Rheumatology

PRO-based model accurately predicts DAS for remote RA treat-to-target

A LASSO-based model using age, sex, disease duration, VAS general health, VAS pain, and 7 HAQ-DI items predicted DAS in RA visits. Across derivation, internal, and external cohorts, AUC-ROC for detecting active disease (DAS>2.4) was 0.89, 0.89, and 0.82, respectively. For remission (DAS<1.6), AUC-ROC values were 0.86, 0.85, and 0.82, indicating strong discrimination without joint counts or labs. Threshold-specific test characteristics allow clinicians to favor sensitivity for flare detection or specificity to limit unnecessary interventions. 1

Antimitochondrial antibodies predict nephritis, vascular events, and death in SLE

In 1114 inception SLE patients, antiwhole mitochondria, antimitochondrial DNA, and antimitochondrial RNA antibodies were all higher than in healthy individuals. Most recent antimitochondrial DNA and RNA antibody levels independently predicted nephritis, with adjusted hazard ratios about 1.6 per SD increase. Baseline antiwhole mitochondria predicted early mortality, while recent antimitochondrial DNA remained associated with mortality throughout follow-up. AmtRNA showed stronger associations with arterial vascular events in females, suggesting sex-specific prognostic information. Serial AMA measurement could refine risk stratification and monitoring intensity for nephritis, arterial events, and death. 2

Continuing nintedanib beyond 12 months benefits SARD-related progressive pulmonary fibrosis

This cohort included 65 SARD-ILD patients with progressive pulmonary fibrosis, mainly systemic sclerosis, idiopathic inflammatory myopathies, and RA. Before nintedanib, percent predicted FVC declined similarly in eventual continuation and discontinuation groups, indicating comparable pre-treatment trajectories. After 12 months, continuation was associated with improved FVC and greater KL-6 reductions compared with early discontinuation. ILD-related survival was significantly better in the continuation group, suggesting a survival advantage with longer treatment. These data support maintaining nintedanib beyond 12 months in tolerating SARD-ILD patients to stabilize lung function and outcomes. 3

Fatigue remains high and stable in inflammatory rheumatic diseases despite improved inflammation

Using a national database (~9300 patients annually), fatigue was assessed in arthritides, spondyloarthritides, connective tissue diseases, and vasculitides from 2007–2023. Between 55% and 67% of patients reported fatigue, with severe fatigue in up to 26%, particularly in systemic sclerosis. Over 17 years, CRP, tender joints, physician global scores, and employment improved substantially, yet mean fatigue scores remained unchanged. Trajectory analysis showed 23% with persistently high and 24% with worsening fatigue, driven more by emotional, functional, coping, and sleep factors than inflammation. 4