Top reports chosen by Annals of Internal Medicine include several on biologics for rheumatoid arthritis and psoriatic arthritis, and mechanisms for lupus and scleroderma.
Hellmann DB and Imboden JB. Update in Rheumatology: Evidence Published in 2014. Ann Intern Med. 2015;162(9):W122-W126. doi:10.7326/M15-0273.
The authors chose these eight articles as last year’s most important high-quality reports on rheumatology. (Most have already been featured on Rheumatology Network.)
And the winner is .... New England Journal of Medicine, for six of the eight.
1. Blockade of Interleukin-17 Receptor A in Psoriatic Arthritis
Mease PJ, Genovese MC, Greenwald MW, et al.Brodalumab, an Anti-IL17RA Monoclonal Antibody, in Psoriatic Arthritis. N Engl J Med 2014; 370:2295-2306. June 12, 2014. doi: 10.1056/NEJMoa1315231
In a phase 2 randomized trial, brodalumab, a human monoclonal antibody against interleukin-17 (IL-17) receptor A, improved response rates of patients with psoriatic arthritis.
2. Continued Use of Combination Therapy for Early Rheumatoid Arthritis
Emery P, Hammoudeh M, FitzGerald O, et al.Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis. N Engl J Med. 2014; 371:1781-1792 November 6, 2014 doi: 10.1056/NEJMoa1316133
Methotrexate plus etanercept was better than methotrexate alone to maintain remission in rheumatoid arthritis (RA).
3. Tofacitinib as Monotherapy for Rheumatoid Arthritis
Lee EB, Fleischmann R, Hall S, et al. for the ORAL Start Investigators. Tofacitinib versus Methotrexate in Rheumatoid ArthritisN Engl J Med 2014; 370:2377-2386 June 19, 2014 doi: 10.1056/NEJMoa1310476
In this phase 3 study, tofacitinib was superior to methotrexate as initial monotherapy in patients with moderate to severe rheumatoid arthritis.
4. Genetic Cause of Familial Polyarteritis Nodosa
Navon Elkan P, Pierce SB, Segel R, et al.Mutant Adenosine Deaminase 2 in a Polyarteritis Nodosa VasculopathyN Engl J Med 2014; 370:921-931. March 6, 2014 doi: 10.1056/NEJMoa1307362
Twenty-four patients with polyarteritis nodosa vasculopathy all had a mutation in the gene for adenosine deaminase 2.
5. Rituximab and Remission in ANCA-Associated Vasculitis
Guillevin L, Pagnoux C, Karras A, et al. for the French Vasculitis Study Group. Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis N Engl J Med. 2014; 371:1771-1780 November 6, 2014 doi: 10.1056/NEJMoa1404231
Rituximab was superior to azathioprine for maintaining remission in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis.
6. Immune Response to Cancer and Scleroderma
Joseph CG, Darrah E, Shah AA, et al.Association of the Autoimmune Disease Scleroderma with an Immunologic Response to Cancer. Science 2014; 10 January 2014: 152-157. doi:10.1126/science.1246886
When cancer develops at the same time as scleroderma, patients are likely to have autoantibodies to RNA polymerase III subunit (RPC1). This study found mutations in the RPC1 gene associated with the autoantibodies.
7. Epidural Glucorticoid Injections (Not) for Lumbar Spinal Stenosis
Friedly JL, Comstock BA, Turner JA, et al.A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis.N Engl J Med 2014; 371:11-21 July 3, 2014 doi: 10.1056/NEJMoa1313265
Glucorticoids had no clinically significant benefit over placebo after six weeks for 400 patients with lumbar central spinal stenosis and moderate-to-severe leg pain and disability.
8. Retinal Toxicity of Hydroxychloroquine
Melles RB, Marmor MF. The Risk of Toxic Retinopathy in Patients on Long-term Hydroxychloroquine Therapy. JAMA Ophthalmol. 2014 Online October 2, 2014. doi:10.1001/jamaophthalmol.2014.3459
But more sensitive diagnostic methods are now finding less severe retinopathy earlier, and retinopathy increases significantly after ten years. This study found that retinopathy occurred in 7.5% of patients, about three times higher than previous estimates.