Clinical Rheumatology Year in Review—2022

PHILADELPHIA—To appreciate just how far we’ve come in the past year, one needs to look no further than the colleague sitting next to you at ACR Convergence 2022, which occurred in person for the first time in three years. For most, this would be enough to celebrate. But there’s more.

On Nov. 11, 2022, Carol A. Langford, MD, MHS, FACP, director, Center for Vasculitis Care and Research, professor of medicine, Harold C. Schott Endowed Chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, presented an overview of clinical updates in rheumatology from November 2021 to November 2022. To craft her talk, Dr. Langford reviewed high-impact journals in rheumatology and internal medicine, noting that several important studies couldn’t be included due to time constraints. Featured articles were those that helped us weigh risks and benefits, directly impacted clinical practice or described innovative therapeutic approaches. She concluded her talk with COVID-19 updates pertinent to patients with rheumatic disease.

Risks & Benefits

The GLORIA trial was a randomized, double-blind, placebo-controlled trial that examined the benefits and harms of 5 mg of prednisolone given daily for two years added to standard of care in patients aged 65 years or older with active rheumatoid arthritis (RA).¹ This was a pragmatic trial, a design that focuses on examining treatments and outcomes in a real-world practice setting. “This means that co-treatments and changes in therapy were permitted,” Dr. Langford explained.

The co-primary outcome for benefit and harm revealed a Disease Activity Score-28 of 0.37 points lower on prednisolone than placebo (95% confidence level 0.23, P<0.0001) and a number needed to harm of 9.5. The addition of prednisolone was associated with lower disease activity and reduction in joint damage, but the tradeoff was a 24% increase in adverse events—the majority of which were due to infections.

Dr. Langford

Dr. Langford cautioned, “We need to consider the study population here. In younger patients newly diagnosed with RA, this might not be generalizable. It was also only a two-year study, which is long in terms of clinical trials but not in the grand scheme of RA.”

Dr. Langford also discussed the ORAL Surveillance trial, which resulted in a revised U.S. Food & Drug Administration (FDA) indication in RA and an added boxed warning for tofacitinib, baricitinib and upadacitinib.² Findings from this trial and others have been featured this year in The Rheumatologist. Further safety data will be particularly important given several new FDA indications for these drugs in psoriasis and spondyloarthritis, as well as a new medication that inhibits Janus kinase (i.e., deucravacitinib).