Clinical and Ultrasound Remission in Rheumatoid Arthritis Patients Treated with JAK Inhibitors: A Real-World Study

Area of Science:

• Rheumatology
• Pharmacology
• Medical Imaging

Background:

• Janus kinase inhibitors (JAKi) are approved for rheumatoid arthritis (RA) treatment, aiming for clinical remission.
• Composite scores like DAS28-CRP can be subjective; ultrasound offers objective assessment of synovial activity.
• JAK inhibitors may influence RA dimensions beyond inflammation.

Purpose of the Study:

• To evaluate clinical and ultrasound-defined remission in RA patients treated with JAK inhibitors under routine care.
• To compare the efficacy of different JAK inhibitors in achieving remission.

Main Methods:

• Cross-sectional study of RA patients treated with baricitinib, filgotinib, tofacitinib, or upadacitinib.
• Clinical remission defined by DAS28-CRP; ultrasound remission defined by absence of power Doppler signal in 32 joints.
• Data collected between November 2022 and April 2023.

Main Results:

• 78 RA patients included; 87.2% female, mean age 59.5 years, 10.6 years disease duration.
• Clinical remission in 42.3%, ultrasound remission in 56.4%; no significant differences between JAKi.
• 60% of patients in remission by either definition met both criteria; 22% had ultrasound remission only, 18% clinical remission only.

Conclusions:

• JAK inhibitors are effective in achieving remission in RA patients.
• Ultrasound detects residual synovitis in clinically remitting patients and silent remission in others, aiding personalized treatment.
• No significant clinical or ultrasonographic differences observed between JAK inhibitors in routine practice.