In the ARIAA study, patients with ACPA positivity and signs of inflammation on magnetic resonance imaging were randomized to receive abatacept or placebo for six months and then followed for an additional 12-month period without treatment. By six months, about 35% of participants in the placebo group developed RA vs. about 8% of those in the abatacept treatment group.8
Based on these studies, Dr. van der Woude explained that abatacept appears to be effective as an RA prevention strategy in patients with ACPA-positive arthralgias. However, the sustained effect of this medication in the long term remains to be determined.
For comparison, methotrexate has a more complicated story. In the TREAT EARLIER trial, methotrexate did not prevent the development of RA over a two-year period compared with placebo. But the study showed a signal of possible benefit in patients with ACPA-negative arthralgias and a high inflammatory burden.9 To Dr. van der Woude, this finding implies that stratifying patients who are at risk of RA into different groups may better enable clinicians to predict which patients will benefit from preventative therapy.
More Research
Dr. van der Woude also addressed a variety of other interesting, RA-related studies.
In a study on telemedicine, Jackson et al. found that the satisfaction with regard to telemedicine of a large, diverse group of patients was not noninferior to in-person rheumatology visits. When the authors looked at satisfaction levels based on patient gender, men were equally satisfied with both types of visits, whereas women were more likely to be satisfied with in-person visits.10
In a study on renal disease from Fukui et al., higher RA disease activity was associated with an accelerated decline in estimated glomerular filtration rate (eGFR), as well as an increased risk of clinically relevant kidney dysfunction.11 These findings are important because among older patients with chronic kidney disease, the risk of serious adverse events has been found to be higher in those treated with low-dose methotrexate—a favorite medication of rheumatologists across the world—compared with those treated with hydroxychloroquine.12
In a study on the risk of lung cancer in RA, Brooks et al. found that patients with RA had a more than 50% increased risk of lung cancer compared with age and gender-matched controls without RA. The risk was highest in patients with RA and interstitial lung disease (ILD), with an approximately three-fold increased risk of disease compared with patients without ILD.13
