With respect to clinical benefit, triple therapy, with sulfasalazine and hydroxychloroquine added to methotrexate, was noninferior to etanercept plus methotrexate in patients with rheumatoid arthritis who had active disease despite methotrexate therapy. (Funded by the Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, and others; CSP 551 RACAT ClinicalTrials.gov number, NCT00405275.)

Treatment with anakinra was associated with short-term improvements in large joint counts and laboratory parameters of active disease. Higher anakinra doses may be more efficacious in treating the systemic inflammatory response in systemic onset juvenile idiopathic arthritis patients. A subset of patients had periods of arthritis during treatment, and local side-effects were frequent. Our experience supports the continued use of interleukin-1 inhibition in systemic juvenile arthritis and the search for more effective and more tolerable forms of interleukin-1 inhibition.

Objectives To determine whether rheumatoid arthritis (RA) and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. Methods We studied U.S. veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint disease activity score [DAS28-ESR]) and functional status (multidimensional health assessment questionnaire [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusion capacity [DLCO]) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden, and medications. Results We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1,073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21 [1.03–1.41]) and MDHAQ (aHR 1.85 [1.29–2.65]) were separately associated with mortality independent of FVC and other confounders. Modeled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (<80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC <80% predicted had the highest risk of death (aHR 4.43 [95% CI 1.70–11.55]). Conclusion Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD.

Objective To examine temporal trends in all‐cause and cause‐specific mortality in patients with rheumatoid arthritis (RA) in the Veterans Health Administration (VHA). Methods We conducted a matched cohort study in the VHA from January 1, 2000 to December 31, 2017. Incident RA patients were matched up to 1:10 on age, sex, and VHA enrollment year to non‐RA patients, then followed until death or end of study period. Cause of death was obtained from the National Death Index. Multivariable Cox regression models stratified by RA diagnosis years were used to examine trends in RA‐related risk of all‐cause and cause‐specific mortality. Results Among 29,779 incident RA patients (matched to 245,226 non‐RA patients), 9,565 deaths occurred. RA patients were at increased risk of all‐cause (adjusted hazard ratio [HRadj] 1.23 [95% confidence interval (95% CI) 1.20–1.26]), cardiovascular (HRadj 1.19 [95% CI 1.14–1.23]), cancer (HRadj 1.19 [95% CI 1.14–1.24]), respiratory (HRadj 1.46 [95% CI 1.38–1.55]), and infection‐related mortality (HRadj 1.59 [95% CI 1.41–1.80]). Interstitial lung disease was the cause of death most strongly associated with RA (HRadj 3.39 [95% CI 2.88–3.99]). Nearly 70% of excess deaths in RA were attributable to cardiopulmonary disease. All‐cause mortality risk related to RA was lower among those diagnosed during 2012–2017 (HRadj 1.10 [95% CI 1.05–1.15]) compared to 2000–2005 (HRadj 1.31 [95% CI 1.26–1.36]), but still higher than for non‐RA controls (P < 0.001). Cause‐specific mortality trends were similar. Conclusion Excess RA‐related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases. Although our findings support that RA‐related mortality risk is decreasing over time, a mortality gap remains for all‐cause and cause‐specific mortality in RA.