Stopping DMARDs in controlled RA more than doubled flare risk

The edition in brief

A meta-analysis of 27 randomised trial publications covering 5,262 people with rheumatoid arthritis in sustained control found that withdrawing a DMARD raised flare risk (RR 2.23), while tapering raised it less (RR 1.56), mainly in the first nine months and mainly with biologics. Withdrawal was associated with radiographic progression, tapering weakly so, and neither reduced adverse events. Dose reduction can be discussed; stopping should generally be avoided. In a subanalysis of a randomised trial, the recombinant zoster vaccine produced seroconversion in 91.9% of 41 patients with autoimmune rheumatic disease on intravenous cyclophosphamide, the same as in patients not on it, without more flares. In a US cohort of 187,106 matched patients, autoimmune rheumatic disease was associated with a 56% higher risk of a long COVID diagnosis, with rituximab, glucocorticoids, obesity and severe acute illness as further risk markers. In 142 people with myositis, statin-associated necrotising myopathy carried higher crude mortality, largely explained by age and cardiometabolic disease. The pearl covers hydroxychloroquine retinal screening.