Abstract 1998—Ten-year Analysis of the Risk of Severe Outcomes Related to Very Low-dose Glucocorticoids in Early Rheumatoid Arthritis
Dr. Solow: Glucocorticoids are often used to bring a patient relief more quickly while waiting for traditional DMARDs to kick in, to treat a flare or to bridge therapy adjustments. This study suggests that even at low doses, severe outcomes (including death, cardiovascular disease and infection) after long-term use are possible. We should be vigilant in reducing steroids to the lowest possible dose, and based on this study, tapering patients off.
Abstract 0233—Abatacept in Spanish Patients with Arthritis Rheumatoid and Interstitial Lung Disease. Multicenter Study of 263 Patients
Dr. Solow: In RA, interstitial lung disease (ILD) is a feared complication. ILD can be seen in up to 10% of RA patients, and it’s progressive. We have observational studies suggesting rituximab may be helpful in ILD; however, there are limited data on other therapy options. This study showed abatacept, after 12 months of follow-up, resulted in forced vital capacity (FVC), diffusion lung capacity for carbon monoxide (DLCO) and imaging that did not worsen. Limitations for this study include the observational nature, it was not blinded, and there was no control group. Further studies are needed; however, this is encouraging, especially in those patients with active joint disease.
Abstract L04—Influenza Adverse Events in Patients with Rheumatoid Arthritis in the Tofacitinib Clinical Program
Dr. Solow: Influenza is a common respiratory illness, and our patients are at higher risk for complications of the disease. This study evaluated trial data that allowed for the assessment of actual infections in patients taking tofacitinib. The results were comparable to methotrexate, adalimumab and, even, placebo. For the majority of the time, symptoms were mild, and doses were not held. In light of the COVID-19 pandemic, this is encouraging news.
Abstract 1994—Rheumatoid Arthritis Improvement After Exposure to an Anti-Inflammatory ‘ITIS’ Diet Is Associated with Changes of Gut Microbiome and Systemic Metabolome
Dr. Solow: So often I am asked, ‘Is there anything I can take or change in my diet that will help my RA?’ Here, we have a study suggesting that changes in the food we consume may affect not only our microbiome in the gut and the metabolites produced, but also clinical disease activity. Significant research is being done in this area as a possible source for the onset of autoimmunity, and it is encouraging to see that even after a patient is diagnosed with RA, specific food consumption may make a difference in clinical symptoms. How changing the microbiome and metabolome may affect long-term disease activity is under investigation.