Rheumatology Month in Review: August 2024

The rheumatology month in review highlights a growing body of evidence supporting bimekizumab's use in treating psoriatic arthritis (PsA) and new research exploring risk factors for developing gout or hyperuricemia.

New Data Supports Bimekizumab for Treating PsA

Responses More Likely With Bimekizumab Over Ustekinumab, Risankizumab in Treating PsA

Bimekizumab seems to be more efficacious than both ustekinumab and risankizumab in treating PsA, according to new findings published in 2 separate papers in Rheumatology and Therapy comparing data from the BE OPTIMAL and BE COMPLETE trials that evaluated bimekizumab with data from the PSUMMIT 1 and PSUMMIT 2 trials of ustekinumab and with data from the KEEPsAKE-1 and KEEPsAKE-2 trials of risankizumab.

Looking at bimekizumab compared with ustekinumab, investigators found that in patients who were biologic disease-modifying anti-rheumatic drug naïve (bDMARD naïve) or with an intolerance to tumor necrosis factor inhibitors (TNFi-IR disease), bimekizumab had a greater likelihood of achieving ACR20, ACR50, and ACR70 at week 52.

Looking at bimekizumab compared with risankizumab, investigators found that in patients who were bDMARD naïve, risankizumab had a greater likelihood of achieving ACR50 and ACR70 at week 52. In patients with TNFi-IR disease, bimekizumab had a greater likelihood of achieving ACR20, ACR50, ACR70, and minimal disease activity (MDA).

Bimekizumab Shows Consistent Efficacy With Or Without Concomitant Methotrexate in PsA

Bimekizumab was well-tolerated and yielded consistent, sustained efficacy in patients with PsA with bDMARDs or TNFi-IR, with or without concomitant methotrexate (+/−MTX), for up to 52 weeks, according to a post hoc analysis of patients in 3 trials of bimekizumab: BE OPTIMAL, in which patients had bDMARD-naïve disease; BE COMPLETE, in which patients had TNFi-IR disease; and the BE VITAL open-label extension study.

The investigators found that, at week 52, bimekizumab yielded a similar rate of ACR50 responses in both patients with +MTX disease and −MTX disease. Similarly, bimekizumab yielded similar rates of complete skin clearance (Psoriasis Area and Severity Index 100% [PASI100] response) sustained from Week 16 in both patients with +MTX disease and with -MTX disease. The proportions of MDA were also similar between patients with +MTX disease and with –MTX disease. Similar trends were seen in placebo/bimekizumab-treated patients.

New Research Reveals Risk Factors for Gout

New Research Identifies Genes Associated With Gout RIsk

Investigators used the Summary Data-based Mendelian Randomization (SMR) approach to analyze expression quantitative trait loci (eQTL) data from blood and renal tissues and genome-wide association study (GWAS) data related to gout.

The investigators identified 14 gene probes in the eQTLGen blood summary-level data that were significantly associated with gout after SMR analysis. These genes are ENSG00000169231 (labeled THBS3; PSMR, 4.16 × 10−13), ENSG00000231064 (labeled THBS3-AS1; PSMR = 1.88 × 10−8), ENSG00000163463 (labeled KRTCAP2; PSMR, 3.88 × 10−6), ENSG00000172977 (labeled KAT5; PSMR, 1.70 × 10−5), and ENSG00000161395 (labeled PGAP3, PSMR = 3.24 × 10−5). They found that increased expression of KRTCAP2 and PGAP3 were associated with an increased risk of gout, and increased expression of THBS3, THBS3-AS1, and KAT5 is associated with a reduced risk of gout. They did not find any significant gene associations in renal tissue with gout, which they stated was likely due to the limited sample size of the kidney tissue

Insulin Resistance Associated With Higher Risk of Gout in Adults

New research has found that higher triglyceride glycemic (TyG) index was associated with an increased likelihood of gout in adults in the United States, in a cross-sectional study of adults with complete TyG index and gout data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2017.

After adjusting for all covariates, TyG index was positively associated with gout, with each unit increase in TyG index associated with 40% higher odds of gout (odds ratio (OR), 1.40 [95% CI, 1.82–2.66]; P <.0001). Accordingly, participants in the highest TyG index tertile group were at high risk of gout (odds ratio (OR), 1.64 [95% CI, 1.06–2.54]; P = .03) compared with those in the lowest tertile group. Investigators found no significant effects of age, race, marital status, PIR level, education, BMI, smoking status, drinking status, hypertension, and diabetes mellitus status on the association between TyG index and gout (all P >.05).

Family History of Arthritis Increases Risk for Multiple Rheumatological Conditions
Family history of rheumatological conditions were associated with increased risk for the same condition as well as other rheumatological conditions, according to new research published in Arthritis Care and Research.

Over 38% of participants reported a family history of arthritis (including fibromyalgia, gout, OA, RA, and SLE), osteoporosis, or CTS. Adults with a family history of these conditions had an average 4.90 odds ratio (odds ratio [OR]; range, 3.68-7.59) of having the same condition and an average 1.24 OR (range, 0.70-2.10) of having a different condition. The strongest association was between family history of OA and prevalence of OA (OR, 7.59 [95%CI, 7.32-7.88]), and family history of SLE and prevalence of SLE (OR, 6.34 [95%CI, 5.17-7.74]).

New Research Suggests Molybdenum May Ward Off Hyperuricemia, Gout
Urinary molybdenum levels were associated with decreased prevalence of hyperuricemia and gout in 15,370 adult participants in the National Health and Nutrition Examination Survey (NHANES), data from which were collected between 1999 and 2016.

Investigators found that urinary molybdenum-to-creatinine ratio was significantly associated with decreased serum uric acid (β, -0.119 [95% CI, -0.148 to -0.090]) concentrations, decreased prevalence of hyperuricemia (odds ratio [OR], 0.73 [95% CI, 0.64–0.83]) and decreased prevalence of gout (OR, 0.71 [95% CI, 0.52–0.94]). Higher urinary molybdenum levels were associated with lower levels of systemic oxidative stress (gamma-glutamyltransferase levels; β, -0.052 [95% CI, -0.067 to -0.037]) and inflammation (C-reactive protein levels; β, -0.184 [95% CI, -0.220 to -0.148]).