The edition · Rheumatology
Pulmonary hypertension in one in eleven with anti-synthetase syndrome, linked to over twice the mortality
A 103-centre registry argues for screening, a probiotic failed to help psoriatic arthritis in a placebo-controlled trial, and a review revisits rheumatoid factor and TNF inhibitor choice.
The edition in brief
In an international registry of 1,868 patients with anti-synthetase syndrome, pulmonary hypertension was present in 8.9%, more than in other myositis, rheumatoid arthritis or interstitial pneumonia with autoimmune features, and similar to lupus and systemic sclerosis. Five-year survival fell from 94% to 88.3% with pulmonary hypertension, which remained independently associated with death (HR 2.52) after adjusting for interstitial lung disease. A randomised double-blind trial of a multispecies probiotic in 66 patients with moderately active psoriatic arthritis found no benefit over placebo at 12 weeks (43% vs 65% reached low disease activity), and no change in gut permeability or microbiome. An Annals of the Rheumatic Diseases systematic review of 21 studies suggested responses to Fc-free TNF inhibitors were maintained in patients with high rheumatoid factor, but the evidence is indirect. The FDA recorded a supplement to the adalimumab-aqvh biosimilar application; its content is not stated. The pearl: screen the retina on hydroxychloroquine and keep the dose at or below 5 mg/kg actual body weight.
A probiotic did not improve psoriatic arthritis in a placebo-controlled trial
A multispecies probiotic did not improve psoriatic arthritis activity versus placebo; it is not a substitute for treatment escalation.
High rheumatoid factor and TNF inhibitors: a review of the Fc question
High rheumatoid factor may reduce Fc-containing TNF inhibitor exposure, but evidence is indirect; do not choose agents on RF level alone.
FDA records a supplement to the adalimumab-aqvh biosimilar licence
An adalimumab biosimilar supplement has been recorded by the FDA; there is no new indication or safety action to act on.
Hydroxychloroquine: dose by actual weight and screen the retina
Dose hydroxychloroquine at 5 mg/kg actual body weight or less, examine the retina within the first year and screen annually after five years.
Anti-synthetase syndrome: consider pulmonary hypertension screening (death HR 2.52)
Consider screening patients with anti-synthetase syndrome for pulmonary hypertension; it affected one in eleven and was linked to more than twice the mortality.
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