In a 24-month clinical trial, tofacitinib proved safe and effective in combination with methotrexate in adult patients with RA…
Upadacitinib Monotherapy Effective in Refractory Rheumatoid Arthritis
NEW YORK (Reuters Health)—Monotherapy with the JAK1-selective inhibitor upadacitinib is effective in patients with active rheumatoid arthritis who have an inadequate response to methotrexate, according to results from the SELECT-MONOTHERAPY phase 3 trial. As many as two-thirds of patients with rheumatoid arthritis receiving methotrexate monotherapy fail to achieve satisfactory disease control. Oral therapy with upadacitinib…
Cardiovascular Risk in Rheumatoid Arthritis: Pathogenesis, Screening & Prevention
SNOWMASS VILLAGE, COLO.—Even in the era of treat to target, cardiovascular disease risk remains elevated and is a major source of mortality and morbidity in patients with rheumatoid arthritis (RA). Screening and management of cardiovascular risk in these patients is critical to ensure these patients are identified and treated. At the 2019 ACR Winter Rheumatology…
7 Insights into Methotrexate Administration, Drug Resistance & Toxicity
CHICAGO—Once methotrexate enters a cell through the reduced folate carrier (RFC), which thinks it is picking up folate, the drug is polyglutamated. It is this polyglutamate methotrexate that provides the actual clinical effect. These methotrexate polyglutamate “species” are added and lost over time, but it’s a slow process. What difference does it make whether a…
Reminder: How to Handle Part D Prior Authorization Requests
Note: Although originally posted in January 2018, the advice below remains valid. We see this issue recur each year. As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B,…
Can IL-6 Predict Sarilumab Response?
Recent post-hoc analyses of two Phase 3 clinical trials show that RA patients with high interleukin 6 levels taking sarilumab experienced improved symptoms and less joint damage than those using other treatments…
Initial Sjögren’s Manifestations Can Go Beyond Dry Eyes & Mouth
Primary Sjögren’s syndrome is a systemic autoimmune condition noted for findings of xerostomia, keratoconjunctivitis sicca and focal lymphocyte infiltrate in salivary glands.1 In the initial publications regarding keratoconjunctivitis sicca, Henrik Sjögren, a Swedish ophthalmologist, described a group of 19 women with dry eyes, some of whom had other organ dryness and inflammatory infiltrates.2,3 The syndrome…
Upadacitinib Monotherapy Proves Promising; Plus FDA Approves Tocilizumab Autoinjector
In a study, RA patients taking upadactinib monotherapy experienced less pain and morning joint stiffness than methotrexate-treated patients…
Case Report: The Hairdresser Who Couldn’t Comb Her Hair
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and morning stiffness at the neck, shoulders and hip girdle. It can be associated with giant cell arteritis (GCA); in fact, the two disorders may represent a continuum of the same disease process. This case describes a patient who initially refused treatment for PMR…
Study Suggests Tocilizumab Monotherapy May Work for Some RA Patients
For patients with rheumatoid arthritis (RA) who respond to subcutaneous tocilizumab, discontinuing methotrexate may be an option and offer an alternative to patients who cannot tolerate or prefer not to take methotrexate. “This is one of the first studies showing that methotrexate may be discontinued in a cohort of patients with a biologic agent without…
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