► van Vollenhoven RF, Fleischmann R, Cohen S, et al, Tofacitinib or Adalimumab(Drug information on adalimumab) versus Placebo in Rheumatoid Arthritis. N Engl J Med (2012) 367:508-519.
Tofacitinib is effective in RA. In a 12-month, phase 3 randomized crossover trial involving 717 RA patients who were receiving stable doses of methotrexate(Drug information on methotrexate), ACR response rates at month 6 were significantly higher among patients receiving either drug than among those on placebo. HAQ-DI and DAS28 scores were also significantly better in the treatment groups. Tofacitinib was associated with more adverse events than adalimumab, however, including increases in lipoprotein fractions, decreases in neutrophil counts and, in two patients, pulmonary tuberculosis.
► Kingsley GH, Kowalczyk A, Taylor H
Ann Rheum Dis (2012) 71:198-205 .
Ann Rheum Dis. (2012) 71: 351–357.
Ann Rheum Dis (2012) 71:1343-1349.
[Drawn from a presentation at the October meeting of the American College of Rheumatology, this list was compiled too early to include the following important reports published concurrently in late December.]
► De Benedetti F, Brunner HI, Ruperto N, et al, Randomized trial of tocilizumab in Systemic Juvenile Idiopathic Arthritis
New Engl J Med (2012) 367:2385-2395.
► Ruperto N, Brunner HI, Quartier P, et al. Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis.
N Engl J Med (2012) 367:2396-2406.
An intractable rheumatic disease of childhood with no good option for treatment suddenly has two. In separate collaborative trials of juvenile idiopathic arthritis, he interleukin-1 inhibitor canakinumab and the interleukin-6 inhibitor tocilizumab prove similarly effective against JIA assessed for the same outcome, the adapted ACR JIA response measure.
Ann Rheum Dis (2012) 71:1329-1334.
Arthritis Rheum (2012) 64:53-61.
► Judge A, Arden NK, Cooper C, et al, Predictors of outcomes of total knee replacement surgery Rheumatology (Oxford) (2012) 51:1804-1813.
Preoperative severity of disease and anxiety or depression were the most potent predictors of postoperative outcomes for total knee replacement, in this prospective study of a cohort in London, England. Patients with rheumatoid arthritis fared better after surgery than those with osteoarthritis of the knee.
► Stamp LK, Taylor WJ, Jones PB, et al, Starting dose is a risk factor for allopurinol(Drug information on allopurinol) hypersensitivity syndrome: A proposed safe starting dose of allopurinol
Arthritis Rheum (2012) 64:2529-2536.
A retrospective case-control study of patients in whom allopurinol sensitivity developed suggests starting the drug at a dose of 1.5 mg per unit of estimated GFR and increasing the dose gradually to allow timely recognition if hypersensitivity arises.
► Bharat A, Xie F, Baddley JW, et al, Incidence and risk factors for Progressive Multifocal Leukoencephalopathy among patients with selected rheumatic diseases
Arthritis Care Res (2012) 64:612-615.
A population-based study of more than 2 million patients with rheumatic disorders show that the incidence of PML is very low, at 0.2 per 100,000 patients who do not have HIV or malignancy.
► Soliman MM, Hyrich KL, Lunt M, et al, Rituximab or a second anti-tumor necrosis factor therapy for rheumatoid arthritis patients who have failed their first anti-tumor necrosis factor therapy? Comparative analysis from the British Society for Rheumatology Biologics Register
Arthritis Care Res(2012)64:1108-1115 .
A registry study involving 1,328 RA patients who switched medications after unsatisfactory results from a first TNF inhibitor lent support for trying rituximab next, rather than a different TNF inhibitor.
► Steinman AJ, Gladman DD, Ibañez D, and MB Urowitz. Outcomes in patients with systemic lupus erythematosus with and without a prolonged serologically active clinically quiescent period
Arthritis Care Res (2012) 64:511-518.
Is treatment justified for patients with SLE whose disease undergoes a sustained quiescent period? This case-control study involving 55 patients with quiescent disease observed over at least three years supports a strategy of observant waiting.
► Muro Y, Sugiura K, Hoshino K, and M Akiyama. Disappearance of anti-MDA-5 autoantibodies in clinically amyopathic DM/interstitial lung disease during disease remission
Rheumatology (Oxford) (2012) 51:800-804.
A longitudinal study suggests that autoantibodies against melanoma differentiation-associated gene 5 may prove a useful marker to monitor disease status in amyopathic dermatomyositis with comorbid ILD.
► Gottenberg JE, Dayer JM, Lukas C, et al, Serum IL-6 and IL-21 are associated with markers of B cell activation and structural progression in early rheumatoid arthritis: results from the ESPOIR cohort
Ann Rheum Dis (2012) 71:1243-1248.
Looking to identify patterns of serum cytokines that correlates with disease status in early rheumatoid arthritis, these researchers found that increases in serum IL-6 and IL-21 correlated with markers of B-cell activaion, and IL-6 is associated with radiographic progression.
► Nielsen SF, Bojesen SE, Schnohr P, and BG Nordestgaard. Elevated rheumatoid factor and long term risk of rheumatoid arthritis: a prospective cohort study
BMJ (2012) Sep 6;345:e5244.
This sets out a case for rheumatoid factor screening in the general population. A study involving nearly 10,000 adults in Copenhagen found as much as a 26-fold greater long term risk of rheumatoid arthritis among individuals with elevated rheumatoid factor, and about one-in-three odds of being diagnosed with RA within a decade.
► Mammen AL, Gaudet D, Brisson D, et al, Increased frequency of DRB1*11:01 in anti-hydroxymethylglutaryl-coenzyme A reductase- associated autoimmune myopathy
Arthritis Care Res (2012) 64:1233-1237.
This study finds a link between an HLA marker and the occurrence of autoimmune myopathy among Caucasians and African-Americans. The findings suggest a "mechanistic link" to statin exposure.
Other Reports of Interest
► Laine J, Uotila T, Antonen J, et al, Joint symptoms after a large waterborne gastroenteritis outbreak--a controlled, population-based questionnaire study
Rheumatology (Oxford) (2012) 51:513-518.
Residents of a Finnish town were about three times as likely to report joint pain if they lived in regions exposed to a 2007 waterborne gastroenteritis than if they did not. Even those people who were exposed but did not develop gastroenteritis were more likely to report joint pain.
► Antohe JL, Bili A, Sartorius JA, et al, Penile alterations with severe sperm abnormalities in antiphospholipid syndrome associated with systemic lupus erythematosus
Clin Rheumatol Epub ahead of print Sept 2012 DOI: 10.1007/s10067-012-2083-4.
Patients who have lupus complicated with antiphospholipid syndrome should have penile examinations if they experience fertility problems, say these researchers. They report not only penile morphological abnormalities associated with erectile dysfunction but also reductions in sperm count and sperm motility, particularly among patients who have taken cyclophosphamide(Drug information on cyclophosphamide).
(Adapted from an invited presentation by David A. Isenberg MD at the 2012 annual meeting of the American College of Cardiology. Dr. Isenberg is professor of rheumatology at University College Hospital London.)