The edition · Rheumatology
Ten years after early peripheral SpA was treated, four in five were in remission and a third off drugs
Long-term follow-up of the CRESPA golimumab trial found drug-free remission in nearly half of patients without psoriasis. Plus ICU outcomes in fulminant small-vessel vasculitis, a baricitinib application supplement, a lupus arthritis activity score and early-life tobacco smoke as a risk for rheumatoid arthritis.
The edition in brief
Of 60 patients with very early peripheral spondyloarthritis randomised to golimumab or placebo in the CRESPA trial, 49 were reassessed after about ten years: 81.6% were in clinical remission and 30.6% in sustained drug-free remission, rising to 48.1% among those without psoriasis (OR 9.1). Remission was not linked to original treatment allocation, and the analysis is descriptive. In 85 ICU admissions for ANCA-associated vasculitis or anti-GBM disease at one UK centre over 23 years, 90-day mortality was 26%, and 28% of survivors developed end-stage kidney disease; outcomes improved after 2008 alongside changes in treatment. The FDA lists a supplement to the baricitinib application with no detail given. The LAMDA score, derived against ultrasound synovitis in 133 patients with lupus arthritis and externally validated in 44, uses swollen joints, ESR, physician assessment and patient pain. In UK Biobank, exposure to tobacco smoke before birth (HR 1.15) and starting smoking in childhood (HR 1.74) were associated with later rheumatoid arthritis.
Fulminant vasculitis in intensive care: one in four died by 90 days
Start vasculitis treatment and involve specialists early in critically ill patients with suspected small-vessel vasculitis.
FDA: supplement to the baricitinib (Olumiant) application
Treat this as an administrative listing; baricitinib prescribing and its precautions are unchanged.
LAMDA: a lupus arthritis score built against ultrasound synovitis
Consider recording the four LAMDA items at lupus arthritis visits; the thresholds are provisional.
Smoke exposure before birth and in childhood was linked to later rheumatoid arthritis
Use family history of rheumatoid arthritis as an added reason to prevent early smoking and smoking in pregnancy.
Screen for latent tuberculosis before every biologic or JAK inhibitor
Screen for latent TB and hepatitis B before any biologic or JAK inhibitor, and stay alert to TB during treatment.
Early peripheral SpA: sustained remission for most, drug-free remission for a third
Refer early peripheral spondyloarthritis promptly and, in sustained remission, consider a monitored trial of tapering, especially without psoriasis.
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