Rheumatology

Reduced-dose JAK inhibitors show comparable 24-month retention in RA with preserved renal function

In this multicentre propensity-matched registry of 1,135 RA patients, reduced initial JAKi dosing produced similar 24-month drug retention versus standard dosing in those with preserved renal function. Disease activity improved similarly and glucocorticoid use remained low in both groups. Reduced dosing performed comparably when poor prognostic factor (PPF) burden was low, whereas standard dosing favored persistence with multiple PPFs. In patients with reduced renal function, standard dosing was associated with higher drug retention, so renal status should guide dosing decisions. 1

Early postpartum period linked to increased RA flares but not increased SpA activity

Ancillary analysis of the GR2 cohort (94 RA, 124 SpA) found RA patients had more flares in the first 6 months postpartum versus pregnancy (62.0% vs 43.5%, p=0.02). SpA patients showed no change in activity postpartum compared with pregnancy (40.7% vs 40.7%). About half of patients who stopped DMARDs during pregnancy restarted biologics postpartum. Breastfeeding duration did not significantly alter postpartum disease activity in either disease. 2

Clinical deep remission predicts higher 5‑year sustained remission and attenuates tapering risk

In a real-world RA cohort (n=541; 145 with 5-year follow-up), patients achieving CliDR had higher 5-year sustained remission (62.5% vs 38.1%; p=0.014). Tapering without CliDR was associated with a large relapse risk (HR 8.47 in non-CliDR patients). The interaction analysis suggested tapering's harmful effect was substantially reduced after achieving CliDR. These data support requiring objective deep remission before elective tapering to minimize relapse. 3