Articles By Richard Conway, MBBChBAO, PhD
TNFi and RA-ILD – The Pendulum Swings Again
TNF inhibitors revolutionised the treatment of rheumatoid arthritis. While highly effective for the joint manifestations of the disease, a note of caution was sounded regarding the potential for worsening of ILD with these agents. Within this framework, a study by England et al presented at ACR23 was highly relevant.
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Cancer and TNF inhibitors
Cancer risk minimisation is a high priority for people with rheumatic diseases, as it is for the general population. Tumor necrosis factor inhibitors (TNFi) have a long history of association with cancer risk discussions. An oral presentation by Suarez-Almazor et al provided more supportive data on using TNFi in this population.
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The Fallacy of Biologic Treatment to Prevent Rheumatoid Arthritis
The window of opportunity concept in RA shifted our focus to trying to treat disease earlier and more aggressively to improve long term outcomes. A natural development of this was to reconsider the possibility of therapeutic interventions aimed at the prevention of rheumatoid arthritis.
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Should You De-escalate DMARDs in RA?
I'm here to talk about de-escalation of DMARDs in patients who are in remission. Should you do it? Here's what I think.
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New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.
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RA-ILD takes centre stage
Interstitial lung disease is common in RA, occurring in approximately 8% of RA patients. It is associated with a poor prognosis, and a median survival of 3 years. This important condition has often been neglected within the spectrum of RA research. That is changing, with excellent research initiatives presented at ACR22. I am going to highlight two select abstracts from Monday’s dedicated RA-ILD session.
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Where are we with treating Pre-Rheumatoid Arthritis?
The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.
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Avoid Abatacept in RA patients with a history of cancer?
The management of RA patients with a history of cancer continues to be an area of concern. General recommendations are to treat patients with a history of solid organ cancer as no different to any other RA patient. Recently, the ORAL-Surveillance study demonstrated evidence of a greater risk of cancer with tofacitinib than with TNF inhibitors. In this setting, two posters both reassure and raise a new cause for concern.
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Topical therapies take centre stage
Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium.
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A Big Leap in Modulating Rheumatoid Disease
Intervention in individuals predisposed to develop rheumatoid arthritis (RA), with a holy grail of prevention of RA, has long been a hot topic. It is well known that seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptides (ACPA) can precede RA disease by many years. Many, but by no means all, patients also seem to go through a pre-RA arthalgia phase of varying duration characterised by the presence of increasing joint pain without frank arthritis.
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