- A review of rheumatology highlights from 2017 found that different subtypes of juvenile arthritis are associated with distinct HLA types, though oligoarthritis and polyarthritis share the same associations. Classification of JIA may move to be based on genotype rather than clinical presentation. - Studies found tocilizumab improves outcomes for giant cell arteritis by reducing prednisone dosage compared to placebo. Baricitinib and tofacitinib were found effective for rheumatoid arthritis and psoriatic arthritis, respectively. - Celecoxib was found as safe for cardiovascular risks as naproxen and ibuprofen. Intra-articular steroids were found to increase cartilage loss in knee osteoarthritis with no pain

1. Highlights Rheumatology 2017
Professor M.S Soyfoo
ULB Erasme
11 Jan 2018

2. Une année intéressante…

3. • Est-ce que le génotype définit mieux AJI que la
clinique?
• Locus MHC
• Cohortes AJI : 5043 Contrôles : 14 390
• Méthodes:
-Fine mapping MHC locus, Immunochip, SNP2HLA,

4. Différents sous type de AJI ont des associations avec des typages HLA
distincts. Cependant ….
• Oligo et polyarthrite ont des associations HLA identiques
• Associations génotypiques oligo et polyarthrite sont identiques à
celles de la PR adulte
• Association enthésites avec spondylarthrite ankylosante de l’adulte
• AJI systémique est distincte
Classification future de AJI basée sur le génotype et non sur la
clinique

5. • Estce que TCZ améliore la rémission sans corticoides?
• ECRDA ..TCZ vs PCO ….4 bras :
-PBO + 26 sem GC
-PBO + 52 sem GC
-TCZ 162mg/sem +26 sem GC
-TCZ 162mg/2sem + 26sem GC
• Primary Outcome: sustained remission (flare free) at 52 weeks:
- Flare defined as as renewal of symptoms or ESR > 30mm/h

6. .
TCZ offers an alternative treatment for GCA that
should limit prednisone dosage while improving
clinical outcomes

7. Is BARI effective among RA with MTX-IR? How does it
compare with a TNFi(ADA)?
•DBRCT, 52 week duration w/ escape at wk24
•Arms: BARI 4mg qd, ADA 40mg qow, vs PBO
•N = 1305
•Primary outcomes: ACR20 at week 12
–Superiority vs PBO
–Non-inferiority vs ADA, with pre-planned superiority
testing
Taylor PC et al. N Engl J Med 2017;376:652-662.

8. Taylor PC et al. N Engl J Med 2017;376:652-662.
Primary and Secondary Efficacy End Points.
BARI demonstrates efficacy for RA
and compares favorablywith ADA,

9. Is TOFA effective for PsA among MTX-IRs?
•DBRCT, 24wk duration w/ escape at wk12
•3 Arms: TOFA 5 or 10mg bid, vs PBO
•N = 395
•Primary outcomes: at week 12
–ACR20
–HAQ-DI
Gladman D et al. N Engl J Med 2017;377:1525-1536.

10. American College of Rheumatology (ACR) 20 Response and Change from Baseline in
Health Assessment Questionnaire–Disability Index (HAQ-DI) Score through 6 Months.
Gladman D et al. N Engl J Med 2017;377:1525-1536. Mease P et al. N Engl J Med 2017;377:1537-1550.
TOFA demonstrates efficacy, similar to ADA, in PsA.

11. Is CEL as safe on CV system as NAP and IBU?
•DBRCT, non-inferiority
•Doses: CEL 100-200 bid (209mg), NAP 375-500 bid (852mg),
IBU 600-800 tid(2045mg)
•N = 24,081; mean tx 20mos and mean f/u 34mos
•Primary outcomes:
–APTC = MI, stroke, CV death
–Renal, GI, mortality
•Intention to treat analysis, also on-treatment
•Pre-specified substudy on blood pressure changes

12. Nissen SE et al. N Engl J Med 2016;:2519-2529.

13. PRECISION TRIAL
Nissen SE et al. N Engl J Med 2016;:2519-2529.

14. Does IA steroid impact cartilage volume and
pain in knee OA?
•DBRCT, comparing IA steroids with IA saline, every
3mos
•N = 140; symptomatic KOA and U/S synovitis
•Primary outcomes at 24 mos:
–Cartilage: thickness, damage and volume
–WOMAC: pain, function, stiffness
Mc Alindon et al. Jama 2017;317(19);1967-75

15. Mc Alindon et al. Jama 2017;317(19);1967-75

16. Intraarticular triamcinolone increased
cartilage loss and had no effect on knee pain

17. Does MEP improve outcomes in EGPA?
•DBRCT, comparing MEP 300mg SQ q4wks with PBO
•N = 136
•Primary outcome = weeks in remission during first year
–Remission defined as:
•BVAS = 0 AND
•the receipt of prednisolone or prednisone at a dose of
4mg or less per day over the 52-week period

18. Wechsler ME et al. N Engl J Med 2017;376:1921-1932.
Remission and First Relapse of Eosinophilic Granulomatosis with Polyangiitis in the
Intention-to-Treat Population.
6-fold higher probability of remission for
MEP over PBO
•70% lower risk for relapse
•Significantly less steroid use over 52
weeks
MEP offers an alternative treatment for EGPA
that
should limit steroid dosage while improving
clinical outcomes

19. Does bariatric surgery associate with reduced risk of PsO or PsA?
Do effects differ by type of bariatric surgery?
–Bypass produces known metabolic effects
–Banding reduces the capacity of stomach
•Observational cohort
•N = 12,364 with bypass and 1,071 with banding
•Primary outcomes:
–PsOor PsA
•Cox regression adjusted for age, sex, alcohol use, SES, smoking,
and diabetes
•Pre-surgery patients served as their own controls

20. Gastric bypass associates with a reduced risk of
PsOand PsA, possibly providing insights into
metabolic correlates associated with PsO/PsA.

21. van der Heijde et al. Ann Rheum Dis 2017;76:1340-1347
Is TOFA better than PBO for AS? At what dosage?
•DBRCT, Phase II
•Dosages: TOFA 2mg bid, 5mg bid, 10mg bid vs PBO
•N = 207
•Primary outcomes at 12 weeks:
–ASAS20
–MRI findings: SI joints and spine (Berlin and SPARCC)

22. Désirée van der Heijde et al. Ann Rheum Dis 2017;76:1340-
1347
©2017 by BMJ Publishing Group Ltd and European League Against Rheumatism

23. TOFA demonstrates short-term
efficacy for AS with evidence
of radiographic improvement.

24. How much can dietary manipulations change SUA?
•RCT, ancillary analysis, n = 103
•DASH diet: Rich in fruits, vegetables, low fat or nonfat dairy,
whole grains, lean meats, fish, nuts and beans.
•Sodium manipulation:
–low (60mmoles/d),
–medium (120mmoles/d)
–high (180mmoles/d)
•Primary outcome:
–Serum urate measured after 30 day sodium trial

25. Juraschek et al. Arthritis and
rheumatology 2017

26. Is LES in combination with ALLO more effective in lowering
serum urate than ALLO alone?
•DBRCT; 3 arms:
–LES 200mg + ALLO 300mg
–LES 400mg + ALLO 300mg
–PBO + ALLO 300mg
•N = 603; ≥ 6mg/dl despite stable ALLO + 2 flares in yr prior
•Outcomes:
–Primary: Proportion achieving < 6mg/dl at 6 months
–Secondary: SUA at 12 months

27. Lesinurad, in combination with ALLO, lowers
SUA.
400mg produced better reductions in SUA
than 200mg
but with increased adverse events.

28. Is 1yr of ROMO better than ALEN for fx prevention?
•DBRCT, ALEN 70mg weekly or ROMO 210mg monthly
•During months 13-24 all women received ALEN
•N = 4093 post-menopausal women with OP (fx and/or BMD)
•Primary outcomes at 24 months:
–Vertebral fx
–Clinical fx = clinically apparent vertebral fx and other fx
–First non-vertebral fx

30. Saag KG et al. N Engl J Med 2017;377:1417-1427.
Incidence of New Vertebral, Clinical, and Nonvertebral Fracture.
Increased number of CV events in the ROMO group
50 vs 38

31. Is there a cancer risk associated with bDMARDs?
•Observational study combining Swedish RA cohorts with
cancer registries
•New initiators; N = 15,129 TNFi
–N = 7,405 other bDMARDs,
–N = 46,610 csDMARDs
•Primary outcomes:
–Any malignant neoplasm, excluding NMSCs
•Secondary outcomes:
–Specific neoplasms
•Cox regression with relevant covariates

32. Hjalmar et al Jama internal medicine
2017