Rheumatology

Two years of ≤7.5 mg/day glucocorticoids in RA causes lumbar spine BMD loss but not femoral loss or more fractures

In randomized trials pooled as an IPD meta-analysis (1112 participants), low-dose glucocorticoids (≤7.5 mg prednisone-equivalent daily) produced greater lumbar spine bone loss over 2 years (mean difference -0.021 g/cm², 95% CI -0.037 to -0.005). Femoral BMD change was not different between groups (0.004 g/cm²; 95% CI -0.008 to 0.016). Thirty-five participants experienced ≥1 clinical fracture with comparable rates between GC and control groups over 2 years. These findings apply to RA patients receiving background DMARDs and low-dose GC for up to 2 years. 1

Modified 3-month rifapentine–isoniazid (3HP-PUMCH) non-inferior to 9 months isoniazid for LTBI in high-risk rheumatic patients

In a multicenter randomized trial of 536 immunosuppressed adults with high-risk rheumatic disease, 3HP-PUMCH yielded 0.00% tuberculosis versus 1.15% with 9H (rate difference -1.15 percentage points). Treatment completion was high in both arms (89.6% vs 91.2%), and hepatotoxicity was less common with 3HP-PUMCH (4.4% vs 10.4%, p=0.010). Drug discontinuation for serious adverse events was low and similar between groups, supporting feasibility in complex rheumatic populations. Non-inferiority margin was prespecified; apply this regimen when rifapentine interactions and local guidance permit. 2

Rheumatoid arthritis predicts higher respiratory mortality in NTM-PD, partly mediated by ILD and inflammation

In a retrospective cohort of 1420 NTM-PD patients, those with RA had higher respiratory-related mortality (multivariable HR 4.30, 95% CI 2.17–8.52). Five-year survival was worse for RA patients (74.7% vs 92.9%), and propensity-matched differences persisted. Sequential adjustment showed ILD and systemic inflammation substantially attenuated the RA-associated hazard, implicating structural lung disease and inflammation as mediators. Clinically, RA patients with NTM-PD warrant careful ILD assessment and aggressive inflammation control where appropriate. 3