The edition · Rheumatology
On a JAK inhibitor for RA, the CDAI at week 12 predicted the year ahead better than the rate of improvement — above 9.3, rethink
A Japanese registry sets week-4 and week-12 CDAI checkpoints for JAK inhibitors, EUSTAR finds no benefit from anticoagulation in scleroderma pulmonary hypertension, PEXIVAS yields a relapse model for ANCA vasculitis, and early mepolizumab in EGPA tracks with more remission.
The edition in brief
Today's rheumatology edition closes on a multicentre Japanese registry of 843 patients with rheumatoid arthritis starting a JAK inhibitor (ARD, 10 September). Four trajectories emerged, from rapid responders (65%) to persistent non-responders (4%). The absolute CDAI at weeks 4 and 12 predicted a favourable course far better than the change from baseline; thresholds were 12.0 at week 4 and 9.3 at week 12, which gives a concrete checkpoint for switching. The lead is a EUSTAR cohort of 614 patients with systemic sclerosis and catheter-confirmed precapillary pulmonary hypertension (Rheumatology, 18 September): oral anticoagulation was not associated with survival (HR 0.98, 0.72 to 1.33) or pulmonary hypertension worsening, including after propensity matching. A PEXIVAS-based model (ARD, 22 September) estimates two-year relapse risk after remission in severe ANCA vasculitis from six routine variables, with moderate discrimination (C 0.71) and awaiting external validation. A Japanese cohort of 64 patients with EGPA (Rheumatology, 21 September) found mepolizumab started within three months of induction associated with more one-year remission (69% vs 27%) and less damage; it is small and non-randomised. The pearl is on recording the CDAI as a number at every review.
Scleroderma pulmonary hypertension: anticoagulation was not associated with better survival
Do not anticoagulate for SSc-associated pulmonary hypertension alone; reserve it for a separate indication.
PEXIVAS model estimates two-year relapse risk after remission in severe ANCA vasculitis
Use known relapse predictors — PR3-ANCA, induction agent, organ involvement, eGFR — to set monitoring intensity after remission in ANCA vasculitis.
EGPA: mepolizumab started within three months of induction was associated with more remission and less damage
In EGPA, consider mepolizumab early rather than only after relapse — it was associated with more steroid-free remission in this cohort.
Write the CDAI as a number at every RA review
Record the CDAI as a number at every RA visit so that treatment decisions rest on the absolute level.
JAK inhibitors in RA: a week-12 CDAI above 9.3 predicts a poor year — plan the switch then
Review RA patients 12 weeks after starting a JAK inhibitor and change treatment if CDAI is still above about 9.
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