Key Messages from Rheumatology Update Europe 2024 (part 1)

March 2024, Amsterdam

Liebe Kolleginnen und Kollegen

Im Special Report finden Sie einen ersten Teil von Kurzbotschaften über Neuerkenntnisse in Publikationen über die letzten 12 Monate. Die Aufstellung ist für den raschen Leser konzipiert, für weitere Ausführungen verweise ich auf die jeweiligen Quellenpublikationen.

Viel Vergnügen
Prof. Dr. med. Beat Michel

Pathogenesis/Immunology (B. Hoyer)

Rheumatoid Arthritis

Insufficient sleep has been shown to produce inflammation and increased IL-6 levels
Association between insomnia and risk of RA
Li et al, Sleep health 2024;83:15

zur Studie

RA synovial tissue biopsy: Cell phenotypes may have treatment relevance;
Fibroblast predominance: poor response
Zhang et al, Nature 2023(623):616

zur Studie

Systemic Sclerosis (B. Maurer)

ssSSc (Systemic Sclerosis without skin involvement)

10% of patients present without skin fibrosis (ssSSc)
ssSc: high prevalence of interstitial lung disease (>40%)
Scl70 predictor for skin fibrosis
Lescoat et al, JAMA 2023;159(8):837

zur Studie

Digital ulcers

Platelet inhibitors (e.g. aspirin) recommended
Garaiman et al, Rheumatology 2023;62:Sl91

zur Studie

Heart

SSc: increased risk of sudden death (>10-fold)
Increased risk of ventricular arrhythmias
Screening for cardiac involvement recommended in all patients
Fairley et al, Seminars Arthritis Rheum 2023;63:152229

zur Studie

Lung

Lung ultrasound as potential tool to decide upon additional HRCT
Radic et al, Diagnostics 2023;13:1429

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SSc-PAH: significant benefit of initial combi ERA (endothelin receptor antagonists) and PDE5i (phosphodiesterase type 5 inhibitors) over monotherapy
Distler et al, Rheumatology 2023;00:1

zur Studie

Rheumatoid Arthritis (D. van der Woude)

Treatment

1^st-line superiority of bDMARDs+MTX over conventional therapy (MTX+pred or MTX+SSZ+HCQ+steroid injections) with regard to clinical outcome (true for abatacept and certolizumab, not for tocilizumab), no differences in radiologic outcomes
Ostergaard et al, Ann Rheum Dis 2023; 82:1286

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Risk of death

Still excess mortality, especially in ACPA-positive smokers (despite treat-to-target)
Heckert et al, Ann Rheum Dis 2023: doi:10.1136/ard-2023-224814

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Pre-RA

Abatacept reduces rates of progression to RA
Abatacept reduces subclinical inflammation (as defined by US)
Cope et al, Lancet 2024;403:838

zur Studie

Psoriatic Arthritis (L. Coates)

Early diagnosis

Screening can help to identify PsA in patients with psoriasis
In primary care, screening should be targeted at high-risk patients
McHugh et al, EULAR 2023, Milan
Grobelski et al, 2023;62:2724

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Treatment

Better outcome of oligoarthritis under Apremilast vs Placebo, less progression to polyarthritis
Mease et al, ACR 2023 San Diego (1691 and 1413)

zum Abstract
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EULAR 2023 recommendations (start of treatment)

Polyarthritis: rapid use of csDMARD//Biologics if 1 csDMARD failure (TNFi, IL-17, IL-12/23, IL-23)//JAKi second line therapy
Oligoarthritis: DMARD if poor prognostic factors//Biologics if 1 csDMARD failure (TNFi, IL-17, IL-12/23, IL-23)
Enthesitis: first-line biologics (no evidence for csDMARDs)
Axial: first-line biologics (TNFi, IL-17) or JAKi (no evidence for csDMARDs)
Grossec et al, EULAR presentation 2023 (not yet published)

Outcome

Women have poorer outcome than men in PsA
Eder et al, ACR 2023, San Diego (1687)

zum Abstract

Tapering

One third achieve at least 50% biologic reduction at 18 months
Similar success with TNFi and other biologics
Similar success with PsA, RA and axSpA
Similar for men and women
Prediction is difficult
Uhrenholt et al, Br J Clin Pharmacol 2023; 89:3152

zur Studie