The edition · Rheumatology
The febuxostat cardiovascular question turns out to be a question about time
A reconstructed individual-participant meta-analysis finds the risk relative to allopurinol changes direction across follow-up. Plus a Class I recall of a tocilizumab infusion vial, biologic choice in rheumatoid lung fibrosis, a deep-learning system that reads sacroiliac MRI as consistently as expert readers, and a stroke risk model built for rheumatoid arthritis rather than borrowed.
The edition in brief
A one-stage individual participant data meta-analysis reconstructed patient-level data from published survival curves in four studies of febuxostat versus allopurinol in gout, totalling 19,090 patients, and modelled the hazard as time-varying. Relative to allopurinol, febuxostat was associated with lower cardiovascular risk in the first four years and no difference beyond 48 months; the mortality pattern was similar and larger. The data are reconstructed rather than original, and the pooled studies mix randomised trials with propensity-matched observational cohorts. Separately, the FDA has classified as Class I an ongoing Fresenius Kabi recall of Tyenne (tocilizumab-aazg) 400 mg/20 mL infusion vials after glass particles were found in the product; this concerns specific manufactured lots rather than the drug. In rheumatoid arthritis with progressive pulmonary fibrosis, a retrospective real-world series of 135 patients found lung function and CT scores broadly stable over 52 weeks on any biologic, with a difference in forced vital capacity favouring interleukin-6 receptor inhibition over TNF inhibition and fewer adverse events on abatacept. A fully automated deep learning pipeline trained on one axial spondyloarthritis trial and tested on two others detected bone marrow oedema, erosions, fat lesions, sclerosis and ankylosis in the sacroiliac joints at a level comparable with agreement between expert readers, with structural lesions read most reliably and bone marrow oedema least. A stroke risk model developed in NHANES data and validated in a Beijing rheumatoid arthritis cohort improved discrimination from an area under the curve of 0.716 to 0.829 once disease activity, anti-CCP status, rheumatoid factor, methotrexate use and disease duration were added, and outperformed the Framingham score. All four are observational or model-development studies; none is a randomised comparison, and the risk model is cross-sectional and awaits prospective testing.
Febuxostat versus allopurinol: the hazard changes with time on treatment
Pooled patient-level data show no early cardiovascular penalty for febuxostat against allopurinol and no difference after four years, so tolerance and renal function should drive the choice rather than cardiovascular fear.
Class I recall of a tocilizumab biosimilar vial for glass particles
Check whether your infusion unit holds the recalled Tyenne 400 mg/20 mL lots and quarantine them: this is a Class I recall for glass particles, not a concern about tocilizumab as a drug.
Which biologic in rheumatoid arthritis with progressive lung fibrosis
In rheumatoid arthritis with progressive pulmonary fibrosis, lung function stayed stable on all three biologic classes over a year, with forced vital capacity favouring interleukin-6 receptor inhibition and the fewest adverse events on abatacept.
Automated reading of sacroiliac MRI matches agreement between experts
Automated sacroiliac MRI scoring now performs about as consistently as expert readers agree with each other, but its weakest lesion is bone marrow oedema — the one clinicians act on.
A positive ANA answers a question you should have asked first
Send an ANA only when a positive or negative result would change what you do, and interpret it by titre and pattern rather than treating any positive as disease.
A stroke risk score built for rheumatoid arthritis rather than borrowed
Assess stroke risk in rheumatoid arthritis using disease activity, serology and disease duration alongside the traditional factors, because general-population calculators discriminate poorly in this group.
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