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Aims. To describe the baseline characteristics of an Australian population-based cohort of rheumatoid arthritis (RA) patients commencing biological therapy. Methods. Descriptive analysis from the Australian Rheumatology Association Database (ARAD). Results. Up to October 2006, there were 681 RA patients taking biologics enrolled in ARAD. Baseline data were available for 624 (72% female, mean (SD) age 57.0 (12.5) years). Of these, 59.5% reported at least one comorbid condition, most commonly hypertension (35.7%) and osteoporosis (30.4%); 61 (9.8%) had a history of malignancy (35 nonmelanoma skin, 5 breast, 4 bowel, 5 cervix, 3 melanoma, 3 prostate and 1 each of lip, lung, myeloma, testis, uterus, vagina). Self-reported infections within the previous 6 months were common (71.5%). Conclusions. History of comorbidities, including recent infections, is common among Australian RA patients commencing biologics, and 10% have a history of malignancy. This may impact future evaluations of health outcomes among this population, including attribution of adverse events of biologic therapy.

Community restrictions due to COVID‐19 have changed healthcare, including increased telehealth use. During the early pandemic phase, a cohort of Australian patients with inflammatory arthritis was surveyed. Self‐reported access to healthcare was maintained and physical health was more likely to be self‐rated poorly than mental health. There was a high level of support for telehealth during and after the pandemic.

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We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction.

Biologic agents have become indispensable in the management of autoimmune disease particularly rheumatological conditions. The lives of countless individuals have been improved following treatment with these drugs. Unfortunately, their cost prohibits more widespread use around the globe. This critical issue has been addressed by the introduction of biosimilars into the market. These therapies have been developed to resemble the originator molecule as closely as possible and to increase competition in the therapy area thus allowing costs to be reduced. Our review is intended to offer an update on biosimilars including logistic considerations on their introduction into routine practice.

Background: Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate and azathioprine, are commonly used for rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). Blood test safety monitoring is mainly undertaken in primary care. Normal blood results are common. Aim: To determine the frequency and associations of persistently normal blood tests in RA patients prescribed methotrexate and IBD patients prescribed azathioprine. Design and setting: Two-year retrospective cohort study using pseudonymised primary care/laboratory data in Hampshire. Method: RA and IBD patients were identified with associated methotrexate (RA) and azathioprine (IBD) prescriptions. NICE-recommended tests and thresholds were applied and persistent normality defined as a) no abnormalities of any tests, and b) individually for alanine aminotransferase (ALT), estimated glomerular filtration rate (eGFR), white blood count (WBC), and neutrophils. Logistic regression was used to identify associations with test normality. Results: Of 702,265 adults, 7102 had RA and 8597 had IBD. 3001 (42.2%) RA patients were prescribed methotrexate and 1162 (13.5%) IBD patients prescribed azathioprine. Persistently normal tests occurred in 1585 (52.8%) of the RA/methotrexate and 657 (56.5%) of the IBD/azathioprine populations. In RA/methotrexate patients 585 (19.5%) had eGFR, 219 (7.3%) ALT, 217 (7.2%) WBC, and 202 (6.7%) neutrophil abnormalities. In IBD/azathioprine patients 138 (4.6%) had WBC, 88 (2.9%) eGFR, 72 (2.4%) ALT and 65 (2.2%) neutrophil abnormalities. Those least likely to have persistent test normality were older and/or had comorbidities. Conclusions: Persistent test normality is common in monitoring these DMARDs in primary care, with few hepatic or haematological abnormalities. More stratified monitoring approaches should be explored.