The edition · Rheumatology
An oral TYK2 inhibitor holds its psoriatic arthritis response to a year
POETYK PsA-1 at 52 weeks in biologic-naive disease, consensus strategies for 22 more rare lupus manifestations, what proton pump inhibitors are and are not doing in scleroderma, and a Boswellia trial worth reading carefully.
The edition in brief
Today's rheumatology desk opens with the 52-week results of POETYK PsA-1, a phase 3 trial of oral deucravacitinib 6 mg daily in 670 biologic-naive patients with active psoriatic arthritis, raised C-reactive protein and at least one hand or foot erosion. ACR20 at week 16 was 54.2% against 34.1% on placebo (P<0.001), responses rose further by week 52, patients crossing over from placebo caught up, and structural damage inhibition was seen at both time points. Serious adverse events were 1.8% against 2.4% at week 16, with no imbalance in cardiovascular events, malignancy or opportunistic infection and no deaths. An international taskforce has added consensus therapeutic strategies for 22 further rare lupus manifestations to the 24 it published previously, covering diffuse pulmonary haemorrhage, bullous and chilblain lupus, interstitial nephritis and podocytopathy, chorea, catatonia, protein-losing enteropathy, intestinal pseudo-obstruction and more. A EUSTAR analysis of 10,660 patients with systemic sclerosis, 81% of them on a proton pump inhibitor, found exposure associated with higher all-cause mortality (hazard ratio 1.88, 95% CI 1.40 to 2.54) but a minimal absolute difference in restricted mean survival at five years, and no reduction in clinically meaningful forced vital capacity decline. A small placebo-controlled trial of a standardised Boswellia serrata extract in 60 people with knee osteoarthritis reported significant reductions in WOMAC and visual analogue scores from day 7. A pearl covers methotrexate counselling. The edition closes with vaccination data in 60,980 patients with autoimmune rheumatic disease.
Deucravacitinib in psoriatic arthritis, with the safety profile that matters
Deucravacitinib gives a real oral option in biologic-naive psoriatic arthritis, and at 52 weeks showed none of the JAK class safety signals.
Twenty-two more rare lupus manifestations now have an agreed starting point
Know the rare-manifestation list exists and where to find it — the value is having a defensible first move at two in the morning.
Proton pump inhibitors in scleroderma: keep prescribing, stop expecting
Keep prescribing proton pump inhibitors for reflux in scleroderma, and drop the claim that they slow lung disease.
A Boswellia trial with a real placebo arm, and sixty patients
Boswellia is reasonable to continue if a patient is already using it, but exercise and weight management stay the recommendation.
The methotrexate conversation has four parts, and folic acid is not the first
Spend the counselling time on the weekly dose, trimethoprim and the fever instruction — not on folic acid.
The initial series is not enough in autoimmune rheumatic disease
Ask about and record vaccination status at every rheumatology review, and recommend a current dose rather than accepting a completed initial series.
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