Rheumatology

Physician assessments exceed patient-reported improvements; swollen joints drive discrepancy

In 73 double-blind RCTs (165 comparisons; 33,956 patients) targeted therapies produced larger physician than patient global improvements (ΔSMDGlobal = -0.09). Physician global SMD was -0.60 and patient global SMD -0.50, a small but consistent gap favoring physician-assessed change. Multivariable analyses identified disability, TJC and SJC as correlates of both assessments, with SJC the only domain explaining the physician–patient contrast. Pain associated independently with patient global assessment, supporting greater emphasis on PRO pain endpoints in trials and practice. 1

Wrist and MCP2/3 joints resolve more slowly after b/tsDMARD start

In Swiss registry data (598 bio-naïve TNFi; 1,942 overall b/tsDMARD starts) most 28-joint count sites improved faster than the wrist. The second and third MCP joints (MCP2/3) and sometimes the knee had similar or slower resolution compared with the wrist. This joint-specific pattern was consistent across b/tsDMARD classes, suggesting anatomical variation in treatment trajectory. When these joints are involved, consider longer follow-up before judging treatment failure or use of bridging intra-articular steroids. 2

Baseline non-inflammatory factors predict unacceptable pain at 2 years in early RA

In a nationwide cohort of 10,297 early RA patients (3,427 with 2‑year data), 1,143 (33%) had unacceptable pain (VAS>40mm) at 2 years. Baseline predictors of unacceptable pain and of unacceptable pain with low inflammation included female sex, worse PROs, low inflammatory markers, and disproportionately more tender than swollen joints. Smoking, non‑European origin, and psychiatric or pain comorbidities predicted more pain over time. These findings imply pain outcomes often reflect non‑inflammatory drivers, requiring multimodal management beyond escalation of anti‑inflammatory therapy. 3