Rheumatology

Large US cohort shows poor LDL goal attainment and under-treatment in rheumatology patients

In ≈4 million US adults with rheumatologic disease and elevated ASCVD risk, mean LDL was 98 mg/dL and only 18.1% achieved LDL <70 mg/dL. Dyslipidemia was common (51.4%) yet 22.7% were not on antihyperlipidemic therapy during the study period. Among those with ASCVD risk 7.5–20% and >20%, 28.5% and 19.9% respectively lacked antihyperlipidemic prescriptions. Authors conclude lipid management is suboptimal and recommend multidisciplinary cardio-rheumatology implementation strategies. 1

Reviews often mishandle combining RCT and non-randomized evidence for harms

Among 195 systematic reviews that synthesized RCTs and NRSIs for the same harms, 91 (46.7%) pooled both designs in one meta-analysis. Major gaps included inclusion of NRSIs at moderate/high risk of bias in 72.5% and use of unadjusted estimates in 49.5% of pooled analyses. When RCTs and NRSIs were meta-analyzed separately, 67.6% showed qualitative disagreement between designs. The authors warn that inadequate, design-unaware syntheses can lead to misleading safety conclusions. 2

Treat-to-target works in elderly-onset RA with reassuring risk-benefit

In a multicenter RCT subset of 425 RA patients, 98 had elderly-onset RA (mean age 73) managed under a fixed T2T protocol. DAS44 trajectories were similar between EORA and YORA, with EORA showing more sustained remission and less active disease. First bDMARD initiation was lower in EORA (28% vs 38%; HR 0.7, 95% CI 0.4–1) and D2T-RA was rare in both groups. Adverse events, glucocorticoid exposure, and biologic survival were comparable, supporting T2T applicability with individualization. 3