The edition · Rheumatology
The steroid you inject is easier to stop than the one you prescribe
In early rheumatoid arthritis, patients given parenteral rather than oral glucocorticoid were half as likely to still be on steroids a year later. Also: only 12% of nearly 95,000 people with gout ever reach target urate, an FDA supplement on abrocitinib, and pooled evidence for the bisphosphonate that has to follow denosumab.
The edition in brief
In the Canadian Early Arthritis Cohort, 2,222 adults with rheumatoid arthritis of under a year's duration were grouped by glucocorticoid use in the first three months: 75% had none, 19% oral, 5% parenteral and 1% both. At 12 months, glucocorticoid use stood at 8%, 47%, 26% and 63% respectively, with adjusted odds ratios for still being on steroids of 9.8 for oral and 4.1 for parenteral against no glucocorticoid. Escalation to advanced therapy was similar at 14% in both the oral and parenteral groups. A cluster analysis of 94,759 patients with incident gout in Catalonia identified three phenotypes: younger patients with few comorbidities (37.0%), older patients with universal type 2 diabetes, 51.3% obesity and the greatest cardiovascular burden (22.8%), and older patients with hypertension and dyslipidaemia but no diabetes (40.2%). Only 12% of the whole cohort achieved sustained serum urate below 6 mg/dl for at least 80% of follow-up. The most comorbid cluster received more urate-lowering prescriptions but achieved worse control than the youngest. The FDA has recorded a supplemental action on abrocitinib (Cibinqo, Pfizer, NDA 213871) dated 2 September 2026; the record does not state what the supplement covers. A GRADE-assessed meta-analysis of six studies, with 683 participants in the primary analysis, found alendronate or zoledronic acid after stopping denosumab reduced incident vertebral fractures (RR 0.29, 95% CI 0.14-0.59), multiple vertebral fractures (RR 0.08, 0.01-0.43) and clinical vertebral fractures (RR 0.18, 0.07-0.49). Any fracture and non-vertebral fracture did not reach significance. Certainty was low to very low.
Route matters: parenteral glucocorticoid in early RA, and getting off it
Patients given parenteral rather than oral glucocorticoid for early rheumatoid arthritis were about half as likely to still be taking steroids at a year (26% vs 47%), with no difference in escalation to advanced therapy.
Three kinds of gout, one shared failure: 12% at target
Across 94,759 people with gout, only 12% stayed at a serum urate below 6 mg/dl — and the most comorbid group had the most prescriptions and the worst control, so titration and follow-up, not prescribing, is where gout care fails.
FDA records a supplemental action on abrocitinib
The FDA has recorded a supplemental action on abrocitinib dated 2 September 2026 without stating its content — worth watching for class-wide JAK inhibitor labelling implications, but no reason to change prescribing today.
Denosumab is not a drug you can simply stop
Denosumab has no safe stopping point without a follow-on antiresorptive — book the next dose before the patient leaves, and agree the exit plan on the day you start it.
After denosumab, a potent bisphosphonate — the pooled numbers behind a rule you already half-follow
Following denosumab with alendronate or zoledronic acid cut incident vertebral fractures by 71% and multiple vertebral fractures by 92% against no follow-on therapy — low-certainty evidence, but enough to make sequential bisphosphonate automatic.
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