Rheumatology最新文献

{"title":"All-cause mortality in statin-associated immune-mediated necrotizing myopathy compared with idiopathic inflammatory myopathy.","authors":"Oluoma M Edeh, Tam N Dinh, Maheswari Muruganandam, Frank X O'Sullivan, Avinash Sahu, Wilmer L Sibbitt","doi":"10.1093/rheumatology/keag536","DOIUrl":"10.1093/rheumatology/keag536","url":null,"abstract":"<p><strong>Objectives: </strong>Statin-associated immune-mediated necrotizing myopathy (IMNM) is a distinct idiopathic inflammatory myopathy (IIM) associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. The present study determined all-cause mortality among patients with statin-associated IMNM.</p><p><strong>Methods: </strong>In this retrospective cohort study of 142 adult patients with IIM evaluated at a tertiary academic medical centre, statin-associated IMNM was defined by IMNM with recent statin exposure. IIM was defined by standard criteria. The primary outcome was all-cause mortality. Age-adjusted Cox proportional hazards models were the primary analyses with additional adjustments for age, diabetes mellitus and hyperlipidaemia with propensity score-weighted Cox models.</p><p><strong>Results: </strong>Among 142 patients with IIM, 41 were statin-associated IMNM who were older and had shorter disease duration (P < 0.05). All-cause mortality was higher in statin-associated IMNM (31.7%, 13/41) than in IIM (23.8%, 24/101) (unadjusted hazard ratio [HR] 2.55, 95% CI 1.24-5.24; P = 0.011), with cardiopulmonary events and infections the major causes of death. In unadjusted analysis, statin-associated IMNM was associated with higher mortality (HR 2.55, 95% CI 1.24-5.24) and attenuated after age adjustment (HR 1.98, 95% CI 0.97-4.03) and was no longer statistically significant after adjustment for diabetes and hyperlipidaemia (HR 1.70, 95% CI 0.71-4.08). Joint stratification by anti-HMGCR status and age (cut-off 60 years) demonstrated that older patients with statin-associated IMNM had the lowest survival among the four strata (log-rank P = 0.036).</p><p><strong>Conclusions: </strong>Statin-associated IMNM is associated with higher mortality than other myositis subtypes; this excess attenuates after adjustment for age and cardiometabolic comorbidity, indicating these pre-existing conditions identify a higher-risk clinical phenotype.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canakinumab-associated suppression of an mTOR-related serum proteomic signature after switching from tocilizumab in Still's disease.","authors":"Kiyu Norimatsu, Tomohiro Koga, Shoichi Fukui, Kazusato Hara, Atsushi Kawakami","doi":"10.1093/rheumatology/keag526","DOIUrl":"10.1093/rheumatology/keag526","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early rheumatoid factor decline predicts subsequent clinical remission in rheumatoid arthritis: the ANSWER cohort.","authors":"Kenya Sugimoto, Ryu Watanabe, Yuya Fujita, Takayuki Fujii, Akira Onishi, Yuji Nozaki, Tetsu Itami, Kosuke Ebina, Yuki Etani, Hirotaka Yamada, Sho Sendo, Akihiro Tanaka, Hideki Amuro, Ayaka Yoshikawa, Takuya Kotani, Masaki Katayama, Wataru Yamamoto, Ryuhei Ishihara, Masao Katsushima, Kazuo Fukumoto, Shinsuke Yamada, Motomu Hashimoto","doi":"10.1093/rheumatology/keag498","DOIUrl":"10.1093/rheumatology/keag498","url":null,"abstract":"<p><strong>Objectives: </strong>To compare early changes in RF across classes of biological or targeted synthetic DMARDs (b/tsDMARDs) and assess whether early RF decline was associated with 12-month clinical remission in RA.</p><p><strong>Methods: </strong>We retrospectively analysed 1423 newly initiated b/tsDMARD treatment courses from the multicentre ANSWER cohort that continued for ≥12 months and had RF measured at baseline and 3 months. Early RF decline was defined as a ≥20% reduction at 3 months. Multivariable regression assessed factors associated with RF change and 12-month Clinical Disease Activity Index (CDAI) remission. Twelve-month remission rates were also compared across four categories of RF reduction.</p><p><strong>Results: </strong>RF reduction differed across classes, with Janus kinase inhibitors (JAKi) showing the greatest decline. Compared with TNF inhibitors (TNFi), JAKi were associated with a greater RF reduction (β = -14.50, 95% CI: -20.04 to -8.97; P < 0.001). The direction was similar in multiple sensitivity analyses and remained significant in propensity score-matched analyses. Early RF decline was independently associated with 12-month CDAI remission (adjusted OR 1.39, 95% CI: 1.04-1.88; P = 0.029). A significant overall trend towards higher 12-month remission rates was observed across categories of greater RF reduction (P for trend = 0.004).</p><p><strong>Conclusion: </strong>Early RF decline differed across b/tsDMARD classes and was associated with 12-month remission. Longitudinal RF dynamics may provide clinically useful prognostic information in RA.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and severity classification in mixed connective tissue disease: a nationwide retrospective study.","authors":"Satoshi Kubo, Yurie Kanda, Hideto Kameda, Masataka Kuwana, Hidehiko Narazaki, Takao Fujii, Keishi Fujio, Yoshinao Muro, Konomi Akamatsu, Koichiro Ohmura, Takehisa Ogura, Yuichiro Shirai, Yujiro Tanabe, Ran Nakashima, Yumi Tsuchida, Shingo Nakayamada, Hisanori Hasegawa, Shintaro Hirata, Shusaku Fukaya, Takashi Kato, Hidekata Yasuoka, Yuta Yamashita, Michihito Kono, Tatsuya Atsumi, Yoshiya Tanaka","doi":"10.1093/rheumatology/keag577","DOIUrl":"10.1093/rheumatology/keag577","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize clinical manifestations, major organ involvement, real-world treatment patterns and factors associated with severity classification in Japanese patients with mixed connective tissue disease (MCTD), aiming to clarify its heterogeneous clinical spectrum.</p><p><strong>Methods: </strong>This nationwide retrospective multicentre study analyzed clinical data from 249 patients who strictly fulfilled the 2019 Japanese Ministry of Health, Labour and Welfare diagnostic criteria for MCTD, derived from an initial real-world registry of 311 clinically diagnosed patients. Clinical features, autoantibodies and therapeutic regimens were summarized and compared between patients with severe vs nonsevere disease.</p><p><strong>Results: </strong>The cohort was 93.1% female (median onset age 40.6 years). Common findings, specifically Raynaud's phenomenon and/or swelling of the fingers or dorsum of the hands, were present in 100%. Phenotypically, an overlap of systemic lupus erythematosus (SLE)-like and systemic sclerosis (SSc)-like features was most frequent (56.0%), while 32.0% had manifestations across all three phenotypic domains (SLE-, SSc- and IIM-like). Major organ involvement occurred in 32.9% of patients, including pulmonary arterial hypertension in 12.8%. Approximately 28.7% of evaluable patients were classified as severe. Off-scale-high anti-U1-RNP antibody status was not associated with severity classification (P = 0.492) or with broad phenotypic categories. Glucocorticoids and immunosuppressive agents were used in 66.7% and 56.5% of the patients, respectively.</p><p><strong>Conclusions: </strong>Mixed connective tissue disease exhibits marked clinical heterogeneity. Severity classification was not associated with off-scale-high anti-U1-RNP antibody status or broad phenotypic categories. These findings support rigorous cardiopulmonary screening and management tailored to the dominant clinical phenotype.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flares and definition of worsening in inflammatory myopathies: a narrative review of the literature.","authors":"Maria Rosa Pellico, Mert Öztaş, Latika Gupta","doi":"10.1093/rheumatology/keag522","DOIUrl":"10.1093/rheumatology/keag522","url":null,"abstract":"<p><p>Idiopathic inflammatory myopathies (IIMs) follow a chronic, polycyclic course in a substantial proportion of patients. Unlike remission, which has recently been standardized, the definition of flare (or worsening) remains highly heterogeneous, creating a divide between clinical trials and real-world practice. Validated core set definitions of worsening exist for trials but were derived by consensus on paper patient profiles and are criticized for inadequate content validity; observational studies instead rely on simplified markers such as enzyme elevation or therapeutic escalation. This review summarizes existing definitions, contrasting the International Myositis Assessment and Clinical Studies Group and Paediatric Rheumatology International Trials Organisation statistical criteria with the variable definitions used in longitudinal cohorts. We examine reported flare rates and predictors, the discordance between global and organ-specific (skin, muscle, lung) worsening, and the lessons offered by flare definitions in other rheumatic and inflammatory diseases. We then propose a multi-domain, treatment-anchored framework intended to bridge statistical rigour and clinical utility.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimalarial exposure and renal histopathologic findings in LN.","authors":"Fadi Kharouf, Pankti Mehta, Qixuan Li, Dafna D Gladman, Laura P Whittall Garcia, Zahi Touma","doi":"10.1093/rheumatology/keag569","DOIUrl":"10.1093/rheumatology/keag569","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the association between antimalarial exposure and renal histopathologic findings at kidney biopsy in patients with LN.</p><p><strong>Methods: </strong>This study was conducted within the University of Toronto Lupus Clinic cohort. To ensure adequate assessment of antimalarial exposure, patients were included if they underwent a kidney biopsy at least 3 months after clinic entry. The kidney biopsy served as the index time point (baseline) for the analysis and corresponded to the clinic visit immediately preceding the biopsy. Antimalarial exposure was defined as use during ≥2 consecutive clinic visits prior to biopsy. Sensitivity analyses evaluated longer durations of continuous antimalarial exposure (≥6 months and ≥1 year). Histopathologic outcomes included proliferative vs non-proliferative LN class, NIH activity index (AI), NIH chronicity index (CI) and interstitial fibrosis and tubular atrophy (IFTA) score. Associations were evaluated using logistic and linear regression models adjusted for demographic, clinical and treatment covariates.</p><p><strong>Results: </strong>The study included 165 patients with biopsy-proven LN (median age 35.3 years; 84.2% female; median disease duration 6.2 years), of whom 50.3% were on antimalarial therapy at baseline. In the adjusted multivariable analyses, antimalarial exposure was not associated with detectable differences in proliferative LN, NIH AI, NIH CI or IFTA score. Sensitivity analyses requiring ≥6 months and ≥1 year of continuous antimalarial exposure yielded similar findings.</p><p><strong>Conclusions: </strong>Antimalarial exposure was not associated with detectable differences in renal histopathologic findings at biopsy. These findings should be interpreted within the limitations of the study design and sample size.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term comparative outcomes of rituximab and belimumab in lupus patients.","authors":"Iftach Sagy, Rona M Smith, Kevin W Loudon, Lisa Willcocks, Hugo Tordesillas, Jane Hollis, David R W Jayne, Frances C Hall, Rachel B Jones","doi":"10.1093/rheumatology/keag572","DOIUrl":"10.1093/rheumatology/keag572","url":null,"abstract":"<p><strong>Objectives: </strong>Although rituximab and belimumab are recommended for SLE and LN, direct long-term comparative evidence is limited. We aimed to compare the effectiveness of rituximab vs belimumab in a real-world setting for treating SLE.</p><p><strong>Methods: </strong>This prospective, single-centre, observational cohort study analysed SLE patients who initiated biologics in the BILAG-BR registry at Addenbrooke's Hospital (2011-2025). We compared treatment periods with rituximab and belimumab among patients stable on therapy, without switching or entering clinical trials. The primary outcome was achieving low disease activity (SLEDAI-2K ≤4 and prednisolone ≤5 mg/day). Drug survival (time to drug switch or loss to follow-up) was also analysed.</p><p><strong>Results: </strong>Overall, 176 patients were included, contributing 175 rituximab treatment courses in 148 patients and 58 belimumab treatment courses in 58 patients. Median follow-up was 3.4 (2.0-5.0) years for rituximab and 2.0 (1.0-3.4) years for belimumab (P < 0.001). At baseline, belimumab users had higher SLEDAI-2K scores (12.4 ± 4.9 vs 9.5 ± 5.4, P < 0.001). In multivariate analyses, belimumab and rituximab did not differ in achieving low disease activity in either the multivariable Cox model (HR 0.92, 95% CI 0.57-1.48) or the propensity score overlap-weighted analysis (HR 0.86, 95% CI 0.54-1.37). Drug survival was similar when used as first-line biologic therapy. In contrast, among second-line biologic users, belimumab showed higher drug survival than rituximab (HR 1.34, 95% CI 1.03-1.77).</p><p><strong>Conclusion: </strong>In this observational cohort, belimumab was associated with similar rates of low disease activity as rituximab. Drug survival differed and warrants further study.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bimekizumab efficacy in male and female patients with axial spondyloarthritis: 52-week results from the phase 3 BE MOBILE trials.","authors":"Martin Rudwaleit, Sofia Ramiro, Denis Poddubnyy, Marina Magrey, Irene E van der Horst-Bruinsma, Atul Deodhar, Vanessa Taieb, Sarah Kavanagh, Natasha de Peyrecave, Lianne S Gensler","doi":"10.1093/rheumatology/keag425","DOIUrl":"10.1093/rheumatology/keag425","url":null,"abstract":"<p><strong>Objectives: </strong>To assess sex-based differences in response to bimekizumab in patients with axial spondyloarthritis (axSpA) from two phase 3 trials.</p><p><strong>Methods: </strong>Improvements to week 52 in measures of disease activity (ASAS40, ASDAS <2.1, BASDAI) and function (BASFI), pain, fatigue, health-related quality of life (HRQoL) and objective signs of inflammation (MRI, hs-CRP) were assessed post hoc in patients with non-radiographic (nr-) and radiographic (r-)axSpA from BE MOBILE 1 (NCT03928704) and BE MOBILE 2 (NCT03928743), respectively. Comparisons were made between sexes at week 16 (bimekizumab vs placebo treatment effect) and week 52 (treatment response in bimekizumab-randomized patients only) using odds ratios for dichotomous outcomes and difference values for continuous outcomes. For hs-CRP, ratio to baseline was calculated due to skewed distribution.</p><p><strong>Results: </strong>While sex distribution was balanced in nr-axSpA (54.3% male), 72.3% of patients with r-axSpA were male. At week 16, bimekizumab-randomized male patients typically had better treatment responses vs placebo compared with female patients across ASAS40, ASDAS <2.1 and improvements in BASDAI, BASFI and measures of HRQoL. At week 52, female patients had longer-term improvements across these outcomes, though male patients continued to have numerically higher treatment responses. In contrast, active inflammation (MRI, hs-CRP) was reduced to similarly low levels in both sexes at week 16 and maintained to week 52, despite baseline differences.</p><p><strong>Conclusion: </strong>Although male patients had earlier clinical responses to bimekizumab treatment, female patients demonstrated longer-term improvements in composite and patient-reported outcomes. Both sexes had substantial improvements in objective inflammation at week 16 and 52, despite baseline differences.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov; NCT03928704 and NCT03928743.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interferon-driven gene signature identifies two distinct subgroups in rheumatoid factor-positive polyarticular juvenile idiopathic arthritis.","authors":"Anna Agrusti, Clémence David, Sylvain Breton, Isabelle Melki, Pierre Quartier, Cécile Dumaine, Heloise Reumaux, Anne-Laure Jurquet, Benjamin Fournier, Luis Seabra, Gillian I Rice, Brigitte Bader-Meunier, Marie-Louise Frémond","doi":"10.1093/rheumatology/keag486","DOIUrl":"10.1093/rheumatology/keag486","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the demographic, clinical, serological, genetic background, course and value of the interferon (IFN) score in a cohort of patients with rheumatoid factor (RF)-positive polyarticular juvenile idiopathic arthritis (pJIA).</p><p><strong>Methods: </strong>Monocentric retrospective study of patients with RF-positive pJIA. Demographic, clinical and laboratory data were collected. The IFN score was calculated based on the expression levels of 24 IFN stimulated genes. Whole exome sequencing was performed in 22 patients.</p><p><strong>Results: </strong>Thirty-two patients were included. The IFN score was positive in 18 patients (56.2%) and negative in 14 patients (43.7%). An increased IFN score was associated with a significantly higher family history of autoimmunity (P = 0.0004), parental first-degree consanguinity (P = 0.05) and prevalence of antibodies to anti-cyclic citrullinated peptide (ACPA) (P = 0.01). Three patients with interstitial lung disease exhibited a positive IFN score. Conversely, demographic features and characteristics of polyarthritis did not differ between the two groups. Clinically inactive disease was achieved in 21/32 (66%) patients, with no significant difference according to the IFN score. Remission was never achieved with methotrexate alone. We identified one patient with a pathogenic de novo mutation in COPA. Additionally, ultra-rare variants in genes related to IFN and/or innate immunity were found in 21/22 (95.5%) patients.</p><p><strong>Conclusion: </strong>The IFN signature identified two distinct subgroups in RF-positive pJIA according to family history and immunological features. Our study suggests that patients with an elevated IFN score should be screened for pulmonary involvement. Future prospective studies are required to validate the use of the IFN score as a biomarker in RF-positive pJIA.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line biologic and targeted synthetic DMARDs versus methotrexate in early rheumatoid arthritis: a meta-analysis of remission outcomes.","authors":"Mark D Russell, Chun J Chan, Aran Sasitharan, Victoria Allen, Mark Gibson, Maryam A Adas, Samantha Goodliffe, Katie Bechman, Andrew P Cope, Sam Norton, Ailsa Bosworth, Peter Foxton, Elizabeth Price, Sana Sharrack, Shouvik Dass, Paul Emery, Lesley Kay, Peter Lanyon, James B Galloway","doi":"10.1093/rheumatology/keag515","DOIUrl":"10.1093/rheumatology/keag515","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate initial therapy with biologic and targeted synthetic DMARDs (b/tsDMARDs), compared with methotrexate, in patients with early RA.</p><p><strong>Methods: </strong>We systematically reviewed and meta-analysed randomized-controlled trials comparing initial b/tsDMARDs, combined with methotrexate or as monotherapy, against methotrexate in methotrexate-naïve adults with early RA. Pairwise and network meta-analysis were performed to compare DAS28 remission attainment, with the primary analysis at 6 months and secondary analyses at 3 and 12 months. Secondary outcomes included ACR50 response and CDAI remission.</p><p><strong>Results: </strong>Twenty-nine trials (13 387 participants) were included. Compared with methotrexate alone, initial b/tsDMARDs plus methotrexate significantly increased DAS28 remission at 6 months (risk ratio [RR] 1.62; 95% CI: 1.39, 1.89), 3 months (RR 1.95; 1.47, 2.57) and 12 months (RR 1.54; 1.39, 1.71), with benefits also observed for CDAI remission and ACR50 response. In network meta-analysis, all b/tsDMARD classes combined with methotrexate had higher remission rates than methotrexate alone. The benefits of b/tsDMARDs plus methotrexate were greater in studies with higher baseline disease activity and a greater proportion of rheumatoid factor-positive participants. As monotherapy, b/tsDMARDs increased DAS28 remission attainment compared with methotrexate at 6 months (RR 1.81; 1.42, 2.31), 3 months (RR 1.92; 1.31, 2.83) and 12 months (RR 1.46; 1.25, 1.71); however, at individual class level, significantly higher remission rates were observed only with tocilizumab and Janus kinase (JAK) inhibitor monotherapy.</p><p><strong>Conclusion: </strong>Initial therapy with b/tsDMARDs in combination with methotrexate is associated with higher remission rates than methotrexate alone in patients with early RA. As monotherapy, higher remission rates were observed for JAK inhibitors and tocilizumab.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}