Rheumatology

TNF inhibitors were associated with substantially lower systemic autoimmune disease risk than IL-6 inhibitors in JIA

This TriNetX-based cohort included 2,384 pediatric JIA patients starting TNF or IL-6 inhibitors, matched 1:1 on baseline characteristics. After matching, TNF inhibitor users had fewer systemic autoimmune diseases than IL-6 inhibitor users (17 vs 45 events). TNF inhibition was associated with markedly reduced SAD risk (HR 0.37, 95% CI 0.20–0.63) compared with IL-6 inhibition. Subgroup and sensitivity analyses showed consistent protective associations across age, sex, and concomitant medication strata. 1

Treat-to-target urate lowering modestly reduced 5-year MACE risk in gout

This emulated target trial followed 109,504 adults with gout newly starting urate-lowering therapy for up to 5 years. Achieving serum urate <6 mg/dL within 12 months was associated with lower MACE risk than not achieving target (weighted HR 0.91, 95% CI 0.89–0.92). Absolute 5-year event-free survival was 1.0% higher with treat-to-target, with larger benefit in patients at high cardiovascular risk. Achieving urate <5 mg/dL yielded greater risk reduction (HR 0.77, 95% CI 0.72–0.81) and higher survival difference. 2

Incident dermatomyositis showed high steroid burden, heterogeneous immunomodulator use, and substantial complications

This study used US commercial claims and a rheumatology EHR network to describe 2,475 and 1,196 patients with incident dermatomyositis, respectively. Among 998 EHR patients with labs, 35% of those with myositis panels had a positive myositis-specific antibody. Glucocorticoid use was common in both cohorts, usually starting above 20 mg/day with high cumulative exposure. Hydroxychloroquine, methotrexate, and mycophenolate were the most frequently used immunomodulators, but regimens varied widely. 3

Low gamma globulin independently predicted herpes zoster risk in SLE

Among 224 SLE patients, 13.4% had herpes zoster, with an incidence of 0.81 per 100 patient-years. On univariable analysis, longer steroid and immunosuppressant exposure, biologic use, and lower gamma globulin levels were associated with zoster. In multivariable analysis, only gamma globulin remained independently associated (OR 0.86, 95% CI 0.74–0.98). A gamma globulin threshold of 10.3 g/L best discriminated zoster risk (AUC 0.71, 95% CI 0.59–0.82). 4