30-Second Takeaway
- Tofacitinib monotherapy achieved better 3‑month control and cost-effectiveness than methotrexate plus steroid bridge in DMARD-naïve RA.
- EULAR safety review highlights higher serious infection risk with bDMARDs versus csDMARDs and increased herpes zoster and VTE with JAK inhibitors.
- Oral glucocorticoid bridging on methotrexate increased flare risk after taper, unlike intra-articular bridging plus triple therapy versus bDMARDs.
- Multimorbidity strongly amplifies serious and opportunistic infection risk in RA, underscoring comorbidity optimization alongside DMARD decisions.
- Targeted therapies in psoriasis/PsA show divergent lipid effects, especially global lipid rises with JAK inhibitors and improvements with TNF inhibitors.
Week ending April 11, 2026
Early RA strategy, multimorbidity infections, PsA trajectories, lipid signatures, PR-to-RA evolution, vitamin D in SLE, and zoster vaccination in Sjögren’s
Tofacitinib monotherapy beats methotrexate plus steroid bridge for early RA control
In this open-label RCT of 116 DMARD-naïve RA patients, tofacitinib 5 mg BID outperformed methotrexate plus single IM betamethasone at 3 months. Clinical improvement by SDAI criteria occurred in 94.1% on tofacitinib versus 75% on methotrexate plus glucocorticoid bridging (P = .02). Tofacitinib produced greater reductions in SDAI, CDAI, DAS28-CRP, and DAS28-ESR, with similar short-term safety between groups. Cost-effectiveness analysis favored tofacitinib, supporting tofacitinib monotherapy as a potential first-line bridging option in DMARD-naïve RA.
EULAR safety SLR: infections, malignancy, and thrombosis across RA DMARDs
This systematic review for the 2025 EULAR RA update included 71 comparative safety studies of csDMARDs, bDMARDs, targeted synthetic DMARDs, and glucocorticoids. Serious infections were generally more frequent with bDMARDs than csDMARDs, while JAK inhibitors conferred higher herpes zoster risk than bDMARDs. Tuberculosis risk was not higher with JAK inhibitors versus bDMARDs, but was increased with infliximab and adalimumab versus etanercept. No consistent excess of major adverse cardiovascular events emerged with JAK inhibitors versus bDMARDs, but venous thromboembolism, especially pulmonary embolism, appeared increased. Nonmelanoma skin cancer was more common in RA versus the general population without clear attribution to a specific DMARD, and no robust monitoring evidence was identified.
Oral glucocorticoid bridging raises flare risk after tapering in early RA
This post hoc NORD-STAR analysis compared flare risk with oral glucocorticoid bridging plus methotrexate, intra-articular bridging plus triple therapy, and bDMARDs in early RA. By 48 weeks, at least one CDAI flare occurred in 43% of oral glucocorticoid, 24% of injection glucocorticoid, and 28% of bDMARD-treated patients. Versus bDMARDs, oral glucocorticoid bridging carried higher over-time flare risk (adjusted RR 1.54; 95% CI 1.16–2.03), whereas intra-articular bridging did not. At the visit after protocol-defined glucocorticoid discontinuation, 27% of patients stopping oral steroids flared, including 29% previously in remission.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.