Controlling RA with biologics did not stop bone loss without osteoporosis treatment

The edition in brief

In 797 patients with active RA treated with biologic or targeted synthetic DMARDs and followed for a median 3.1 years, disease activity fell sharply (CDAI about 26 to 7), yet femoral neck and radius T scores fell significantly in those not on osteoporosis treatment, and 58% overall lost bone density. Neither disease control nor duration of advanced therapy was associated with keeping bone. In 500 treatment courses after a JAK inhibitor was stopped, abatacept was more often stopped for ineffectiveness than a second JAK inhibitor when the first failed for lack of effect (HR 2.83); after toxicity, TNF and IL-6 receptor inhibitors were stopped for adverse events less often than JAK cycling. APEX reported durable ACR responses and low radiographic progression to week 48 with guselkumab in 1,020 biologic-naive patients with erosive PsA. An Italian emulated trial of 990 PsA patients found no difference in six-month effectiveness or retention between TNF, IL-17 and IL-23 inhibitors. A single-centre cohort found 53.8% of lupus nephritis patients reached a stringent deep renal response by 24 months on add-on belimumab.