Which biologics do patients like best?

NO INTESTINAL LUNG DISEASE. A study of 2,701 rheumatoid arthritis patients finds that methotrexate treatment is not apparently associated with an increased risk of rheumatoid arthritis interstitial lung disease (RA-ILD) and it may in fact delay the onset of ILD. The study was published in BMJ Open. Of 92 ILD cases, 39, or 2.5 percent, were associated with patients receiving methotrexate as compared to 53, or 4.8 percent, that occurred in patients were not receiving methotrexate. ILD was associated more often with higher age at rheumatoid arthritis onset, smoking status, male gender, the presence of rheumatoid arthritis nodules and a longer duration of having gone untreated for rheumatoid arthritis symptoms. Chest XRay (©Thailoei92ShutterStock.com)

REFERENCE:  Patrick Kiely, AD Busby, E Nikiphorou, et al. "Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts," BMJ Open. May 5, 2019. DOI:10.1136/bmjopen-2018-028466

COMBINATION TREATMENT REDUCES BAD CHOLESTEROL. A combination of prednisolone with hydroxychloroquine and methotrexate proved to be more effective in reducing low-density lipoprotein (LDL) levels and in increasing high-density lipoproteins (HDL), find researchers writing in the Journal of Research in Medical Sciences. This was a small study of 200 patients parceled into three combination treatment groups. One with  prednisolone and hydroxychloroquine; a second added methotrexate to the regimen and the third, added sulfasalazine to the mix of three-neither combination worked as well as three-drug regimen. (©Designer 491, AdobeStock)

REFERENCE:  Karimifar M, Sepehrifar MS, Moussavi H, et al. "The effects of conventional drugs in the treatment of rheumatoid arthritis on the serum lipids," Journal of Research in Medical Sciences. Dec. 28, 2018. DOI: 10.4103/jrms.JRMS_869_17

WHEN IS BEST TO TEST OF LIVER AND KIDNEY DISEASE? The liver and kidney enzyme test alanine aminotransferase (ALT) may be best conducted before rheumatoid arthritis patients start methotrexate, not during treatment, researchers report in the International Journal of Rheumatic Diseases. The study found that only a small number of tests conducted after methotrexate was started captured elevated enzyme levels. More elevated enzyme levels were identified pre-treatment. The study included 213 patients who were just starting methotrexate. Over the course of 4.3 years, 6,288 ALT tests were performed of which 7 percent were over the upper limit of normal. 70 percent of patients on treatment experienced recurrent elevations. No patient in this group experienced liver failure, but two were diagnosed with non-alcoholic fatty liver disease. (©Yodiyim, AdobeStock)

REFERENCE:  Karlsson Sundbaum J, Eriksson , Hallberg P, et al. "Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long-term follow-up of predictors, surveillance, and outcome in clinical practice," International Journal of Rheumatic Diseases. April 22, 2019. DOI:10.1111/1756-185X.13576.

FRACTURE RISK HIGHESTS WITH OPIOID USERS. A study of 11,412 patients with rheumatoid arthritis shows that the use of opioids, SSRIs and glucocorticoids were associated with the increased risk of fracture. While patients who were receiving statins and TNFi had fewer vertebral fractures. 914 fractures were documented within three years. There was a significant risk of fractures among patients who used glucocorticoids for at least three months, but the risk rose for opioid users after only 30 days. For patients taking SSRIs, the risk of fracture rose when an SSRI was taken for longer than three months. (©PollapatChirawongShutterstock.com)

REFERENCE:  Ozen G, Pedro S, Wolfe F, et al. "Medications associated with fracture risk in patients with rheumatoid arthritis," Annals of the Rheumatic Diseases. May 15, 2019. DOI: 10.1136/annrheumdis-2019-215328.
http://ard.bmj.com/cgi/pmidlookup?view=long&pmid=31092411

INCREASED RISK FOR ADVERSE PREGNANCY OUTCOMES. "Women with psoriatic arthritis and ankylosing spondylitis have increased risk for selected adverse pregnancy outcomes," report researchers in Arthritis Care and Research. "They also found that active disease and corticosteroid use, may increase the risk for some adverse pregnancy outcomes in women with these conditions." Psoriatic arthritis patients was associated with increased risk for moderate preterm delivery, oligohydramnios and Caesarean delivery. Ankylosing spondylitis was an associated with an increased risk intensive care deliveries. Second trimester trimester corticosteroid use was associated with preterm delivery.

REFERENCE:  Chelsey J. F. Smith MD, Gretchen Bandoli, PhD, Arthur Kavanaugh MD, Christina D. Chambers PhD, MD. "Birth Outcomes and Disease Activity during Pregnancy in a Prospective Cohort of Women with Psoriatic Arthritis and Ankylosing Spondylitis," Arthritis Care and Research. DOI: 10.1002/acr.23924

SARCOIDOSIS:  "This case report represents the first instance of cutaneous sarcoidosis most likely induced by tocilizumab in patients affected by giant cell arteritis. In addition, our case emphasizes that although tocilizumab in monotherapy confirms to be an effective treatment for giant cell arteritis, further immunological disorders could be unmasked, and the discussed side effect of the drug could be dose-dependent." Sarcoidosis signs DesignuaShutterstock

REFERENCE:  Del Giorno R, Iodice A, Mangas C,   Gabutti L. "New-onset cutaneous sarcoidosis under tocilizumab treatment for giant cell arteritis: a quasi-paradoxical adverse drug reaction. Case report and literature review," Thereapeutics Advances in Musculoskeletal Disease. April 12m 2019. DOI:10.1177/1759720X19841796