of 30,328 patients with RA (RA cohort) matched to 121,312 individuals without RA (non-RA cohort).

Disclosures: The study was financially supported by grants from the Chang Gung Memorial Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Ding M-C et al. Eur Arch Otorhinolaryngol. 2021 Feb 3. doi: 10.1007/s00405-021-06638-3.

Key clinical point: Patients with rheumatoid arthritis (RA) have a higher risk for peritonsillar abscess (PTA) and longer hospital stay than those without RA.

Major finding: The RA cohort had a significantly higher PTA incidence (incidence rate ratio, 1.73, P = .017) and cumulative incidence (P = .016) than the non-RA cohort. PTA was also associated with a significantly longer length of hospital stay in the RA cohort vs. the non-RA cohort (6.5 ± 4.5 days vs. 4.6 ± 2.8 days; P = .045).

Study details: The data come from a real-world evidence study of 30,328 patients with RA (RA cohort) matched to 121,312 individuals without RA (non-RA cohort).

Disclosures: The study was financially supported by grants from the Chang Gung Memorial Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Ding M-C et al. Eur Arch Otorhinolaryngol. 2021 Feb 3. doi: 10.1007/s00405-021-06638-3.

Key clinical point: Magnetic resonance imaging (MRI)-detected tenosynovitis is highly predictive of rheumatoid arthritis (RA), irrespective of anti-citrullinated protein antibodies (ACPA) status.

Major finding: The sensitivity of imaging-detected tenosynovitis was high for both, ACPA-positive RA (88%) and ACPA-negative RA (82%). The sensitivity of MRI-detected tenosynovitis for RA was significantly higher than that for psoriatic arthritis (65%; P = .001), peripheral spondylarthritis (53%; P less than .001), reactive arthritis (36%; P less than .001), and self-limiting undifferentiated arthritis (42%; P less than .001).

Study details: The data come from a large cross-sectional MRI study of 1,211 consecutive patients with early arthritis who underwent contrast-enhanced 1.5T MRI of hand and foot at diagnosis.

Disclosures: The study received funding from the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation programme. The authors declared no conflicts of interest.

Source: Matthijssen XME et al. Ann Rheum Dis. 2021 Feb 5. doi: 10.1136/annrheumdis-2020-219302.

Key clinical point: Magnetic resonance imaging (MRI)-detected tenosynovitis is highly predictive of rheumatoid arthritis (RA), irrespective of anti-citrullinated protein antibodies (ACPA) status.

Major finding: The sensitivity of imaging-detected tenosynovitis was high for both, ACPA-positive RA (88%) and ACPA-negative RA (82%). The sensitivity of MRI-detected tenosynovitis for RA was significantly higher than that for psoriatic arthritis (65%; P = .001), peripheral spondylarthritis (53%; P less than .001), reactive arthritis (36%; P less than .001), and self-limiting undifferentiated arthritis (42%; P less than .001).

Study details: The data come from a large cross-sectional MRI study of 1,211 consecutive patients with early arthritis who underwent contrast-enhanced 1.5T MRI of hand and foot at diagnosis.

Disclosures: The study received funding from the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation programme. The authors declared no conflicts of interest.

Source: Matthijssen XME et al. Ann Rheum Dis. 2021 Feb 5. doi: 10.1136/annrheumdis-2020-219302.

Key clinical point: Magnetic resonance imaging (MRI)-detected tenosynovitis is highly predictive of rheumatoid arthritis (RA), irrespective of anti-citrullinated protein antibodies (ACPA) status.

Major finding: The sensitivity of imaging-detected tenosynovitis was high for both, ACPA-positive RA (88%) and ACPA-negative RA (82%). The sensitivity of MRI-detected tenosynovitis for RA was significantly higher than that for psoriatic arthritis (65%; P = .001), peripheral spondylarthritis (53%; P less than .001), reactive arthritis (36%; P less than .001), and self-limiting undifferentiated arthritis (42%; P less than .001).

Study details: The data come from a large cross-sectional MRI study of 1,211 consecutive patients with early arthritis who underwent contrast-enhanced 1.5T MRI of hand and foot at diagnosis.

Disclosures: The study received funding from the Dutch Arthritis Foundation and the European Research Council under the European Union’s Horizon 2020 research and innovation programme. The authors declared no conflicts of interest.

Source: Matthijssen XME et al. Ann Rheum Dis. 2021 Feb 5. doi: 10.1136/annrheumdis-2020-219302.

Key clinical point: Nonsurgical periodontal treatment (NSPT) was associated with a significant reduction in disease activity score (DAS28), tender joint counts (TJC), swollen joint counts (SJC), visual analogical scale (VAS), and C-reactive protein (CRP) in patients with rheumatoid arthritis (RA) and periodontitis.

Major finding: NSPT significantly reduced DAS28 (P less than .001), TJC (P less than .001), SJC (P = .008), VAS (P = .02), and CRP (P = .01) in patients with RA and periodontitis.

Study details: Data come from a meta-analysis of 9 studies that compared RA-related indicator changes between NSPT and no treatment groups.

Disclosures: The work was supported by the Natural Science Foundation of Tianjin, China, and the Science and Technology Foundation of Tianjin Health Commission, China. The authors declared no conflicts of interest.

Source: Sun J et al. Clin Oral Investig. 2021 Jan 29. doi: 10.1007/s00784-021-03807-w.

Key clinical point: Nonsurgical periodontal treatment (NSPT) was associated with a significant reduction in disease activity score (DAS28), tender joint counts (TJC), swollen joint counts (SJC), visual analogical scale (VAS), and C-reactive protein (CRP) in patients with rheumatoid arthritis (RA) and periodontitis.

Major finding: NSPT significantly reduced DAS28 (P less than .001), TJC (P less than .001), SJC (P = .008), VAS (P = .02), and CRP (P = .01) in patients with RA and periodontitis.

Study details: Data come from a meta-analysis of 9 studies that compared RA-related indicator changes between NSPT and no treatment groups.

Disclosures: The work was supported by the Natural Science Foundation of Tianjin, China, and the Science and Technology Foundation of Tianjin Health Commission, China. The authors declared no conflicts of interest.

Source: Sun J et al. Clin Oral Investig. 2021 Jan 29. doi: 10.1007/s00784-021-03807-w.

Key clinical point: Nonsurgical periodontal treatment (NSPT) was associated with a significant reduction in disease activity score (DAS28), tender joint counts (TJC), swollen joint counts (SJC), visual analogical scale (VAS), and C-reactive protein (CRP) in patients with rheumatoid arthritis (RA) and periodontitis.

Major finding: NSPT significantly reduced DAS28 (P less than .001), TJC (P less than .001), SJC (P = .008), VAS (P = .02), and CRP (P = .01) in patients with RA and periodontitis.

Study details: Data come from a meta-analysis of 9 studies that compared RA-related indicator changes between NSPT and no treatment groups.

Disclosures: The work was supported by the Natural Science Foundation of Tianjin, China, and the Science and Technology Foundation of Tianjin Health Commission, China. The authors declared no conflicts of interest.

Source: Sun J et al. Clin Oral Investig. 2021 Jan 29. doi: 10.1007/s00784-021-03807-w.

Key clinical point: Tocilizumab is more effective than rituximab for reducing disease activity in patients with rheumatoid arthritis (RA) who had an inadequate response to tumor necrosis factor (TNF) inhibitors stratified for synovial B-cell status.

Major finding: At 16 weeks, the rituximab group vs. the tocilizumab group showed no significant difference in the rate of Clinical Disease Activity Index (CDAI50%; 45% vs. 56%; P = .31). However, the tocilizumab group had a significantly higher response rate compared with the rituximab group for both CDAI50% (63% vs. 36%; P = .035) and CDAI­major treatment response (50% vs. 12%, P = .0012).

Study details: The data come from a 48-week, biopsy-driven, multicenter, open-label, phase 4 trial involving 164 patients randomly assigned to receive either 2 1 gm rituximab infusions at an interval of 2 weeks (n=83) or 8 mg/kg tocilizumab infusions at 4-week intervals (n=81).

Disclosures: The study received funding from the UK National Institute for Health Research. MH Buch, A Nerviani, VC Romão, P Verschueren, B Dasgupta, A Cauli, PC Taylor, CJ Edwards, J Isaacs, E Choy, C Pitzalism, P Sasieni, MJ Lewis, and F Humby reported relationships with various pharmaceutical companies and/or research organizations. C Pitzalis reported a patent relevant to the work. The remaining authors declared no conflicts of interest.

Source: Humby F et al. Lancet. 2021 Jan 23. doi: 10.1016/S0140-6736(20)32341-2.

Key clinical point: Tocilizumab is more effective than rituximab for reducing disease activity in patients with rheumatoid arthritis (RA) who had an inadequate response to tumor necrosis factor (TNF) inhibitors stratified for synovial B-cell status.

Major finding: At 16 weeks, the rituximab group vs. the tocilizumab group showed no significant difference in the rate of Clinical Disease Activity Index (CDAI50%; 45% vs. 56%; P = .31). However, the tocilizumab group had a significantly higher response rate compared with the rituximab group for both CDAI50% (63% vs. 36%; P = .035) and CDAI­major treatment response (50% vs. 12%, P = .0012).

Study details: The data come from a 48-week, biopsy-driven, multicenter, open-label, phase 4 trial involving 164 patients randomly assigned to receive either 2 1 gm rituximab infusions at an interval of 2 weeks (n=83) or 8 mg/kg tocilizumab infusions at 4-week intervals (n=81).

Disclosures: The study received funding from the UK National Institute for Health Research. MH Buch, A Nerviani, VC Romão, P Verschueren, B Dasgupta, A Cauli, PC Taylor, CJ Edwards, J Isaacs, E Choy, C Pitzalism, P Sasieni, MJ Lewis, and F Humby reported relationships with various pharmaceutical companies and/or research organizations. C Pitzalis reported a patent relevant to the work. The remaining authors declared no conflicts of interest.

Source: Humby F et al. Lancet. 2021 Jan 23. doi: 10.1016/S0140-6736(20)32341-2.

Key clinical point: Tocilizumab is more effective than rituximab for reducing disease activity in patients with rheumatoid arthritis (RA) who had an inadequate response to tumor necrosis factor (TNF) inhibitors stratified for synovial B-cell status.

Major finding: At 16 weeks, the rituximab group vs. the tocilizumab group showed no significant difference in the rate of Clinical Disease Activity Index (CDAI50%; 45% vs. 56%; P = .31). However, the tocilizumab group had a significantly higher response rate compared with the rituximab group for both CDAI50% (63% vs. 36%; P = .035) and CDAI­major treatment response (50% vs. 12%, P = .0012).

Study details: The data come from a 48-week, biopsy-driven, multicenter, open-label, phase 4 trial involving 164 patients randomly assigned to receive either 2 1 gm rituximab infusions at an interval of 2 weeks (n=83) or 8 mg/kg tocilizumab infusions at 4-week intervals (n=81).

Disclosures: The study received funding from the UK National Institute for Health Research. MH Buch, A Nerviani, VC Romão, P Verschueren, B Dasgupta, A Cauli, PC Taylor, CJ Edwards, J Isaacs, E Choy, C Pitzalism, P Sasieni, MJ Lewis, and F Humby reported relationships with various pharmaceutical companies and/or research organizations. C Pitzalis reported a patent relevant to the work. The remaining authors declared no conflicts of interest.

Source: Humby F et al. Lancet. 2021 Jan 23. doi: 10.1016/S0140-6736(20)32341-2.

Key clinical point: This study found an increased risk of first fracture before age 50 years in people with rheumatoid arthritis (RA) diagnosed before this age.

Major finding: Overall, the rate of first fractures occurring before age 50 was significantly higher in patients diagnosed with RA before age 50 (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.10-1.40). The IRR of first fracture before age 50 was significantly higher in women (1.29; 95% CI, 1.12-1.49) and not in men diagnosed with RA before age 50 (1.15; 95% CI, 0.92-1.43). IRR of subsequent fractures below age 50 was also higher in both men and women but not significantly so.

Study details: A retrospective observational study of RA cases (n = 36,858) and matched controls (n=110,574) from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a grant through the Pfizer competitive I-CRP funding program. The authors declared no conflicts of interest.

Source: Erwin J et al. Osteoporos Int. 2021 Feb 11. doi: 10.1007/s00198-021-05862-1.

Key clinical point: This study found an increased risk of first fracture before age 50 years in people with rheumatoid arthritis (RA) diagnosed before this age.

Major finding: Overall, the rate of first fractures occurring before age 50 was significantly higher in patients diagnosed with RA before age 50 (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.10-1.40). The IRR of first fracture before age 50 was significantly higher in women (1.29; 95% CI, 1.12-1.49) and not in men diagnosed with RA before age 50 (1.15; 95% CI, 0.92-1.43). IRR of subsequent fractures below age 50 was also higher in both men and women but not significantly so.

Study details: A retrospective observational study of RA cases (n = 36,858) and matched controls (n=110,574) from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a grant through the Pfizer competitive I-CRP funding program. The authors declared no conflicts of interest.

Source: Erwin J et al. Osteoporos Int. 2021 Feb 11. doi: 10.1007/s00198-021-05862-1.

Key clinical point: This study found an increased risk of first fracture before age 50 years in people with rheumatoid arthritis (RA) diagnosed before this age.

Major finding: Overall, the rate of first fractures occurring before age 50 was significantly higher in patients diagnosed with RA before age 50 (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.10-1.40). The IRR of first fracture before age 50 was significantly higher in women (1.29; 95% CI, 1.12-1.49) and not in men diagnosed with RA before age 50 (1.15; 95% CI, 0.92-1.43). IRR of subsequent fractures below age 50 was also higher in both men and women but not significantly so.

Study details: A retrospective observational study of RA cases (n = 36,858) and matched controls (n=110,574) from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a grant through the Pfizer competitive I-CRP funding program. The authors declared no conflicts of interest.

Source: Erwin J et al. Osteoporos Int. 2021 Feb 11. doi: 10.1007/s00198-021-05862-1.

Key clinical point: Early age at first pregnancy (less than 22 years) and early menopause (45 years and earlier) were associated with a higher risk of rheumatoid arthritis (RA), whereas long-term progestogen use (more than 24 months) before menopause was associated with a reduced risk.

Major finding: The risk of RA was a significantly increased with early age at first pregnancy (less than 22 vs. 27 or more years; hazard ratio [HR], 1.34; P_trend = .028) and menopause (45 or less vs. 53 or more years; HR, 1.40; P_trend = .039). Risk of RA was inversely related to exposure to progestogen only in perimenopause (more than 24 vs. 0 months; multi-adjusted HR, 0.77; P_trend = .004).

Study details: This study included 78,452 women, with 698 incident cases of RA using data from the French E3N-EPIC cohort study.

Disclosures: The study was funded by a research grant from FOREUM Foundation for Research in Rheumatology. The authors declared no conflicts of interest.

Source: Salliot C et al. Rheumatology (Oxford). 2021 Feb 6. doi: 10.1093/rheumatology/keab101.

Key clinical point: Early age at first pregnancy (less than 22 years) and early menopause (45 years and earlier) were associated with a higher risk of rheumatoid arthritis (RA), whereas long-term progestogen use (more than 24 months) before menopause was associated with a reduced risk.

Major finding: The risk of RA was a significantly increased with early age at first pregnancy (less than 22 vs. 27 or more years; hazard ratio [HR], 1.34; P_trend = .028) and menopause (45 or less vs. 53 or more years; HR, 1.40; P_trend = .039). Risk of RA was inversely related to exposure to progestogen only in perimenopause (more than 24 vs. 0 months; multi-adjusted HR, 0.77; P_trend = .004).

Study details: This study included 78,452 women, with 698 incident cases of RA using data from the French E3N-EPIC cohort study.

Disclosures: The study was funded by a research grant from FOREUM Foundation for Research in Rheumatology. The authors declared no conflicts of interest.

Source: Salliot C et al. Rheumatology (Oxford). 2021 Feb 6. doi: 10.1093/rheumatology/keab101.

Key clinical point: Early age at first pregnancy (less than 22 years) and early menopause (45 years and earlier) were associated with a higher risk of rheumatoid arthritis (RA), whereas long-term progestogen use (more than 24 months) before menopause was associated with a reduced risk.

Major finding: The risk of RA was a significantly increased with early age at first pregnancy (less than 22 vs. 27 or more years; hazard ratio [HR], 1.34; P_trend = .028) and menopause (45 or less vs. 53 or more years; HR, 1.40; P_trend = .039). Risk of RA was inversely related to exposure to progestogen only in perimenopause (more than 24 vs. 0 months; multi-adjusted HR, 0.77; P_trend = .004).

Study details: This study included 78,452 women, with 698 incident cases of RA using data from the French E3N-EPIC cohort study.

Disclosures: The study was funded by a research grant from FOREUM Foundation for Research in Rheumatology. The authors declared no conflicts of interest.

Source: Salliot C et al. Rheumatology (Oxford). 2021 Feb 6. doi: 10.1093/rheumatology/keab101.

Key clinical point: A modern treat-to-target (T2T) approach with the use of tumor necrosis factor inhibitors (TNFi) resulted in low disease activity (LDA) and remission in 90% of pregnant patients with rheumatoid arthritis (RA).

Major finding: Among patients treated with T2T, 90.4% and 76.1% of patients were in LDA or remission, respectively, in the third trimester. Mean disease activity over time was lower in patients treated with the T2T approach vs. reference cohort (P less than .001).

Study details: Findings are from an analysis of 309 patients with RA from the PreCARA cohort who wished to conceive or were pregnant. Patients were treated with a T2T approach with the use of TNFi and/or a combination of disease-modifying antirheumatic drugs along with obvious pregnancy restrictions. The reference cohort consisted of pregnant patients with RA treated according to the 2002-2010 standards from the PARA study.

Disclosures: This investigator-initiated study was supported by UCB and Dutch Arthritis Foundation (ReumaNederland). The investigators did not report any competing interests.

Source: Smeele HTW et al. Ann Rheum Dis. 2021 Feb 10. doi: 10.1136/annrheumdis-2020-219547.

Key clinical point: A modern treat-to-target (T2T) approach with the use of tumor necrosis factor inhibitors (TNFi) resulted in low disease activity (LDA) and remission in 90% of pregnant patients with rheumatoid arthritis (RA).

Major finding: Among patients treated with T2T, 90.4% and 76.1% of patients were in LDA or remission, respectively, in the third trimester. Mean disease activity over time was lower in patients treated with the T2T approach vs. reference cohort (P less than .001).

Study details: Findings are from an analysis of 309 patients with RA from the PreCARA cohort who wished to conceive or were pregnant. Patients were treated with a T2T approach with the use of TNFi and/or a combination of disease-modifying antirheumatic drugs along with obvious pregnancy restrictions. The reference cohort consisted of pregnant patients with RA treated according to the 2002-2010 standards from the PARA study.

Disclosures: This investigator-initiated study was supported by UCB and Dutch Arthritis Foundation (ReumaNederland). The investigators did not report any competing interests.

Source: Smeele HTW et al. Ann Rheum Dis. 2021 Feb 10. doi: 10.1136/annrheumdis-2020-219547.

Key clinical point: A modern treat-to-target (T2T) approach with the use of tumor necrosis factor inhibitors (TNFi) resulted in low disease activity (LDA) and remission in 90% of pregnant patients with rheumatoid arthritis (RA).

Major finding: Among patients treated with T2T, 90.4% and 76.1% of patients were in LDA or remission, respectively, in the third trimester. Mean disease activity over time was lower in patients treated with the T2T approach vs. reference cohort (P less than .001).

Study details: Findings are from an analysis of 309 patients with RA from the PreCARA cohort who wished to conceive or were pregnant. Patients were treated with a T2T approach with the use of TNFi and/or a combination of disease-modifying antirheumatic drugs along with obvious pregnancy restrictions. The reference cohort consisted of pregnant patients with RA treated according to the 2002-2010 standards from the PARA study.

Disclosures: This investigator-initiated study was supported by UCB and Dutch Arthritis Foundation (ReumaNederland). The investigators did not report any competing interests.

Source: Smeele HTW et al. Ann Rheum Dis. 2021 Feb 10. doi: 10.1136/annrheumdis-2020-219547.

Key clinical point: Citrate-free adalimumab biosimilar (CT-P17) and European Union-approved adalimumab (EU-adalimumab) demonstrated equivalent efficacy and comparable safety in patients with rheumatoid arthritis (RA).

Major finding: At week 24, CT-P17 and EU-adalimumab groups showed similar 20% improvement by the American College of Rheumatology criteria response rate (82.7%). The 95% confidence interval (CI; −5.94 to 5.94) and 90% CI (−4.98 to 4.98) for estimated treatment difference were within predefined equivalence margin, demonstrating therapeutic equivalence. Overall, safety was similar between both treatment groups.

Study details: This was a randomized, double-blind phase 3 study of 648 patients with RA who were randomly allocated to receive 40 mg of either CT-P17 (n=324) or EU-adalimumab (n=324), every 2 weeks until week 48.

Disclosures: This study was funded by Celltrion, Inc. (Incheon, Republic of Korea). The authors reported receiving support, investigator fees, speaking fees, and/or consulting for various pharmaceutical companies including Celltrion, Inc. SJ Lee, YJ Bae, GE Yang, and JK Yoo reported being employees of Celltrion, Inc.

Source: Kay J et al. Arthritis Res Ther. 2021 Feb 5. doi: 10.1186/s13075-020-02394-7.

Key clinical point: Citrate-free adalimumab biosimilar (CT-P17) and European Union-approved adalimumab (EU-adalimumab) demonstrated equivalent efficacy and comparable safety in patients with rheumatoid arthritis (RA).

Major finding: At week 24, CT-P17 and EU-adalimumab groups showed similar 20% improvement by the American College of Rheumatology criteria response rate (82.7%). The 95% confidence interval (CI; −5.94 to 5.94) and 90% CI (−4.98 to 4.98) for estimated treatment difference were within predefined equivalence margin, demonstrating therapeutic equivalence. Overall, safety was similar between both treatment groups.

Study details: This was a randomized, double-blind phase 3 study of 648 patients with RA who were randomly allocated to receive 40 mg of either CT-P17 (n=324) or EU-adalimumab (n=324), every 2 weeks until week 48.

Disclosures: This study was funded by Celltrion, Inc. (Incheon, Republic of Korea). The authors reported receiving support, investigator fees, speaking fees, and/or consulting for various pharmaceutical companies including Celltrion, Inc. SJ Lee, YJ Bae, GE Yang, and JK Yoo reported being employees of Celltrion, Inc.

Source: Kay J et al. Arthritis Res Ther. 2021 Feb 5. doi: 10.1186/s13075-020-02394-7.

Key clinical point: Citrate-free adalimumab biosimilar (CT-P17) and European Union-approved adalimumab (EU-adalimumab) demonstrated equivalent efficacy and comparable safety in patients with rheumatoid arthritis (RA).

Major finding: At week 24, CT-P17 and EU-adalimumab groups showed similar 20% improvement by the American College of Rheumatology criteria response rate (82.7%). The 95% confidence interval (CI; −5.94 to 5.94) and 90% CI (−4.98 to 4.98) for estimated treatment difference were within predefined equivalence margin, demonstrating therapeutic equivalence. Overall, safety was similar between both treatment groups.

Study details: This was a randomized, double-blind phase 3 study of 648 patients with RA who were randomly allocated to receive 40 mg of either CT-P17 (n=324) or EU-adalimumab (n=324), every 2 weeks until week 48.

Disclosures: This study was funded by Celltrion, Inc. (Incheon, Republic of Korea). The authors reported receiving support, investigator fees, speaking fees, and/or consulting for various pharmaceutical companies including Celltrion, Inc. SJ Lee, YJ Bae, GE Yang, and JK Yoo reported being employees of Celltrion, Inc.

Source: Kay J et al. Arthritis Res Ther. 2021 Feb 5. doi: 10.1186/s13075-020-02394-7.

Key clinical point: Positivity for antipeptidyl-arginine deiminase type-3 (anti-PAD3) antibodies was associated with higher disease activity and joint damage scores in patients with rheumatoid arthritis (RA).

Major finding: Patients positive vs. negative for anti-PAD3 had significantly higher 28-swollen joint count (7.1 vs. 4.3; P less than .0001), 28-joint disease activity score-erythrocyte sedimentation rate (4.2 vs. 3.7; P = .005), and radiographic damage (14.9 vs. 8.8; P = .02).

Study details: Findings are from the assessment of biomarkers in 851 patients with RA and 516 disease controls (axial spondyloarthritis, n=320; psoriatic arthritis, n=196) from the Swiss Clinical Quality Management registry.

Disclosures: This work was supported by the De Reuter Foundation. M Mahler, C Bentow, and L Martinez-Prat declared being current or former employees at Inova Diagnostics. All the other authors declared no conflicts of interest.

Source: Lamacchia C et al. Rheumatology (Oxford). 2021 Jan 27. doi: 10.1093/rheumatology/keab050.

Key clinical point: Positivity for antipeptidyl-arginine deiminase type-3 (anti-PAD3) antibodies was associated with higher disease activity and joint damage scores in patients with rheumatoid arthritis (RA).

Major finding: Patients positive vs. negative for anti-PAD3 had significantly higher 28-swollen joint count (7.1 vs. 4.3; P less than .0001), 28-joint disease activity score-erythrocyte sedimentation rate (4.2 vs. 3.7; P = .005), and radiographic damage (14.9 vs. 8.8; P = .02).

Study details: Findings are from the assessment of biomarkers in 851 patients with RA and 516 disease controls (axial spondyloarthritis, n=320; psoriatic arthritis, n=196) from the Swiss Clinical Quality Management registry.

Disclosures: This work was supported by the De Reuter Foundation. M Mahler, C Bentow, and L Martinez-Prat declared being current or former employees at Inova Diagnostics. All the other authors declared no conflicts of interest.

Source: Lamacchia C et al. Rheumatology (Oxford). 2021 Jan 27. doi: 10.1093/rheumatology/keab050.

Key clinical point: Positivity for antipeptidyl-arginine deiminase type-3 (anti-PAD3) antibodies was associated with higher disease activity and joint damage scores in patients with rheumatoid arthritis (RA).

Major finding: Patients positive vs. negative for anti-PAD3 had significantly higher 28-swollen joint count (7.1 vs. 4.3; P less than .0001), 28-joint disease activity score-erythrocyte sedimentation rate (4.2 vs. 3.7; P = .005), and radiographic damage (14.9 vs. 8.8; P = .02).

Study details: Findings are from the assessment of biomarkers in 851 patients with RA and 516 disease controls (axial spondyloarthritis, n=320; psoriatic arthritis, n=196) from the Swiss Clinical Quality Management registry.

Disclosures: This work was supported by the De Reuter Foundation. M Mahler, C Bentow, and L Martinez-Prat declared being current or former employees at Inova Diagnostics. All the other authors declared no conflicts of interest.

Source: Lamacchia C et al. Rheumatology (Oxford). 2021 Jan 27. doi: 10.1093/rheumatology/keab050.