Objective To assess the effect of bimekizumab, a dual inhibitor of IL-17F and IL-17A, on maintenance of stringent clinical response outcomes to three years in patients with axial spondyloarthritis (axSpA) from two phase 3 studies and their open-label extension (OLE). Methods Achievement of stringent clinical outcomes (Assessment of SpondyloArthritis international Society ≥40% improvement/partial remission [ASAS40/PR]), disease activity outcomes (Axial Spondyloarthritis Disease Activity Score low disease activity/inactive disease [ASDAS LDA/ID], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] <2), no/minimal or mild pain/fatigue (BASDAI Q1/Q2 <2/<4, respectively) and resolution of enthesitis (Maastricht Ankylosing Spondylitis Enthesitis Score [MASES]=0) are reported pooled across BE MOBILE 1 (non-radiographic [nr]-axSpA) and 2 (radiographic [r]-axSpA), to Week 164 for bimekizumab-randomised patients who achieved each outcome at Week 16. Data are descriptive, reported as non-responder imputation (NRI), modified NRI (mNRI), multiple imputation (MI) or observed case (OC). Results Of 349 bimekizumab-randomised patients, at Week 16, 45.8% achieved ASAS40, 24.6% ASAS PR, 43.6% ASDAS LDA, 16.6% ASDAS ID (NRI). The majority sustained achievement of these outcomes at Week 164 (80.4%/66.3%/78.8%/61.0%, respectively; mNRI/MI). Similar trends were observed for pain/fatigue reduction and resolution of enthesitis. Respectively, 36.2% and 38.0% who achieved ASDAS LDA and BASDAI <2 at Week 16 maintained their response at every visit to Week 164 (as observed). Conclusion In this exploratory analysis, across the full axSpA disease spectrum, the majority of patients who achieved stringent clinical outcomes with bimekizumab treatment at Week 16 maintained their response over three years, supporting deep and sustained efficacy with long-term bimekizumab treatment.
Objective Safe and effective strategies for discontinuing systemic medications in children and adolescents with juvenile idiopathic arthritis remain to be defined. This study aimed to determine flare risks following medication discontinuation and to evaluate the impact of disease subtype, remission duration, medication class and discontinuation strategy. Methods A systematic review and meta-analysis (PROSPERO-CRD420251168572) was conducted using MEDLINE, EMBASE, and Web of Science evidence synthesis through October 2025. Included studies evaluated medication withdrawal-stopping versus tapering strategies in JIA patients (≤18 years) in remission. Flare was the primary outcome. Random-effects metaanalysis, subgroup analyses, meta-regression, and RoB 2 and ROBINS-I assessments were performed. Results 18 studies assessing 1,905 patients were included. Flare proportions ranged between 13%-78%, with a pooled estimate of 45% (95%CI:33%-56%;I²=97%). Lower proportions were observed with tapering, including interval spacing (25%[95%CI:8%-42%]) and dose reduction (42%[95%CI:18%-65%]) compared to stopping (57%[95%CI:44%-70%]); differences were not statistically significant. Tapering strategy was the only significant moderator of flare risk (β=0.26, p=0.02), explaining 19% of heterogeneity. Most flares occurred within 6-12 months. Flare proportions also varied by disease subtype, medication class, and remission duration before. Recapture of remission was reported in 50%-100% of patients. Incidence rate sensitivity analyses yielded consistent findings (0.35 flares/person-year). Conclusion Medication discontinuation in JIA carried significant flare risk across both cumulative proportion and person-year rates. The observed heterogeneity primarily mirrored the clinical variation in withdrawal strategies. Differences in flare proportions may reflect residual drug exposure rather than the true strategy effects. The high recapture rate provides reassurance for advancing medication discontinuation approaches.
Objective The objective of this study was to determine the prevalence of three common forms of arthritis (rheumatoid arthritis, osteoarthritis, and gout) in Alaska Native and American Indian (AN/AI) peoples of Alaska. Methods We identified adults with a potential diagnosis of rheumatoid arthritis, osteoarthritis, or gout based on queries of the electronic health records within participating organizations in the Alaska Tribal Health System based on ICD-9 and ICD-10 codes. We performed medical record abstraction for a subset of individuals with potential arthritis to confirm the diagnosis, classification criteria documented in the medical record, and associated clinical features. We applied the validation results to the full sample of adults with potential arthritis identified from electronic health record queries to estimate the point prevalence of each form of arthritis as of December 31, 2019. Results Of the three types of arthritis, osteoarthritis was the most common (overall age-adjusted prevalence 14.0% (95% CI 13.2-14.8%)), followed by rheumatoid arthritis (overall age-adjusted prevalence 2.39% (95% CI 2.19-2.60%)), then gout (overall age-adjusted prevalence 1.33% (95% CI 1.20-1.47%)). Osteoarthritis and rheumatoid arthritis were more common in women than men, while gout was more common in men than women. The prevalence of all three types of arthritis increased with age. Conclusion Compared to U.S. or global population-based studies, the prevalence of osteoarthritis in AN/AI peoples of Alaska is similar, while the prevalence of gout is lower than expected and the prevalence of rheumatoid arthritis is high and similar to prior studies in this population.
Objective The purpose of this study was to examine the association between adverse childhood experiences (ACEs) and self-reported rheumatoid arthritis (RA), and to investigate potential psychosocial and behavioural mediators of this relationship. Methods Exploratory and confirmatory factor analyses (EFA; CFA) were conducted to assess the dimensionality of ACEs. Hypothesized direct and indirect pathways from a latent ACEs construct to RA were tested using structural equation modeling (SEM) with data (N = 44,142) from the Canadian Longitudinal Study on Aging. Putative mediation through depression, anxiety, obesity, and smoking was examined. Analyses adjusted for sociodemographic factors, asthma, and childhood passive smoking. Moderation by birth sex was tested with multigroup SEM. Results EFA and CFA supported a higher-order latent childhood adversity factor with three first-order factors (physical abuse, sexual abuse, household dysfunction). SEM showed a small but significant direct ACEs-RA association, as well as significant associations operating through depression, obesity, and smoking. Birth sex appeared to moderate the indirect pathway through obesity, with a stronger association for men. An indirect association through smoking was observed only in men, though the between-group difference was not statistically significant. Conclusion ACEs were significantly associated with self-reported RA, partially through indirect pathways involving depression, obesity, and smoking, with evidence of sex-specific effects on the obesity pathway. Targeted screening and intervention for ACEs-affected individuals with psychosocial and behavioural risk factors may help reduce RA burden. Prospective mediation research examining gene-environment interactions (e.g., smoking × RA risk alleles) and sex-specific mechanisms is warranted.
