Biologic Disease Modifying Anti-Rheumatic Drugs (BDMARDs) are effective in reducing symptoms of inflammatory arthritis and slowing disease progression. Current guidelines recommend pausing these for surgery, but evidence about benefits, risks and experiences of stopping or continuing BDMARDs during the perioperative period is limited. This qualitative study explores the experiences and perspectives of those taking part in a randomised controlled trial comparing the outcomes for adults with inflammatory arthritis who continue or pause BDMARDs in the perioperative period for orthopaedic surgery (the PERISCOPE study). Thematic analysis of qualitative semi-structured interviews (conducted 2023-24; in person, by phone or video call) with 26 adults (age 18+) with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis living in the UK, and participating in PERISCOPE. In the sample, 11 continued biologics and 15 stopped them prior to surgery. A central theme ‘the need for surgery overshadows the benefits and risks of stopping or continuing biologics’, and two sub-themes ‘living with arthritis involves accepting risk and uncertainty’ and ‘biologics (the term most used by participants for BDMARDs) are potentially life-changing, and people worry about them not working’ were developed. Many participants described an ongoing and sometimes trial-and-error approach to treatment, and an acceptance of treatment uncertainty and risks as the disease progressed and needs changed over time. The pain and loss of function when requiring surgery sometimes meant that associated risks, including those related to continuing or stopping biologics were accepted or overshadowed, even for participants who described life-changing benefits and expressed a preference to continue biologics. Many of these participants described worrying about pausing biologics in case they stopped working or caused a flare or further damage to joints when paused. The consequences of pausing biologics for surgery is a key concern for people living with inflammatory arthritis. However, the need for surgery and an acceptance of uncertainty and risk can mean that treatment preferences and concerns about risks are not always given full consideration. This has implications for decision-making should people be offered the choice to continue or pause biologics for surgical procedures. ISRCTN17691638 (http://www.isrctn.org/). People with inflammatory arthritis experience a trial-and-error approach to treatment and learn to accept treatment uncertainty and risks. Biologics can be life-changing, and people worry about pausing or changing these, or what happens next if medication stops working. The need for surgery can overshadow associated risks, including those related to stopping or continuing biologics in the perioperative phase.
Avacopan, an oral C5a-receptor inhibitor, demonstrated improved remission and renal outcomes in the pivotal randomised ADVOCATE trial in ANCA-associated vasculitis (AAV). However, evidence from routine clinical practice remains limited, particularly in the United Kingdom and among patients with advanced kidney disease. We assessed early real-world use of avacopan across Northern Ireland before subsequent regulatory action concerning the integrity and reliability of data from ADVOCATE. In this retrospective multicentre cohort study, adults with newly diagnosed or relapsing AAV who received avacopan between March 2023 and July 2025 in the five Northern Ireland Health and Social Care Trusts were identified from electronic healthcare records (EHCR). Data on demographics, disease phenotype, kidney function, concomitant immunosuppression, glucocorticoid exposure, relapses, and adverse events and remission rates were collected. Forty patients started avacopan; median age was 61 years, 75
Abstract Background Depressive symptoms are common in psoriatic arthritis (PsA) and may influence treatment response. This study examined their association with achieving remission after starting a new systemic antirheumatic therapy, and tested whether this association differs by sex. Methods Data from PsA patients in the ongoing prospective longitudinal observational cohort study RABBIT-SpA were analyzed. Depressive symptoms were assessed with the WHO-5 Well-Being Index (none/mild vs. moderate/severe). Outcomes included minimal disease activity (MDA) and Disease Activity in Psoriatic Arthritis (DAPSA) remission at 3 and 6 months. Logistic regression assessed the association between baseline well-being and remission, adjusted for confounders identified using directed acyclic graphs. A sex × well-being interaction term was included in each model to test whether this association differs by sex. Multiple imputation handled missing data. Results Moderate/severe depressive symptoms were present in 29% of 1,888 patients (34% of women, 23% of men). In adjusted analyses, higher baseline well-being was associated with remission (OR per 10-point increase: 1.06–1.14 across outcomes and timepoints, reaching significance for MDA at 6 months and DAPSA remission at both timepoints). Interaction testing showed no evidence that this association differed by sex; all four 95% confidence intervals included 1 ( p ≥ 0.29). Both sexes with moderate/severe symptoms achieved MDA and DAPSA remission less frequently than those with no/mild symptoms. Although disease activity improved in both groups over time, it remained higher in patients with moderate/severe symptoms. Conclusions Depressive symptoms were associated with higher disease activity and less frequent remission in PsA, with no evidence that this effect differed by sex. Routine screening for depressive symptoms should be considered in PsA management to identify patients at risk of suboptimal treatment response. Clinical trial number Not applicable.
Relugolix is a recently approved oral gonadotropin-releasing hormone (GnRH) antagonist (2021), indicated for the treatment of prostate cancer. While musculoskeletal adverse effects are frequently reported, data on severe manifestations remain rare. We describe the case of a patient who developed polyarthritis associated with myositis-like features accompanied by marked systemic inflammation and fever, following the initiation of relugolix treatment. Discontinuation of the drug combined with a short course of corticosteroids resulted in complete remission, with no relapse after six months of corticosteroid-free follow-up. This case suggests a potential association between relugolix and severe inflammatory musculoskeletal manifestations, including polyarthritis with myositis-like features. Although causality cannot be definitively established, the temporal relationship, improvement after relugolix withdrawal, and absence of recurrence with subsequent androgen deprivation support the possibility of a drug-specific effect. Clinicians should be aware of these potentially severe but poorly documented adverse events.
Hip and knee osteoarthritis (OA) are increasingly prevalent among older adults and often impair daily functioning. Current OA treatment guidelines emphasize the importance of self-management, particularly through improving physical activity, weight management, and sleep. Although these behaviors are essential for effective OA management, many individuals experience barriers to adopting and maintaining them. To help patients overcome these challenges, support needs to be tailored to their individual needs. Digital interventions offer the potential to deliver personalized support if informed by users’ experiences and needs. Therefore, this study examines the experiences and perceived needs of individuals with OA regarding behavior change in physical activity, weight management, and sleep supported by a digital intervention. Semi-structured interviews were conducted with 20 Dutch adults diagnosed with hip and/or knee OA. The interviews focused on participants’ experiences with changing physical activity, weight management, and sleep, including perceived barriers and facilitators, as well as desired support needs. Visual probes were used to elicit concrete reactions to potential digital support components. Data were analyzed using a thematic analysis approach, combining inductive coding and theme development with a deductive framework structured by behavioral domains (physical activity, weight management, and sleep) and the dimensions of facilitators, barriers, and support needs. Pain and other OA-related symptoms were the most prominent barriers to engaging in physical activity and adequate sleeping. Weight management was primarily hindered by psychological and environmental factors. Facilitators for behavior change were categorized into symptom management, motivational drivers, psychological reinforcement, and behavioral strategies. Support needs were discussed less extensively, resulting in relatively few practical suggestions. Nevertheless, across all behaviors, there was a desire for personalized guidance and support in planning, monitoring and feedback, cues to action, and tailored education for behavior change. This study enhances the understanding of the barriers and facilitators experienced by individuals with hip and/or knee OA in managing physical activity, weight management, and sleep. It also provides insight into broad categories of support preference regarding behavior change support. These findings can help inform the development of more adaptive and personalized digital interventions to enhance self-management among people with OA.
