Objectives: The role of JAK inhibitors in immune-mediated adverse events was not included in the EULAR 2021 guidance on the management of rheumatic immune-related adverse events (irAE) from checkpoint inhibitors or the society of immunotherapy of cancer guidelines on this topic. We aim to describe the role of JAK inhibitors for the management of immune-mediated adverse events with a review of case reports. Methods: Pubmed, EMBASE and MEDLINE searches were performed from inception until 25 May 2025 for case reports/series of the use of JAK inhibitors to treat checkpoint inhibitor-induced immune adverse events. Five EMA-licensed JAK inhibitors (tofacitinib, baritinib, upadacitinib, filgotinib and ruxolitinib) were included in addition to peficitinib. The 11 FDA-approved checkpoint inhibitors were included. Results: Published case reports, case series and cohort data included 104 patients. Most patients received tofacitinib (82%). Pembrolizumab monotherapy represented the most common immune checkpoint inhibitor. The commonest cancers were lung (20%), followed by gastric (17%) and metastatic melanoma (16%). The indication for JAK inhibitor therapy for irAEs was predominantly myocarditis (70%), followed by myositis (33%) and hepatitis (24%). Tumour progression was observed in 38% of patients, with 14% remaining in remission. Across all patients, 4% died due to progression of their cancer. Conclusion: JAK inhibitors are emerging as a promising option for the treatment of immune checkpoint inhibitor-related toxicities. The currently published evidence, primarily from case reports and case series, suggests they have efficacy, particularly in patients who have failed to respond to other cytokine inhibition strategies.

Gout is the most prevalent inflammatory arthritis, yet one of the worst managed. Our objective was to assess how the COVID-19 pandemic impacted incidence and quality of care for people with gout in England, UK. With the approval of National Health Service England, we did a population-level cohort study using primary care and hospital electronic health record data for 17·9 million adults registered with general practices using TPP health record software, via the OpenSAFELY platform. The study period was from March 1, 2015, to Feb 28, 2023. Individuals aged 18-110 years were defined as having incident gout if they were assigned index diagnostic codes for gout, were registered with TPP practices in England for at least 12 months before diagnosis, did not receive prescriptions for urate-lowering therapy more than 30 days before diagnosis, and had not been admitted to hospital or attended an emergency department for gout flares more than 30 days before diagnosis. Outcomes assessed were incidence and prevalence of people with recorded gout diagnoses, incidence of gout hospitalisations, initiation of urate-lowering therapy, and attainment of serum urate targets (≤360 μmol/L). From a reference population of 17 865 145 adults, 246 695 individuals were diagnosed with incident gout. The mean age of individuals with incident gout was 61·3 years (SD 16·2). 66 265 (26·9%) of 246 695 individuals were female, 180 430 (73·1%) were male, and 189 035 (90·9%) of 208 050 individuals with available ethnicity data were White. Incident gout diagnoses decreased by 30·9% in the year beginning March, 2020, compared with the preceding year (1·23 diagnoses vs 1·78 diagnoses per 1000 adults). Gout prevalence was 3·07% in 2015-16, and 3·21% in 2022-23. Gout hospitalisations decreased by 30·1% in the year commencing March, 2020, compared with the preceding year (9·6 admissions vs 13·7 admissions per 100 000 adults). Of 228 095 people with incident gout and available follow-up, 66 560 (29·2%) were prescribed urate-lowering therapy within 6 months. Of 65 305 individuals who initiated urate-lowering therapy with available follow-up, 16 790 (25·7%) attained a serum urate concentration of 360 μmol/L or less within 6 months of urate-lowering therapy initiation. In interrupted time-series analyses, urate-lowering therapy prescribing improved modestly during the pandemic, compared with pre-pandemic, whereas urate target attainment was similar. Using gout as an exemplar disease, we showed the complexity of how health care was impacted during the COVID-19 pandemic. We observed a reduction in gout diagnoses but no effect on treatment metrics. We showed how country-wide, routinely collected data can be used to map disease epidemiology and monitor care quality. None.

Background: Pneumococcal pneumonia is an important cause of morbidity and mortality amongst patients with inflammatory arthritis. Vaccination is recommended by the National Institute for Health and Care Excellence (NICE) but it remains unclear how vaccine efficacy is impacted by different immunosuppressive agents. Our objective was to compare the chance of a seroconversion following vaccination against pneumococcus in patients with inflammatory arthritis to that in the general population, as well as to compare the chance of seroconversion across different targeted therapies. Methods: We searched MEDLINE, Embase and the Cochrane Library databases from inception until 20 June 2023. We included randomized controlled trials and observational studies. Aggregate data were used to undertake a pairwise meta-analysis. Our primary outcome of interest was vaccine seroconversion. We accepted the definition of serological response reported by the authors of each study. Results: Twenty studies were identified in the systematic review (2807 patients) with ten reporting sufficient data to be included in the meta-analysis (1443 patients). The chance of seroconversion in patients receiving targeted therapies, relative to the general population, was 0.61 (95% CI 0.35 to 1.08). The reduced odds of response were skewed strongly by the effects of abatacept and rituximab with no difference between patients on TNF inhibitors (TNFis) or IL-6 inhibition and healthy controls. Within different inflammatory arthritis populations the findings remained consistent, with rituximab having the strongest negative impact on vaccine response. TNF inhibition monotherapy was associated with a greater chance of vaccine response compared with methotrexate (2.25 (95% CI 1.28 to 3.96)). JAK inhibitor (JAKi) studies were few in number and did not present comparable vaccine response endpoints to include in the meta-analysis. The information available does not suggest any significant detrimental effects of JAKi on vaccine response. Conclusion: This updated meta-analysis confirms that, for most patients with inflammatory arthritis, pneumococcal vaccine can be administered with confidence and that it will achieve comparable seroconversion rates to the healthy population. Patients on rituximab were the group least likely to achieve a response and further research is needed to explore the value of multiple-course pneumococcal vaccination schedules in this population.

Objective: To assess the reproducibility of patient-reported tender (TJCs) and swollen joint counts (SJCs) of patients with rheumatoid arthritis (RA) compared to trained clinicians.Methods: We conducted a systematic literature review and metaanalysis of studies comparing patient-reported TJCs and/or SJCs to clinician counts in patients with RA. We calculated pooled summary estimates for correlation. Agreement was compared using a Bland-Altman approach.Results: Fourteen studies were included in the metaanalysis. There were strong correlations between clinician and patient TJCs (0.78, 95% CI 0.76–0.80), and clinician and patient SJCs (0.59, 95% CI 0.54–0.63). TJCs had good reliability, ranging from 0.51 to 0.85. SJCs had moderate reliability, ranging from 0.28 to 0.77. Agreement for TJCs reduced for higher TJC values, suggesting a positive bias for self-reported TJCs, which was not observed for SJCs.Conclusion: Our metaanalysis has identified a strong correlation between patient- and clinician-reported TJCs, and a moderate correlation for SJCs. Patient-reported joint counts may be suitable for use in annual review for patients in remission and in monitoring treatment response for patients with RA. However, they are likely not appropriate for decisions on commencement of biologics. Further research is needed to identify patient groups in which patient-reported joint counts are unsuitable.

Objectives: Current guidelines recommend pneumococcal vaccination in individuals who are over the age of 65 or are immunosuppressed due to a disease or treatment. The objective of this study was to assess vaccine uptake rates in people with inflammatory arthritis for the pneumococcal, influenza and Covid-19 vaccines and factors determining uptake. Methods: We conducted a retrospective single centre cohort study in the UK of individuals with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis between October and December 2023. Data were collected for age, gender, co-morbidities, immunosuppressive therapies and dates of vaccines. Logistic regression was used to evaluate predictors of vaccine uptake, with adjustments for demographic and clinical factors. Results: Nine hundred and six individuals were identified; 46% were receiving treatment with conventional synthetic DMARD (csDMARD), 26% were on biologic monotherapy, and 23% were on both biologic and csDMARDs. Three hundred and sixteen individuals (35%) received a pneumococcal vaccine, lower than uptake for influenza (63%) and Covid-19 (87%) vaccines. Predictors of pneumococcal vaccine uptake included age, with older patients more likely to be vaccinated (odds ratio [OR] for age ≥ 65 years: 1.67; 95% CI: 1.21, 2.29). Those on biologic therapy demonstrated higher likelihood of vaccination (OR for biologic therapy: 1.81; 95% CI: 1.33, 2.47). Additional Joint Committee on Vaccination and Immunisation Green Book indicators also positively influenced vaccine uptake (OR: 1.67; 95% CI: 1.19, 2.33). Conclusion: Pneumococcal vaccine uptake in inflammatory rheumatic diseases is low, especially in younger patients and those not on biologic therapy. The study highlights the need for a focused approach, distinct from strategies for other vaccines, to address this public health challenge.

In COVID-19 the right lung has higher degree of opacification on plain radiograph than the left lung. Right lung opacificiation is a stronger predictor for critical care admission and death.