Rheumatoid Arthritis

Some subjects in rheumatology seem to create contention the more they get explored, and one of those areas is a traditional crowd favourite for discussion at EULAR - clinically suspect arthralgias. At EULAR 2023 in Milan, the perfect platform was provided for an airing of grievances, in a debate entitled ‘Clinically suspect arthralgias: fact or myth’.

T cells are known to play a key role in RA pathogenesis and the diversity of the T cell repertoire is known to be reduced in RA. 

Day 3 was a sunny warm day in Milan at the 2023 EULAR Congress meeting. Here are a few of my favorite abstracts from today.

A nationwide population-based study, by Beydon et al. (OP0044), has performed a more recent (2010-2020) analysis of cancer incidence in people living with RA within the French national claim database, compared to general population, measured in the French Network of Population-Based Cancer Registries.

The use of artificial intelligence to analyse large data sets using its subset component machine learning has taken centre stage recently in the management of rheumatic conditions, including rheumatoid arthritis. The use of AI is now starting to cross the various stages in patient care from detection, diagnosis, treatment and the prediction of long-term outcome.

Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial intelligence in medicine and rheumatology.

An artificial intelligence model to assess pre-RA hand MRIs has confirmed what human readers have known before: that bone marrow edema and tenosynovitis are objectively the best predictors of future RA development in patients with clinically suspect arthralgias or undifferentiated arthritis.

In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors. 

Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis. While for a long time RA treatments, such as methotrexate (MTX), have been considered a risk factor, recent data have shown the innocuity of MTX on lung disease (and in fact suggests it could reduce risk of ILD by increasing disease control and remission).