Top Clinical Articles in Rheumatology from 2012


Drawn from an invited session at the American College of Rheumatology annual meeting, these publications have been judged the best clinical reports in rheumatology from the past year.

Clinical Trials

?  van Vollenhoven RF, Fleischmann R, Cohen S, et al, Tofacitinib or Adalimumab versus Placebo in Rheumatoid Arthritis. N Engl J Med (2012) 367:508-519.

Tofacitinib is effective in RA. In a 12-month, phase 3 randomized crossover trial involving 717 RA patients who were receiving stable doses of methotrexate, ACR response rates at month 6 were significantly higher among patients receiving either drug than among those on placebo. HAQ-DI and DAS28 scores were also significantly better in the treatment groups. Tofacitinib was associated with more adverse events than adalimumab, however, including increases in lipoprotein fractions, decreases in neutrophil counts and, in two patients, pulmonary tuberculosis.


?  Kingsley GH, Kowalczyk A, Taylor H, A randomized placebo-controlled trial of MTX in PsA. Rheumatology (2012) 51(8): 1368-1377.

This randomized trial with negative results raised the question whether methotrexate should continue to be used for psoriatic arthritis. See the companion editorial, reached via a hyperlink at the end of the text.

?  Yazici Y, Curtis JR, Ince A, et al, Efficacy of tocilizumab in patients with moderate to severe active rheumatoid arthritis and a previous inadequate response to disease-modifying antirheumatic drugs: the ROSE study
Ann Rheum Dis
(2012) 71:198-205 .

A randomized double-blind placebo-controlled trial of tocilizumab in RA patients who failed to respond to DMARDs showed significant improvements in the treatment group, starting as soon as the first week after tocilizumab was added to their DMARD medication.


?  Tak PP, Rigby W, Rubbert-Roth A, et al, Sustained inhibition of progressive joint damage with rituximab plus methotrexate in early active rheumatoid arthritis: 2-year results from the randomised controlled trial IMAGE
Ann Rheum Dis.
(2012) 71: 351–357.

After two years, patients in this randomized trial who received rituximab rather than placebo in addition to their existing methotrexate treatment for early rheumatoid arthritis continued to show reduced signs of joint damage and sustained improvements in clinical, radiographic, and functional outcomes.

?  van Vollenhoven RF, Petri MA, Cervera R, et al, Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response Ann Rheum Dis (2012) 71:1343-1349.

Analysis of phase 3 results from the BLISS trial of belimumab for lupus established that adding the drug to standard therapy will benefit patients who have higher disease activity, anti-dsDNA positivity, low complement or were being treated with corticosteroids.


[Drawn from a presentation at the October meeting of the American College of Rheumatology, this list was compiled too early to include the following important reports published concurrently in late December.]

?  De Benedetti F, Brunner HI, Ruperto N, et al, Randomized trial of tocilizumab in Systemic Juvenile Idiopathic ArthritisNew Engl J Med (2012) 367:2385-2395.

?   Ruperto N, Brunner HI, Quartier P, et al. Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis.N Engl J Med (2012) 367:2396-2406.

An intractable rheumatic disease of childhood with no good option for treatment suddenly has two. In separate collaborative trials of juvenile idiopathic arthritis, he interleukin-1 inhibitor canakinumab and the interleukin-6 inhibitor tocilizumab prove similarly effective against JIA assessed for the same outcome, the adapted ACR JIA response measure.

Observational Studies

?  Grayson PC, Maksimowicz-McKinnon K, Clark TM, et al,

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