Rheumatology

Baseline PROs, tender‑swollen discordance, and sociodemographics predict persistent unacceptable pain in early RA

In a Swedish cohort of 10,297 early RA patients (3,427 with 2‑year data), 33% had unacceptable pain at 2 years and 26% had unacceptable pain despite low inflammation. Baseline predictors of unacceptable pain included female sex, worse patient‑reported outcomes, low inflammatory markers, and more tender than swollen joints. Smoking, non‑European origin, and psychiatric or pain comorbidities were associated with greater pain over time. Authors conclude factors beyond inflammation substantially contribute to persistent pain and recommend assessing PROs and joint count discordance early. 1

DEAP score modestly predicts 6‑month methotrexate monotherapy success (AUC ~0.66)

Multicenter retrospective cohorts identified four baseline predictors of MTX monotherapy success: age >60, normal ESR, lower DAS28‑ESR (≤5.1), and lower glucocorticoid dose. The derived DEAP score showed modest discrimination (AUC 0.66 development, AUC 0.63 external validation, N=265). Calibration was acceptable and decision‑curve analysis suggested net benefit across 35%–80% threshold probabilities. This tool may help early risk stratification where resources are limited, but performance is only moderate. 2

Meta‑analysis finds a modestly increased thyroid cancer risk in RA, stronger in Chinese cohorts

A meta‑analysis of 14 cohort studies (≈1.97 million participants) found RA associated with higher thyroid cancer risk (HR 1.28, 95% CI 1.05–1.55). The association was stronger in Chinese populations (HR 1.79, 95% CI 1.26–2.54) and absent in other populations. Association persisted with extended covariate adjustment (HR 1.38, 95% CI 1.09–1.73). Authors note limitations and call for well‑designed prospective studies to clarify surveillance implications. 3