Rheumatoid Arthritis Year in Review: 2022

In the third installment of our Year in Review series, Rheumatology Network interviewed Ayman Askari, MD, to discuss the recent trends, studies presented at the American College of Rheumatology (ACR) Convergence 2022, and the pressing issues that face rheumatologists treating rheumatoid arthritis moving into 2023. He stresses the importance of vaccination, particularly the COVID-19 vaccination, in patients with rheumatic diseases, like rheumatoid arthritis, and believes comparisons between Janus kinase (JAK) inhibitors should be more thoroughly researched in the upcoming year. Askari is a consultant rheumatologist at the Robert Jones and Agnes Hunt Orthopedic Hospital.

Ayman Askari, MD

Rheumatology Network: To touch on rheumatoid arthritis more broadly in 2022, have there been any new studies or data presented this year that stands out to you?

Ayman Askari, MD: I attended a few talks at the ACR regarding upadacitinib, which is a product by AbbVie. In the SELECT and SELECT-COMPARE trials, as well as other various studies, it seems to be an effective product.

There were also seminars on psoriatic arthritis and talks on anti-interleukin 23, but as far as rheumatoid arthritis, I would focus on upadacitinib and JAK inhibitors. I think in the future, rheumatologists are going to be using more JAK inhibitors because it's an oral tablet and it has a very short half-life. So that will influence my future practice.

RN: Have you noticed any overarching trends in rheumatoid arthritis management and treatment over the past year?

AA: I wouldn't say that there are major changes. We just came out of COVID and COVID has affected our practice. So, we are talking a lot about vaccination and COVID vaccination. Medications that can suppress the immune system, like rituximab, for example, can make patients more prone to COVID. But I would say there are no fundamental issues with rheumatoid, apart from the more prevalent use of JAK inhibitors.

RN: What are some of the most pressing issues in rheumatoid arthritis that you would hope to see be addressed or receive a greater focus in 2023?

AA: I think vaccination for COVID and for herpes zoster is going to be focused on in 2023. The use of JAK inhibitors and the comparison between various JAKs is an issue for discussion. We have JAK1, JAK2, JAK3, and there is a Tyrosine kinase 2 (TYK2) also. These new modalities in addressing immune suppression are going to be researched more or observed more. I mean, it's already been researched and published, but side effects such deep vein thrombosis (DVT) and herpes zoster, which are always on our minds, could be observed more in the upcoming year.

RN: Is there anything else that you would like our audience to know before we wrap up?

AA: Well, I saw something in the exhibition regarding blood tests that some of your labs are producing. Particularly, one in California was producing rapid autoimmune tests which interests me if they are doing it at a low cost. That might be an advantage for the public in the future, not necessarily just for rheumatoid arthritis but for all the connective tissue disorders. That’s definitely one of the things that caught my eye during the recent conference.