151
|
Santos-Moreno P, Rodríguez-Vargas GS, Martínez S, Ibatá L, Villarreal-Peralta L, Aza-Cañon A, Rivero M, Rodriguez P, Rojas-Villarraga A. Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry. OPEN ACCESS RHEUMATOLOGY: RESEARCH AND REVIEWS 2022; 14:269-280. [PMID: 36426199 PMCID: PMC9680987 DOI: 10.2147/oarrr.s385423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Purpose To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
Collapse
Affiliation(s)
- Pedro Santos-Moreno
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
- Correspondence: Pedro Santos-Moreno, Rheumatology Department, Biomab IPS, Calle 48 # 13-86, Bogotá, Colombia, Tel +57 320 8094232, Email
| | | | - Susan Martínez
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | - Linda Ibatá
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | | | | | - Manuel Rivero
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
| | | | | |
Collapse
|
152
|
Balsa A, González-Álvaro I, Sanmartí R, Corominas H. How do Spanish Rheumatologists handle referral? Survey of knowledge and approach before and after a training workshop. REUMATOLOGIA CLINICA 2022; 18:564-566. [PMID: 34973902 DOI: 10.1016/j.reumae.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
| | | | - Raimon Sanmartí
- Servicio de Reumatología, Hospital Universitari Clínic, IDIBAPS, Barcelona, Spain
| | - Hector Corominas
- Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Hospital Dos de Maig, Barcelona, Spain
| |
Collapse
|
153
|
Seppen B, Wiegel J, ter Wee MM, van Schaardenburg D, Roorda LD, Nurmohamed MT, Boers M, Bos WH. Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial. Arthritis Rheumatol 2022; 74:1737-1745. [PMID: 35818342 PMCID: PMC9826407 DOI: 10.1002/art.42292] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self-monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]) and efficacy (reduction in number of visits) of patient-initiated care assisted using a smartphone app, compared to usual care. METHODS A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 1:1 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28-ESR between the groups. RESULTS Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups was within the noninferiority limit: -0.04 in favor of the app intervention group (95% CI -0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]). CONCLUSION Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28-ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.
Collapse
Affiliation(s)
- Bart Seppen
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Jimmy Wiegel
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Marieke M. ter Wee
- Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Dirkjan van Schaardenburg
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, Academic Medical CenterAmsterdamThe Netherlands
| | | | - Michael T. Nurmohamed
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Maarten Boers
- Reade Rheumatology, and the Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | | |
Collapse
|
154
|
Glintborg B, Jensen DV, Terslev L, Hendricks O, Østergaard M, Horskjær Rasmussen S, Jensen MP, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Agerbo J, Ziegler C, Hetland ML. Nationwide, large-scale implementation of an online system for remote entry of patient-reported outcomes in rheumatology: characteristics of users and non-users and time to first entry. RMD Open 2022; 8:rmdopen-2022-002549. [PMID: 36418086 PMCID: PMC9685239 DOI: 10.1136/rmdopen-2022-002549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Aims In May 2020, a nationwide, web-based system for remote entry of patient-reported outcomes (PROs) in inflammatory rheumatic diseases was launched and implemented in routine care (DANBIO-from-home). After 1.5 years of use, we explored clinical characteristics of patients who did versus did not use the system, and the time to first entry of PROs. Methods All patients followed in DANBIO were informed about DANBIO-from-home by electronic invitations or when attending their clinic. Characteristics of patients who did/did not use DANBIO-from-home in the period after implementation were explored by multivariable logistic regression analyses including demographic and clinical variables (gender, age group, diagnosis, disease duration, use of biological disease-modifying agent (bDMARD), Health Assessment Questionnaire (HAQ), Patient Acceptable Symptom Scale (PASS)). Time from launch to first entry was presented as cumulative incidence curves by age group (<40/40–60/61–80/>80 years). Results Of 33 776 patients, 68% entered PROs using DANBIO-from-home at least once. Median (IQR) time to first entry was 27 (11–152) days. Factors associated with data entry in multivariate analyses (OR (95% CI)) were: female gender (1.19 (1.12 to 1.27)), bDMARD treatment (1.41 (1.33 to 1.50)), age 40–60 years (1.79 (1.63 to 1.97)), 61–80 years (1.87 (1.70 to 2.07), or age >80 years (0.57 (0.50 to 0.65)) (reference: age <40 years), lower HAQ (0.68 (0.65 to 0.71)) and PASS ‘no’ (1.09 (1.02 to 1.17). Diagnosis was not associated. Time to first entry of PROs was longest in patients <40 years of age (119 (24–184) days) and shortest in the 61–80 years age group (25 (8–139) days). Conclusion A nationwide online platform for PRO in rheumatology achieved widespread use. Higher age, male gender, conventional treatment and disability were associated with no use.
Collapse
Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Vendelbo Jensen
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Gentofte, Denmark
| | - Lene Terslev
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Thomas Adelsten
- Department of Rheumatology, Zealand University Hospital Koge, Koge, Denmark
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital Koge, Koge, Denmark
| | - Kamilla Danebod
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Malene Kildemand
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Heidi Lausten Munk
- Rheumatology Research Unit, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jens Kristian Pedersen
- Department of Rheumatology, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Jette Agerbo
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Connie Ziegler
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| |
Collapse
|
155
|
O’Brien CM, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS, Metsios GS, Fenton SAM. Autonomous motivation to reduce sedentary behaviour is associated with less sedentary time and improved health outcomes in rheumatoid arthritis: a longitudinal study. BMC Rheumatol 2022; 6:58. [PMID: 36210469 PMCID: PMC9549664 DOI: 10.1186/s41927-022-00289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This longitudinal study investigated whether changes in autonomous and controlled motivation to reduce sedentary behaviour were associated with variability in sedentary, standing and stepping time and, in turn, disease activity, systemic inflammation, pain and fatigue in rheumatoid arthritis (RA).
Methods
People with RA undertook assessments at baseline (T1, n = 104) and 6 months follow-up (T2, n = 54) to determine autonomous and controlled motivation to reduce sedentary behaviour (Behavioural Regulation in Exercise Questionnaire-2), free-living sedentary, standing and stepping time (7 days activPAL3μ wear), Disease Activity Score-28 (DAS-28), systemic inflammation (c-reactive protein [CRP]), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). N = 52 participants provided complete data at T1 and T2. Statistical analyses: In a series of models (A and B), path analyses examined sequential associations between autonomous and controlled motivation to reduce sedentary behaviour with activPAL3μ-assessed behaviours and, in turn, RA outcomes.
Results
Models demonstrated good fit to the data. Model A (sedentary and stepping time): autonomous motivation was significantly negatively associated with sedentary time and significantly positively related to stepping time. In turn, sedentary time was significantly positively associated with CRP and pain. Stepping time was not significantly associated with any health outcomes. Model B (standing time): autonomous motivation was significantly positively associated with standing time. In turn, standing time was significantly negatively related to CRP, pain and fatigue.
Conclusions
Autonomous motivation to reduce sedentary behaviour is associated with sedentary and standing time in RA which may, in turn, hold implications for health outcomes.
Collapse
|
156
|
Novella-Navarro M, Benavent D, Ruiz-Esquide V, Tornero C, Díaz-Almirón M, Chacur CA, Peiteado D, Villalba A, Sanmartí R, Plasencia-Rodríguez C, Balsa A. Predictive model to identify multiple failure to biological therapy in patients with rheumatoid arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221124028. [PMID: 36226311 PMCID: PMC9549195 DOI: 10.1177/1759720x221124028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Despite advances in the treatment of rheumatoid arthritis (RA) and the wide
range of therapies available, there is a percentage of patients whose
treatment presents a challenge for clinicians due to lack of response to
multiple biologic and target-specific disease-modifying antirheumatic drugs
(b/tsDMARDs). Objective: To develop and validate an algorithm to predict multiple failure to
biological therapy in patients with RA. Design: Observational retrospective study involving subjects from a cohort of
patients with RA receiving b/tsDMARDs. Methods: Based on the number of prior failures to b/tsDMARDs, patients were classified
as either multi-refractory (MR) or non-refractory (NR). Patient
characteristics were considered in the statistical analysis to design the
predictive model, selecting those variables with a predictive capability. A
decision algorithm known as ‘classification and regression tree’ (CART) was
developed to create a prediction model of multi-drug resistance. Performance
of the prediction algorithm was evaluated in an external independent cohort
using area under the curve (AUC). Results: A total of 136 patients were included: 51 MR and 85 NR. The CART model was
able to predict multiple failures to b/tsDMARDs using disease activity
score-28 (DAS-28) values at 6 months after the start time of the initial
b/tsDMARD, as well as DAS-28 improvement in the first 6 months and baseline
DAS-28. The CART model showed a capability to correctly classify 94.1%
NR and 87.5% MR patients with a
sensitivity = 0.88, a specificity = 0.94, and an AUC = 0.89 (95% CI:
0.74–1.00). In the external validation cohort, 35 MR and 47 NR patients were
included. The AUC value for the CART model in this cohort was 0.82 (95% CI:
0.73–0.9). Conclusion: Our model correctly classified NR and MR
patients based on simple measurements available in routine clinical
practice, which provides the possibility to characterize and individualize
patient treatments during early stages.
Collapse
Affiliation(s)
| | - Diego Benavent
- Rheumatology, Hospital Universitario La Paz,
Madrid, Spain
| | | | | | | | | | - Diana Peiteado
- Rheumatology, Hospital Universitario La Paz,
Madrid, Spain
| | | | | | | | | |
Collapse
|
157
|
Carballo N, Pérez García C, Grau S, Monfort J, Durán-Jordà X, Echeverría-Esnal D, Ferrández O. Real-world effectiveness and persistence of reference etanercept versus biosimilar etanercept GP2015 among rheumatoid arthritis patients: A cohort study. Front Pharmacol 2022; 13:980832. [PMID: 36263118 PMCID: PMC9575986 DOI: 10.3389/fphar.2022.980832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Although several randomized clinical trials have confirmed that there is no difference in efficacy between etanercept and its biosimilar versions in the treatment of rheumatoid arthritis (RA), limited real-world evidence is available. We conducted a cohort study to compare the effectiveness and treatment persistence between the reference etanercept (ETN) and the biosimilar GP2015 in RA patients in a real-life setting. Adults with a diagnosis of RA who initiated treatment with ETN or GP2015, between January 2007 and December 2019, were included. The follow-up period was 52 weeks. The primary outcome was the mean of change in the DAS28-CRP values and the adjusted mean difference from baseline to 52 weeks between ETN and GP2015. Other effectiveness endpoints assessed were the rate of patients who achieved remission or low disease activity (LDA) at week 52, who showed a reduction of DAS28-CRP value greater than or equal to 1.2 from baseline to week 52 and rate of good responder patients (those meeting both effectiveness measures) at week 52. Treatment effectiveness over time (baseline, 26 and 52 weeks) was compared between the ETN and GP2015 groups using mixed effects models. Treatment persistence (probability of maintaining the same treatment over time) was also evaluated and shown using Kaplan–Meier survival curves. A total of 115 RA patients were included (ETN, n = 90; GP2015, n = 25). No differences were observed in the primary outcome: DAS28-CRP score decreased from baseline to week 52 [5.1 to 2.7 (mean of change -2.37) in ETN group and 5.0 to 2.2 (mean of change -2.84) in GP2015 group, p-value = 0.372] and the adjusted mean difference was −0.37 (−1.03 to 0.29). No differences were also observed in the other effectiveness endpoints assessed among patients treated with ETN or GP2015: rate of patients who achieved remission (54.1% vs. 66.7%, p-value = 0.303) and LDA (71.6% vs. 80.9%, p-value = 0.391) at week 52, reduction of DAS28-CRP value greater than or equal to 1.2 from baseline to week 52 (75.6% vs. 80.9%, p-value = 0.613) and rate of good responder patients (58.1% vs. 76.1%, p-value = 0.202). Drug survival was 82% and 80% for ETN and GP2015, respectively (log-rank p-value = 0.804). Etanercept and its biosimilar GP2015 show similar effectiveness and treatment persistence in RA patients in a real-life setting.
Collapse
Affiliation(s)
- Nuria Carballo
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Nuria Carballo, ; Santiago Grau,
| | | | - Santiago Grau
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Nuria Carballo, ; Santiago Grau,
| | - Jordi Monfort
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Rheumatology Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
| | - Xavier Durán-Jordà
- Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain
| | | | - Olivia Ferrández
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
158
|
Md Yusof MY, Alivernini S, Chatzidionysiou K. Editorial: Advance in B-cell therapies for the treatment of rheumatic and musculoskeletal diseases. Front Med (Lausanne) 2022; 9:1020859. [PMID: 36213643 PMCID: PMC9532963 DOI: 10.3389/fmed.2022.1020859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Md Yuzaiful Md Yusof
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
- National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Stefano Alivernini
- Immunology Core Facility, Gemelli Science Technological Park, GSTeP, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)—Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
159
|
Jiang N, Li Q, Li H, Fang Y, Wu L, Duan X, Xu J, Zhao C, Jiang Z, Wang Y, Wang Q, Leng X, Li M, Tian X, Zeng X. Chinese registry of rheumatoid arthritis (CREDIT) V: sex impacts rheumatoid arthritis in Chinese patients. Chin Med J (Engl) 2022; 135:2210-2217. [PMID: 36103962 PMCID: PMC9771299 DOI: 10.1097/cm9.0000000000002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients. METHODS Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits. RESULTS A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0 vs . 6.7 mg/L), pain visual analogue scale (4.8 vs . 4.5), patient's and physician's global assessment (4.9 vs . 4.5 and 4.9 vs . 4.5), 28-joint disease activity score using DAS28-CRP (4.3 vs . 4.0) simplified disease activity index (21.9 vs . 19.9), and clinical disease activity index (19.3 vs . 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4% vs . 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women. CONCLUSIONS In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.
Collapse
Affiliation(s)
- Nan Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qin Li
- Department of Rheumatology, the First People's Hospital of Yunnan Province, Kunming, Yunnan 650032, China
| | - Hongbin Li
- Department of Rheumatology, the Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia 010050, China
| | - Yongfei Fang
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Cheng Zhao
- Department of Rheumatology, The First Affiliated Hospital of Guangxi Medical University, Manning, Guangxi 530021, China
| | - Zhenyu Jiang
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| |
Collapse
|
160
|
Xu J, Yu J, Jiao W, Chen G, Liu L, Zhang M, Wu D. Scientific Knowledge of Rheumatoid Arthritis: A Bibliometric Analysis from 2011 to 2020. J Pain Res 2022; 15:2761-2772. [PMID: 36106313 PMCID: PMC9467447 DOI: 10.2147/jpr.s362717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Recently, research on rheumatoid arthritis (RA) has made rapid progress and grown rapidly. It is a challenge to comprehensively understand RA research and hotspots. The aim of this study was to explore the current status and research trends of RA through bibliometric analysis and to provide directions for future development. Methods Publications on RA from 2011 to 2020 were retrieved from the Web of Science Core Collection database (WoSCC). VOSviewer, CiteSpace and online bibliometric platform were used to analyze publication characteristics, including countries, institutions, journals, authors, core references, and keywords. Results A total of 17,037 publications were included. The publications steadily increased over the 10 years. The United States (3648 publications), with the largest proportion of publications and citations, was the largest contributor. Karolinska Institutet (508) and Annals of the Rheumatoid Disease (763) were the most active institution and journal, respectively. Emery P (193) and Tanaka Y (193) were the most prolific authors, and Smolen JS ranked first among the cited authors. The most cited reference focused on recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs. A co-occurrence network analysis revealed four highly connected clusters of keywords in RA research, including etiology, pathology, prognosis, biomarkers and treatment of RA. Conclusion The present study shows a systematic and comprehensive overview of the RA-related research in the past 10 years. Clinical trials on the long-term efficiency and safety of JAK inhibitors and other novel targeted drugs may be the potential research directions for future study in this field.
Collapse
Affiliation(s)
- Jia Xu
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Department of Gynecology, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, People's Republic of China
| | - Jiahui Yu
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Wei Jiao
- First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Guangxing Chen
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lijuan Liu
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Mingying Zhang
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Danbin Wu
- Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| |
Collapse
|
161
|
Novella-Navarro M, Balsa A. Difficult-to-Treat Rheumatoid Arthritis in Older Adults: Implications of Ageing for Managing Patients. Drugs Aging 2022; 39:841-849. [PMID: 36104655 PMCID: PMC9626415 DOI: 10.1007/s40266-022-00976-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Difficult-to-treat rheumatoid arthritis is a heterogeneous term in which patients may present with difficulties in their management for different reasons. This can ultimately lead to patients being exposed to multiple treatments because of inefficacy (resulting from mechanisms intrinsic to rheumatoid arthritis or from non-inflammatory causes such as chronic pain syndrome or structural damage, among others), toxicity or adverse effects that may be linked to comorbidities. One particular group in which such characteristics may be more patent is older patients. Increasing life expectancy, an ageing population and the late onset of rheumatoid arthritis have led to an increased interest in the particularities of treating older patients. This may pose a challenge for physicians, as ageing has implications for optimal patient treatment owing to the potential presence of comorbidities, the risk of adverse events and perceptions of disease status by both physicians and patients. All of these factors may have implications for classifying and managing patients aged > 65 years as difficult-to-treat rheumatoid arthritis, as these patients could be misclassified. This can occur when a significant proportion may still exhibit signs of active disease but not necessarily be difficult to treat because the treatment criterion has not been fulfilled. Alternatively, patients may be exposed to multiple biologic/targeted disease-modifying antirheumatic drugs because of contraindications and/or comorbid conditions. Treatment-to-target strategies and an adequate assessment of inflammatory rheumatoid arthritis activity in older patients should be undertaken, taking special care with associated comorbidities, polypharmacy and risk profiles. Such an approach can help to ensure appropriate treatment for older adults and avoid the misclassification of difficult-to-treat patients.
Collapse
Affiliation(s)
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
162
|
Bartlett SJ, Bykerk VP, Schieir O, Valois MF, Pope JE, Boire G, Hitchon C, Hazlewood G, Bessette L, Keystone E, Thorne C, Tin D, Bingham CO. "From Where I Stand": using multiple anchors yields different benchmarks for meaningful improvement and worsening in the rheumatoid arthritis flare questionnaire (RA-FQ). Qual Life Res 2022; 32:1307-1318. [PMID: 36074252 DOI: 10.1007/s11136-022-03227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The Rheumatoid Arthritis Flare Questionnaire (RA-FQ) is a patient-reported measure of disease activity in RA. We estimated minimal and meaningful change from the perspective of RA patients, physicians, and using a disease activity index. METHODS Data were from 3- to 6-month visits of adults with early RA enrolled in the Canadian Early Arthritis Cohort. Participants completed the RA-FQ, the Patient Global Assessment of RA, and the Patient Global Change Impression at consecutive visits. Rheumatologists recorded joint counts and MD Global. Clinical Disease Activity Index (CDAI) scores were computed. We compared mean RA-FQ change across categories using patients, physicians, and CDAI anchors. RESULTS The 808 adults were mostly white (84%) women (71%) with a mean age of 55 and moderate-high disease activity (85%) at enrollment. At V2, 79% of patients classified their RA as changed; 59% were better and 20% were worse. Patients reporting they were a lot worse had a mean RA-FQ increase of 8.9 points, whereas those who were a lot better had a -6.0 decrease. Minimal worsening and improvement were associated with a mean 4.7 and - 1.8 change in RA-FQ, respectively, while patients rating their RA unchanged had stable scores. Physician and CDAI classified more patients as worse than patients, and minimal and meaningful RA-FQ thresholds differed by group. CONCLUSION Thresholds to identify meaningful change vary by anchor used. These data offer new evidence demonstrating robust psychometric properties of the RA-FQ and offer guidance about improvement or worsening, supporting its use in RA care, research, and decision-making.
Collapse
Affiliation(s)
- Susan J Bartlett
- Centre for Outcomes Research and Evaluation, McGill University, 5252 de Maisonneuve, #3D.57, Montreal, QC, H4A 3S5, Canada. .,Research Institute, McGill University Health Center, Montreal, QC, Canada. .,Arthritis Research Canada, Vancouver, Canada.
| | - Vivian P Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Orit Schieir
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Marie-France Valois
- Centre for Outcomes Research and Evaluation, McGill University, 5252 de Maisonneuve, #3D.57, Montreal, QC, H4A 3S5, Canada
| | - Janet E Pope
- St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada
| | - Gilles Boire
- University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Glen Hazlewood
- Arthritis Research Canada, Vancouver, Canada.,University of Calgary, Calgary, AB, Canada
| | | | | | | | - Diane Tin
- The Arthritis Center, Newmarket, ON, Canada
| | | | | |
Collapse
|
163
|
Rosina S, Giancane G, Ruperto N. Emerging therapies for juvenile arthritis: agents in early clinical trials. Expert Opin Investig Drugs 2022; 31:1109-1124. [PMID: 36066506 DOI: 10.1080/13543784.2022.2121698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic condition in childhood. The management of JIA has been revolutionized thanks to the development of new powerful drugs and the possibility to conduct controlled clinical trials with support from legislative initiatives and availability of international collaborative networks. Trials are still needed in children because we now have new drugs related to specific JIA category. AREAS COVERED The review is centered on the latest achievements in the field, focusing on new investigational drugs which are currently or have been recently tested for JIA treatment, encompassing agents in early phase of clinical development. EXPERT OPINION Despite the tremendous improvement witnessed in the field of JIA treatment in the past 20 years, there are still many unmet needs to be prioritized. Studies on disease pathogenesis will hopefully help in the identification of new treatment targets for individual JIA categories, that could possibly favor a stricter disease control and contribute to solve the issue of refractory JIA. Novel strategies aimed at the prevention of the risk of long-term joint damage are also desirable, as well as the discovery of predictive biomarkers for treatment efficacy and safety in the individual patient.
Collapse
Affiliation(s)
- Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy.,UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genova, Italy
| |
Collapse
|
164
|
Graham RN, Panagiotidis E. [18F]FDG PET/CT in rheumatoid arthritis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:234-244. [PMID: 36066112 DOI: 10.23736/s1824-4785.22.03461-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
[18F]fluorodeoxyglucose (FDG) PET/CT can be used to image the inflammation in rheumatoid arthritis. Specifically, the synovial metabolic activity can be evaluated visually and measured using standard uptake values. Fluorine-18-labeled Sodium fluoride (NaF) PET/CT can be used to determine synovial osteoblastic activity. Response assessment using FDG PET/CT is routine in many cancers and this is now an emerging technique for rheumatoid arthritis. Vasculitis in rheumatoid arthritis (RA) can be also studied with FDG PET/CT and aortic calcification with NaF PET/CT. These techniques could be useful in determining RA disease severity. FDG PET/CT is a useful technique to exclude underlying malignancy when RA does not follow the expected course. A number of novel tracers are being studied with regard to their applicability in rheumatoid arthritis and some of these could even be used in a theranostic manner in the future.
Collapse
Affiliation(s)
- Richard N Graham
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK -
| | | |
Collapse
|
165
|
Smolen JS, Feist E, Fatenejad S, Grishin SA, Korneva EV, Nasonov EL, Samsonov MY, Fleischmann RM. Olokizumab versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med 2022; 387:715-726. [PMID: 36001712 DOI: 10.1056/nejmoa2201302] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The cytokine interleukin-6 is involved in the pathogenesis of rheumatoid arthritis. Olokizumab, a humanized monoclonal antibody targeting the interleukin-6 cytokine directly, is being tested for the treatment of rheumatoid arthritis. METHODS In a 24-week, phase 3, multicenter, placebo- and active-controlled trial, we randomly assigned (in a 2:2:2:1 ratio) patients with rheumatoid arthritis and an inadequate response to methotrexate to receive subcutaneous olokizumab at a dose of 64 mg every 2 or 4 weeks, adalimumab (40 mg every 2 weeks), or placebo; all patients continued methotrexate therapy. The primary end point was an American College of Rheumatology 20 (ACR20) response (≥20% fewer tender and swollen joints and ≥20% improvement in three of five other domains) at week 12, with each olokizumab dose tested for superiority to placebo. We also tested the noninferiority of each olokizumab dose to adalimumab with respect to the percentage of patients with an ACR20 response (noninferiority margin, -12 percentage points in the lower boundary of the 97.5% confidence interval for the difference between groups). RESULTS A total of 464 patients were assigned to receive olokizumab every 2 weeks, 479 to receive olokizumab every 4 weeks, 462 to receive adalimumab, and 243 to receive placebo. An ACR20 response at week 12 occurred in 44.4% of the patients receiving placebo, in 70.3% receiving olokizumab every 2 weeks (difference vs. placebo, 25.9 percentage points; 97.5% confidence interval [CI], 17.1 to 34.1), in 71.4% receiving olokizumab every 4 weeks (difference vs. placebo, 27.0 percentage points; 97.5% CI, 18.3 to 35.2), and in 66.9% receiving adalimumab (difference vs. placebo, 22.5 percentage points; 95% CI, 14.8 to 29.8) (P<0.001 for the superiority of each olokizumab dose to placebo). Both olokizumab doses were noninferior to adalimumab with respect to the percentage of patients with an ACR20 response at week 12 (difference, 3.4 percentage points [97.5% CI, -3.5 to 10.2] with olokizumab every 2 weeks and 4.5 percentage points [97.5% CI, -2.2 to 11.2] with olokizumab every 4 weeks). Adverse events, most commonly infections, occurred in approximately 70% of the patients who received olokizumab. Antibodies against olokizumab were detected in 3.8% of the patients receiving the drug every 2 weeks and in 5.1% of those receiving it every 4 weeks. CONCLUSIONS In patients with rheumatoid arthritis who were receiving maintenance methotrexate, olokizumab was superior to placebo and noninferior to adalimumab in producing an ACR20 response at 12 weeks. Larger and longer trials are required to determine the efficacy and safety of olokizumab in patients with rheumatoid arthritis. (Supported by R-Pharm; CREDO2 ClinicalTrials.gov number, NCT02760407.).
Collapse
Affiliation(s)
- Josef S Smolen
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Eugen Feist
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Saeed Fatenejad
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Sergey A Grishin
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Elena V Korneva
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Evgeniy L Nasonov
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Mikhail Y Samsonov
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| | - Roy M Fleischmann
- From the Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna (J.S.S.); Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Germany (E.F.); SFC Medica, Charlotte, NC (S.F.); R-Pharm (S.A.G., E.V.K., M.Y.S.), V.A. Nasonova Research Institute of Rheumatology (E.L.N.), and Sechenov Medical University (M.Y.S.) - all in Moscow; and the University of Texas Southwestern Medical Center at Dallas and Metroplex Clinical Research Center - both in Dallas (R.M.F.)
| |
Collapse
|
166
|
Nasra S, Bhatia D, Kumar A. Recent advances in nanoparticle-based drug delivery systems for rheumatoid arthritis treatment. NANOSCALE ADVANCES 2022; 4:3479-3494. [PMID: 36134349 PMCID: PMC9400644 DOI: 10.1039/d2na00229a] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 05/28/2023]
Abstract
Nanotechnology has increasingly emerged as a promising tool for exploring new approaches, from treating complex conditions to early detection of the onset of multiple disease states. Tailored designer nanoparticles can now more comprehensively interact with their cellular targets and various pathogens due to a similar size range and tunable surface properties. The basic goal of drug delivery is to employ pharmaceuticals only where they are needed, with as few adverse effects and off-target consequences as possible. Rheumatoid arthritis (RA) is a chronic inflammatory illness that leads to progressive loss of bone and cartilage, resulting in acute impairment, decreased life expectancy, and increased death rates. Recent advancements in treatment have significantly slowed the progression of the disease and improved the lives of many RA sufferers. Some patients, on the other hand, attain or maintain illness remission without needing to continue immunosuppressive therapy. Furthermore, a large percentage of patients do not respond to current treatments or acquire tolerance to them. As a result, novel medication options for RA therapy are still needed. Nanocarriers, unlike standard medications, are fabricated to transport drugs directly to the location of joint inflammation, evading systemic and negative effects. As a result, researchers are reconsidering medicines that were previously thought to be too hazardous for systemic delivery. This article gives an overview of contemporary nanotechnology-based tactics for treating rheumatoid arthritis, as well as how the nanotherapeutic regimen could be enhanced in the future.
Collapse
Affiliation(s)
- Simran Nasra
- Biological & Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus Navrangpura Ahmedabad Gujarat India +91796191127
| | - Dhiraj Bhatia
- Biological Engineering Discipline, Indian Institute of Technology, IIT Gandhinagar Palaj 382355 Gujarat India
| | - Ashutosh Kumar
- Biological & Life Sciences, School of Arts & Sciences, Ahmedabad University, Central Campus Navrangpura Ahmedabad Gujarat India +91796191127
| |
Collapse
|
167
|
Schally J, Brandt HC, Brandt-Jürgens J, Burmester GR, Haibel H, Käding H, Karberg K, Lüders S, Muche B, Protopopov M, Rios Rodriguez V, Torgutalp M, Verba M, Zinke S, Poddubnyy D, Proft F. Validation of the Simplified Disease Activity Index (SDAI) with a quick quantitative C-reactive protein assay (SDAI-Q) in patients with rheumatoid arthritis: a prospective multicenter cross-sectional study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114107. [PMID: 36003590 PMCID: PMC9393358 DOI: 10.1177/1759720x221114107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives The Simplified Disease Activity Index (SDAI) is a recommended composite score for assessing the remission status in patients with rheumatoid arthritis (RA). However, determination of C-reactive protein (CRP) levels takes several hours and sometimes days and limits the use of the SDAI in the clinical setting. The aim of this study was to validate the SDAI using a quick quantitative C-reactive protein (qCRP) assay (as SDAI-Q) in RA patients. Design This is a multicenter, prospective, cross-sectional pilot study in RA patients. Methods Adult patients (⩾18 years) with a clinical diagnosis of RA were recruited between January 2020 and September 2020 from five rheumatologic centers located in Berlin, Germany. SDAI, SDAI-Q, Clinical Disease Activity Index (CDAI), and DAS28 scores comprising CRP, qCRP, or erythrocyte sedimentation rate (ESR) were calculated. The agreement of disease activity categories was analyzed using cross tabulations and weighted Cohen's kappa. The agreement of numerical values was analyzed with Bland-Altman plots and intraclass correlation coefficients (ICCs). Results Overall, 100 RA patients were included in the statistical analysis. The mean value of qCRP (7.89 ± 16.98 mg/l) was slightly higher than that of routine laboratory CRP (6.97 ± 15.02 mg/l). Comparing SDAI and SDAI-Q, all patients were assigned to identical disease activity categories. Agreement of disease activity categories by CDAI and SDAI/SDAI-Q was observed in 93% with a weighted Cohen's kappa of 0.929 (95% confidence interval (CI) = 0.878; 0.981). Conclusion The SDAI-Q showed an absolute agreement regarding the assignment of disease activity categories in comparison with the conventional SDAI. Therefore, the SDAI-Q may facilitate the application of a treat-to-target concept in clinical trials and clinical routine as a quickly available disease activity score incorporating CRP as an objective parameter.
Collapse
Affiliation(s)
- Julia Schally
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Gerd R. Burmester
- Department of Rheumatology and Clinical
Immunology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie
Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henriette Käding
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin,
Berlin, Germany
| | - Susanne Lüders
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maryna Verba
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research
Center Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology
and Rheumatology (including Nutrition Medicine), Charité –
Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and
Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin,
Germany
| |
Collapse
|
168
|
Aletaha D, Kerschbaumer A, Kastrati K, Dejaco C, Dougados M, McInnes IB, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar M, Winthrop KL, Ravelli A, Betteridge N, Burmester GRR, Bijlsma JW, Bykerk V, Caporali R, Choy EH, Codreanu C, Combe B, Crow MK, de Wit M, Emery P, Fleischmann RM, Gabay C, Hetland ML, Hyrich KL, Iagnocco A, Isaacs JD, Kremer JM, Mariette X, Merkel PA, Mysler EF, Nash P, Nurmohamed MT, Pavelka K, Poor G, Rubbert-Roth A, Schulze-Koops H, Strangfeld A, Tanaka Y, Smolen JS. Consensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an update. Ann Rheum Dis 2022; 82:773-787. [PMID: 35953263 DOI: 10.1136/ard-2022-222784] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Targeting interleukin (IL)-6 has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease. Interference with the IL-6 pathway can be directed at the specific receptor using anti-IL-6Rα antibodies or by directly inhibiting the IL-6 cytokine. This paper is an update of a previous consensus document, based on most recent evidence and expert opinion, that aims to inform on the medical use of interfering with the IL-6 pathway. METHODS A systematic literature research was performed that focused on IL-6-pathway inhibitors in inflammatory diseases. Evidence was put in context by a large group of international experts and patients in a subsequent consensus process. All were involved in formulating the consensus statements, and in the preparation of this document. RESULTS The consensus process covered relevant aspects of dosing and populations for different indications of IL-6 pathway inhibitors that are approved across the world, including rheumatoid arthritis, polyarticular-course and systemic juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still's disease, Castleman's disease, chimeric antigen receptor-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19. Also addressed were other clinical aspects of the use of IL-6 pathway inhibitors, including pretreatment screening, safety, contraindications and monitoring. CONCLUSIONS The document provides a comprehensive consensus on the use of IL-6 inhibition to treat inflammatory disorders to inform healthcare professionals (including researchers), patients, administrators and payers.
Collapse
Affiliation(s)
- Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Kastriot Kastrati
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Brunico Hospital, Brunico, Italy
| | - Maxime Dougados
- Rheumatology, Universite Paris Descartes Faculte de Medecine Site Cochin, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, Enschede, Netherlands and Stichting Tools Patient Empowerment, University of Twente, Enschede, The Netherlands
| | - Kevin L Winthrop
- Schools of Medicine and Public Health, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Bykerk
- Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, ASS G. Pini, University of Milan, Milano, Italy
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Catalin Codreanu
- Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Bernard Combe
- Immunorhumatologie, CHU Lapeyronie, Montpellier, France
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York City, New York, USA
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Paul Emery
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Roy M Fleischmann
- Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cem Gabay
- Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Merete Lund Hetland
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark.,Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joel M Kremer
- Medicine Rheumatology, Albany Medical College, Albany, New York, USA
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Center for Immunology of Viral Infections and Auto-immune Diseases, Université Paris-Sud, Gif-sur-Yvette, France
| | - Peter A Merkel
- Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eduardo F Mysler
- Organización Médica de Investigación SA, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | | | - Karel Pavelka
- Rheumatology Department, Charles University, Praha, Czech Republic
| | - Gyula Poor
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| |
Collapse
|
169
|
Fukuda W, Kadoya M, Omoto A, Yanagida T, Isoda Y, Sunaga A, Kusuoka H, Ueno K, Morita S, Kohno M, Kawahito Y. Treatment of rheumatoid arthritis and its outcomes in an aging society: a single-center cohort study in Japan from 2011 to 2020. Arthritis Res Ther 2022; 24:190. [PMID: 35945556 PMCID: PMC9361625 DOI: 10.1186/s13075-022-02883-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background We conducted a single-center cohort study of rheumatoid arthritis (RA) patients from 2011 to 2020 to understand their real world treatment and outcomes, especially changes in physical function and quality of life (QOL) in elderly patients, including those aged ≥ 80 years. Methods For RA patients attending our outpatient clinic, we annually recorded tender and swollen joint counts, laboratory findings, therapeutic drugs, and scores from the Japanese Health Assessment Questionnaire and EuroQoL-5 Dimensions questionnaire. We examined changes in treatment and outcomes over time, by age group, in patients enrolled over a 10-year period, from 2011 to 2020. Results One thousand eight hundred thirty RA patients were enrolled and data were recorded once a year, and a total of 9299 patient records were evaluated. The average age of patients increased by 3.7 years during the study period; the patients aged rapidly. Intensive pharmacological treatment was more frequent in younger patients. Disease activity, physical function, and QOL showed improvement in all age groups over the study period. Physical function and QOL showed greater changes with aging, compared with disease activity. This may be due to the effects of accumulated RA damage, disability due to aging, and depression. Conclusions Intensive pharmacological treatment contributes to not only control of disease activity but also the improvement of physical activity and QOL, even in elderly patients. Relieving age-related physical impairment and depression may improve the QOL of very elderly RA patients.
Collapse
Affiliation(s)
- Wataru Fukuda
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto City, Kyoto, 605-0981, Japan.
| | - Masatoshi Kadoya
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto City, Kyoto, 605-0981, Japan
| | - Atsushi Omoto
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto City, Kyoto, 605-0981, Japan
| | - Takuya Yanagida
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto City, Kyoto, 605-0981, Japan
| | - Yu Isoda
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto City, Kyoto, 605-0981, Japan
| | - Atsuhiko Sunaga
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroaki Kusuoka
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kentaro Ueno
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
170
|
Ellatif M, Sharif B, Baxter D, Saifuddin A. Update on imaging of the cervical spine in rheumatoid arthritis. Skeletal Radiol 2022; 51:1535-1551. [PMID: 35146552 DOI: 10.1007/s00256-022-04012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.
Collapse
Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK.
| | - Ban Sharif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
| | - David Baxter
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
171
|
Shafran IH, Alasti F, Smolen JS, Aletaha D. Response to: ‘Comment on ‘Implication of baseline levels and early changes of C-reactive protein for subsequent clinical outcomes of patients with rheumatoid arthritis treated with tocilizumab’’ by Pethoe-Schramm et al. Ann Rheum Dis 2022; 81:e137. [DOI: 10.1136/annrheumdis-2020-218403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/04/2022]
|
172
|
Nanoscale self-assembling prodrugs of sulfapyridine for treatment of arthritis: Harnessing the dual approach. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
173
|
Ellrodt J, Pincus T, Shadick NA, Stratton J, Santacroce L, Katz JN, Smolen J, Solomon DH. Satisfaction With a Virtual Learning Collaborative Aimed at Implementing Treat-to-Target in Rheumatoid Arthritis. J Clin Rheumatol 2022; 28:265-269. [PMID: 35612561 PMCID: PMC9336553 DOI: 10.1097/rhu.0000000000001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Limited information is available concerning experiences of participants in a virtual learning collaborative (LC), and little qualitative data or participant feedback on how this format can be improved. One prior in-person LC in rheumatology successfully improved adherence with treat-to-target (TTT) for RA. We conducted a virtual LC on TTT and herein report on participant satisfaction. METHODS We conducted a virtual LC with 18 rheumatology practices from across the United States during 2020 to 2021. The LC included a virtual kickoff meeting and monthly videoconferences, accompanied by data submission and feedback. At the conclusion of the LC, we surveyed the 45 LC participants concerning individual experience and satisfaction. RESULTS All sites and 78% of participants responded to the surveys. The LC included small and large practices, 14 academic and 4 nonacademic, and respondents ranged in their roles: 24 physicians, 5 nurses or nurse practitioners, 3 administrators, and 3 other roles. Overall, 94% of respondents indicated they were either somewhat or very satisfied with the LC, and 94% said they would recommend a similar LC to a colleague. Aspects of the LC described as "very useful" included a kickoff meeting, intersite discussion, and monthly speakers; however, digital tools such as the Web site and meeting recordings were not found useful. CONCLUSIONS Virtual LCs are feasible, and participants reported strong satisfaction. Virtual LCs were highly valued by rheumatologists, trainees, and their practice staffs. Potential topics were identified for future LCs that could improve the quality of care delivered to rheumatology patients.
Collapse
Affiliation(s)
- Jack Ellrodt
- From the Brigham and Women's Hospital, Boston MA
| | | | | | | | | | | | | | | |
Collapse
|
174
|
Lei S, Li Z, Zhang X, Zhou S. Efficacy and safety of progressively reducing biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis in persistent remission: a study protocol for a non-inferiority randomized, controlled, single-blind trial. Trials 2022; 23:600. [PMID: 35897052 PMCID: PMC9327307 DOI: 10.1186/s13063-022-06543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background To compare the effects of two biologic disease-modifying antirheumatic drug (bDMARD) administration strategies on the maintenance effect and safety of patients with rheumatoid arthritis (RA) in remission, to analyze the effects of gradual drug reduction and dose maintenance treatment on clinical outcomes in patients who have achieved remission with different types of bDMARDs, to search and screen out people who may benefit from drug reduction strategies, and to provide references for drug reduction strategies and treatment options for patients with RA in remission, so as to help improve the safety of the treatment and reduce the economic burden. Methods The study will be a 24-month non-inferiority randomized, controlled, single-blind trial and is planned to be launched in our hospital from September 2021 to August 2023. Patients will be randomized in a ratio of 2:1 to two groups: maintenance or injection spacing by 50%/gradual reduction of dosage every 3 months up to complete stop. When the patient relapses, return to the last effective dose. If the remission can be maintained, the medication of bDMARDs can be stopped 9 months after enrollment. The primary outcome will be the persistent flare rate. Discussion Our study may provide a reference for the selection of drug reduction strategies and treatment options for patients with RA in remission, so as to help improve the safety of the treatment and reduce the economic burden. Trial registration Chinese Clinical Trial Registry ChiCTR2100044751. Registered on 26 March 2021
Collapse
Affiliation(s)
- Shangwen Lei
- Department of Rheumatology, Gansu Provincial People's Hospital, 204 Donggang West Road, Lanzhou, 730000, People's Republic of China.
| | - Zijia Li
- Department of Rheumatology, Gansu Provincial People's Hospital, 204 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Xiaoli Zhang
- Department of Thoracic surgery, Gansu Provincial People's Hospital, Lanzhou, 730000, People's Republic of China
| | - Shuhong Zhou
- Department of Rheumatology, Gansu Provincial People's Hospital, 204 Donggang West Road, Lanzhou, 730000, People's Republic of China
| |
Collapse
|
175
|
Complementary and Alternative Medicines Used by Individuals With Rheumatological Diseases to Cope With Sleeplessness. Holist Nurs Pract 2022; 37:45-50. [PMID: 35766827 DOI: 10.1097/hnp.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study aims to determine complementary and alternative medicine methods used by rheumatology patients to cope with insomnia and to evaluate their attitudes toward complementary and alternative medicine methods. This descriptive study was completed with 167 patients followed up by the rheumatology unit of a university hospital. Data were collected with the patient identification form and the Holistic Complementary and Alternative Medicine Questionnaire. The mean age of the participants was 44.76 ± 8.96 years and the mean disease duration was 52.90 ± 35.51 months. Most of the participants (69.5%) were women, with 64.1% primary school graduates. Majority of the participants (96.4%) knew complementary and alternative medicine methods, and the main source of information (51.5%) was the internet and social media. The most frequently applied method was phytotherapy (58.7%), the most frequently used plant (30.5%) was stinging nettle and the mean Holistic Complementary and Alternative Medicine Questionnaire score of the patients was 26.68 ± 3.51. Rheumatology patients frequently use complementary and alternative medicine methods to cope with insomnia symptoms and the most commonly used complementary and alternative medicine method used by patients is phytotherapy.
Collapse
|
176
|
VEGF Profile in Early Undifferentiated Arthritis Cohort. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060833. [PMID: 35744097 PMCID: PMC9230586 DOI: 10.3390/medicina58060833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/29/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Early undifferentiated arthritis (UA) is a group of inflammatory joint diseases that are not classified under any specific rheumatic or connective tissue disorder and might evolve into chronic inflammatory arthritis or may be a self-limiting condition. Early recognition and treatment are crucial for the future course of the disease. Vascular endothelial growth factor (VEGF) is an angiogenic regulator that induces the growth of new capillary blood vessels, which are important in joint invasion and destruction during the progression of chronic inflammatory arthritis. The aim of this study was to assess VEGF levels associated with sociodemographic, clinical, laboratory, and ultrasound findings in the early UA patient cohort as well as to evaluate VEGF as a potential prognostic marker for arthritis outcomes. Materials and Methods: Seventy-six patients with inflammatory arthritis in at least one joint, with a duration of arthritis <12 months at the study entry that did not meet any rheumatic disease classification criteria, were enrolled after informed consent was obtained. Patient’s sociodemographic, laboratory data, and clinical disease characteristics were recorded, VEGF levels were measured, and ultrasound (US) of tender and swollen joints was performed. Results: VEGF levels had positive correlation with conventional rheumatic disease activity and diagnostic markers: erythrocyte sedimentation rate (ESR), C−reactive protein (CRP), and rheumatoid factor (RF) (p < 0.05). RF-positive patients had higher VEGF values (p = 0.024). A statistically higher number of patients whose VEGF levels were below the median value presented with active infection (p = 0.046). In patients with a higher number of swollen joints, and a higher score of synovitis and power doppler (PD) seen on US, VEGF levels were statistically significantly higher. Patients who after 12-month follow-up developed rheumatoid arthritis (RA) had statistically higher VEGF levels at baseline compared with those who developed spondyloarthropathies (p = 0.028). Conclusions: This study demonstrated that VEGF levels significantly represented inflammatory processes that were present in the joints (number of swollen joints, synovitis, and PD changes) of the early UA cohort.
Collapse
|
177
|
Nozaki Y, Oribe M, Tomita D, Itami T, Hayashi S, Maeda T, Fukuda K, Kuroda R, Funahashi K, Matsubara T, Kinoshita K, Matsumura I. Iguratimod Versus Salazosulfapyridine in Rheumatoid Arthritis Patients with an Inadequate Response to Methotrexate: Adjusted with Propensity Score Matching. Mod Rheumatol 2022; 33:472-480. [PMID: 35695707 DOI: 10.1093/mr/roac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Methotrexate (MTX) is recommended as a first-line conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) for treating rheumatoid arthritis (RA). No studies have established which csDMARDs are useful as add-on drugs for RA patients with an inadequate response (IR) to MTX. This retrospective study sought to identify an add-on csDMARD treatment strategy for RA patients with MTX-IR. PATIENTS AND METHODS We collected the cases of RA patients treated with salazosulfapyridine (SASP) or iguratimod (IGU) as the additional csDMARD for MTX-IR during a 24-month follow-up at four institutions in Japan. We performed propensity score matching to evaluate the retention rate, clinical efficacy, and safety profile (n=54, each group). RESULTS The retention rates at 24 months of combination therapy in the patients with any-reason discontinuations were 38.5% (MTX+SASP group) and 67.8% (MTX+IGU group). At 3 and 6 months of follow-up, the MTX+IGU group's DAS28-CRP was significantly decreased versus the MTX+SASP group, and at 3 months the MTX+IGU group's good-responder percentage (22.9%) was significantly higher versus the MTX+SASP group's (10.7%). Conversely, compared to the MTX+SASP group, the MTX+IGU group showed a greater reduction in the eGFR from baseline after 3 months during follow-up. CONCLUSIONS IGU is a useful add-on csDMARD for RA patients with MTX-IR; its high retention rate and good clinical response make it a useful combination therapy for controlling RA disease activity. However, the renal function of these patients should be monitored during follow-up.
Collapse
Affiliation(s)
- Yuji Nozaki
- Department of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan
| | | | - Daisuke Tomita
- Department of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan
| | - Tetsu Itami
- Department of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Toshihisa Maeda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Koji Fukuda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Matsubara Mayflower Hospital, Kato, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | | | - Koji Kinoshita
- Department of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan
| |
Collapse
|
178
|
Strand V, Zhang L, Arnaud A, Connolly-Strong E, Asgarian S, Withers JB. Improvement in clinical disease activity index when treatment selection is informed by the tumor necrosis factor-ɑ inhibitor molecular signature response classifier: analysis from the study to accelerate information of molecular signatures in rheumatoid arthritis. Expert Opin Biol Ther 2022; 22:801-807. [PMID: 35442122 DOI: 10.1080/14712598.2022.2066972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A blood-based molecular signature response classifier (MSRC) predicts non-response to tumor necrosis factor-ɑ inhibitors (TNFi) in rheumatoid arthritis (RA). RESEARCH DESIGN AND METHODS This is an interim analysis of data collected in the Study to Accelerate Information of Molecular Signatures (AIMS) in RA from patients who received the MSRC test between September 2020 and November 2021. Absolute changes in clinical disease activity index (CDAI) scores from baseline were evaluated at 12 weeks (n = 470) and 24 weeks (n = 274). RESULTS Predicted TNFi non-responders who received a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) with an alternative mechanism of action (altMOA) experienced up to 1.8-fold greater improvements in CDAI scores than those treated with a TNFi (12 weeks: 12.2 vs 8.0; p-value = 0.083; 24 weeks: 14.2 vs 7.8 p-value = 0.009). In patients with a molecular signature of non-response to TNFi in high disease activity at baseline, this corresponded to 43.2% relative improvement in achieving a lower CDAI disease activity level when likely TNFi non-responders were treated with a non-TNFi therapy (38.9% vs 55.7%). Commensurate improvements in efficiency of spend are expected when TNFi are avoided in favor of altMOA. CONCLUSIONS RA treatment selection informed by MSRC test results improves clinical outcomes in real-world care and offers improvements in efficiency of healthcare spending.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lixia Zhang
- Scipher Medicine Corporation, Waltham, MA, USA
| | - Alix Arnaud
- Scipher Medicine Corporation, Waltham, MA, USA
| | | | | | | |
Collapse
|
179
|
Zhao Z, Hua Z, Luo X, Li Y, Yu L, Li M, Lu C, Zhao T, Liu Y. Application and pharmacological mechanism of methotrexate in rheumatoid arthritis. Biomed Pharmacother 2022; 150:113074. [PMID: 35658215 DOI: 10.1016/j.biopha.2022.113074] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022] Open
Abstract
Methotrexate (MTX) has been used for the treatment of rheumatoid arthritis (RA) for about forty years and to date MTX remains the part of global standard of treatment for RA. The efficacy of MTX in RA is the result of multiple mechanisms of action. In order to summarize the possible pharmacological mechanisms of MTX in the treatment of RA, this review will elaborate on folate antagonism, promotion of adenosine accumulation, regulation of inflammatory signaling pathways, bone protection and maintenance of immune system function.
Collapse
Affiliation(s)
- Zixuan Zhao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhenglai Hua
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xinyi Luo
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yang Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Liuchunyang Yu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ming Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Ting Zhao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Yuanyan Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China.
| |
Collapse
|
180
|
Ramon Haddad PA, Vargas-Santos AB, Silva Freire Coutinho E, Rocha Pereira L, Henrique da Mota LM, Pires de Albuquerque C, Brandão de Resende Guimarães MF, Louzada-Júnior P, Rossi Bonfiglioli K, de Carvalho Sacilotto N, Radominski SC, Aliel Vigano Pugliesi A, Lobato da Cunha Sauma MDF, Alves Pereira I, Viegas Brenol C, da Rocha Castelar-Pinheiro G. Performance of the Rheumatoid Arthritis Disease Activity Index in the Assessment of Disease Activity in Rheumatoid Arthritis-Findings From the REAL Study. J Clin Rheumatol 2022; 28:206-211. [PMID: 35319537 DOI: 10.1097/rhu.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Although telemedicine use has been under discussion for decades, this topic has gained unprecedented importance during the COVID-19 pandemic. The Rheumatoid Arthritis Disease Activity Index (RADAI) is a user-friendly tool, fully self-administered, to assess rheumatoid arthritis (RA) disease activity. The aim of this study was to compare the performance of RADAI with other disease activity indices, functional status, and inflammatory markers in a large cohort of RA patients. METHODS We assessed the concurrent validity of RADAI against Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 Joints-C-reactive protein, Disease Activity Score in 28 Joints-erythrocyte sedimentation rate, Simplified Disease Activity Index, and physician assessment of disease activity and the correlation of RADAI with Health Assessment Questionnaire-Disability Index and inflammatory markers at the REAL Study baseline. We also evaluated the correlation of the change in RADAI and the change in CDAI over a 6-month follow-up. RESULTS From the 1115 patients included in the REAL Study, 1113 had RADAI scores in the first assessment. At baseline, correlations between RADAI and other disease activity indices were strong, ranging from 0.64 (comparison with physician assessment) to 0.79 (comparison with CDAI). Correlation between the change in RADAI score over the 6 months of follow-up and the change in CDAI score over the same period was moderate/strong for the overall group and within the stratified analyses. CONCLUSION The strong correlation of RADAI with other well-established tools for disease activity measurement reassures its use with RA patients' follow-up, especially in this new era of telemedicine.
Collapse
Affiliation(s)
| | | | | | - Leticia Rocha Pereira
- Institute of Social Medicine, Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro
| | | | | | | | - Paulo Louzada-Júnior
- Disciplina de Reumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto
| | - Karina Rossi Bonfiglioli
- Disciplina de Reumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Nathália de Carvalho Sacilotto
- Serviço de Reumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo
| | | | | | | | | | - Claiton Viegas Brenol
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | |
Collapse
|
181
|
Iannone F, Conti F, Cauli A, Farina A, Caporali R. Subcutaneously-Administered Infliximab in the Management of Rheumatoid Arthritis: A Short Narrative Review of Current Clinical Evidence. J Inflamm Res 2022; 15:3259-3267. [PMID: 35673354 PMCID: PMC9167594 DOI: 10.2147/jir.s240593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
The first subcutaneous (SC) formulation of infliximab CT-P13 has been authorized for the treatment of rheumatoid arthritis (RA) in Europe in 2019. Later, in 2020, approved indications were extended also to ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn's disease (CD) and ulcerative colitis (UC). The present review provides summary of the key features of SC infliximab, with particular focus on pharmacokinetic profile, clinical development program in comparison with the intravenous (IV) formulation, and the latest evidence in the literature. We conclude that SC infliximab represents a new and promising approach in the treatment of patients with RA, offering an optimized clinical profile and a more practical option in comparison to the IV formulation. Nevertheless, SC formulation can improve the use of national health systems resources (e.g., through the time of healthcare workers not having to supervise infusions) and facilitate social distancing measures during the COVID-19 pandemic, as the patient can self-inject the medicine at home without going to the hospital. The limitations of the SC infliximab are mainly due to the limited experience of use in clinical practice and the absence of long-term drug retention data.
Collapse
Affiliation(s)
- Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, Università Degli Studi Di Bari Aldo Moro, Bari, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical, Internal, Anesthetic and Cardiovascular Sciences, Sapienza Università di Roma, Rome, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Alberto Farina
- Medical Affairs Department, Celltrion Healthcare Italy srl, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| |
Collapse
|
182
|
Norvang V, Haavardsholm EA, Tedeschi SK, Lyu H, Sexton J, Mjaavatten MD, Kvien TK, Solomon DH, Yoshida K. Using observational study data as an external control group for a clinical trial: an empirical comparison of methods to account for longitudinal missing data. BMC Med Res Methodol 2022; 22:152. [PMID: 35643430 PMCID: PMC9148529 DOI: 10.1186/s12874-022-01639-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Observational data are increasingly being used to conduct external comparisons to clinical trials. In this study, we empirically examined whether different methodological approaches to longitudinal missing data affected study conclusions in this setting. Methods We used data from one clinical trial and one prospective observational study, both Norwegian multicenter studies including patients with recently diagnosed rheumatoid arthritis and implementing similar treatment strategies, but with different stringency. A binary disease remission status was defined at 6, 12, and 24 months in both studies. After identifying patterns of longitudinal missing outcome data, we evaluated the following five approaches to handle missingness: analyses of patients with complete follow-up data, multiple imputation (MI), inverse probability of censoring weighting (IPCW), and two combinations of MI and IPCW. Results We found a complex non-monotone missing data pattern in the observational study (N = 328), while missing data in the trial (N = 188) was monotone due to drop-out. In the observational study, only 39.0% of patients had complete outcome data, compared to 89.9% in the trial. All approaches to missing data indicated favorable outcomes of the treatment strategy in the trial and resulted in similar study conclusions. Variations in results across approaches were mainly due to variations in estimated outcomes for the observational data. Conclusions Five different approaches to handle longitudinal missing data resulted in similar conclusions in our example. However, the extent and complexity of missing observational data affected estimated comparative outcomes across approaches, highlighting the need for careful consideration of methods to account for missingness in this setting. Based on this empirical examination, we recommend using a prespecified advanced missing data approach to account for longitudinal missing data, and to conduct alternative approaches in sensitivity analyses. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01639-0.
Collapse
|
183
|
Bond M, Tomelleri A, Buttgereit F, Matteson EL, Dejaco C. Looking ahead: giant-cell arteritis in 10 years time. Ther Adv Musculoskelet Dis 2022; 14:1759720X221096366. [PMID: 35634351 PMCID: PMC9136445 DOI: 10.1177/1759720x221096366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
Although great improvements have been achieved in the fields of diagnosing and treating patients with giant-cell arteritis (GCA) in the last decades, several questions remain unanswered. The progressive increase in the number of older people, together with growing awareness of the disease and use of advanced diagnostic tools by healthcare professionals, foretells a possible increase in both prevalence and number of newly diagnosed patients with GCA in the coming years. A thorough clarification of pathogenetic mechanisms and a better definition of clinical subsets are the first steps toward a better understanding of the disease and, subsequently, toward a better use of existing and future therapeutic options. Examination of the role of different imaging techniques for GCA diagnosing and monitoring, optimization, and personalization of glucocorticoids and other immunosuppressive agents, further development and introduction of novel drugs, identification of prognostic factors for long-term outcomes and management of treatment discontinuation will be the central topics of the research agenda in years to come.
Collapse
Affiliation(s)
- Milena Bond
- Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charitè University Medicine Berlin, Berlin, Germany
| | - Eric L. Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Christian Dejaco
- Professor, Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Via Ospedale 11, 39031 Brunico, Italy
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| |
Collapse
|
184
|
Kip MMA, de Roock S, Currie G, Marshall DA, Grazziotin LR, Twilt M, Yeung RSM, Benseler SM, Vastert SJ, Wulffraat N, Swart JF, IJzerman MJ. Pharmacological treatment patterns in patients with juvenile idiopathic arthritis in the Netherlands: a real-world data analysis. Rheumatology (Oxford) 2022; 62:SI170-SI180. [PMID: 35583252 PMCID: PMC9949706 DOI: 10.1093/rheumatology/keac299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/07/2022] [Accepted: 05/07/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate medication prescription patterns among children with JIA, including duration, sequence and reasons for medication discontinuation. METHODS This study is a single-centre, retrospective analysis of prospective data from the electronic medical records of JIA patients receiving systemic therapy aged 0-18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype) and medication prescriptions were extracted and analysed using descriptive statistics, Sankey diagrams and Kaplan-Meier survival methods. RESULTS Over a median of 4.2 years follow-up, the 20 different medicines analysed were prescribed as monotherapy (n = 15) or combination therapy (n = 48 unique combinations) among 236 patients. In non-systemic JIA, synthetic DMARDs were prescribed to almost all patients (99.5%), and always included MTX. In contrast, 43.9% of non-systemic JIA patients received a biologic DMARD (mostly adalimumab or etanercept), ranging from 30.9% for oligoarticular persistent ANA-positive JIA, to 90.9% for polyarticular RF-positive JIA. Among systemic JIA, 91.7% received a biologic DMARD (always including anakinra). When analysing medication prescriptions according to their class, 32.6% involved combination therapy. In 56.8% of patients, subsequent treatment lines were initiated after unsuccessful first-line treatment, resulting in 68 unique sequences. Remission was the most common reason for DMARD discontinuation (44.7%), followed by adverse events (28.9%) and ineffectiveness (22.1%). CONCLUSION This paper reveals the complexity of pharmacological treatment in JIA, as indicated by: the variety of mono- and combination therapies prescribed, substantial variation in medication prescriptions between subtypes, most patients receiving two or more treatment lines, and the large number of unique treatment sequences.
Collapse
Affiliation(s)
- Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht
| | - Sytze de Roock
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Gillian Currie
- Department of Community Health Sciences,Department of Paediatrics, Cumming School of Medicine,Alberta Children’s Hospital Research Institute,Department of Medicine
| | - Deborah A Marshall
- Department of Community Health Sciences,Alberta Children’s Hospital Research Institute,Department of Medicine
| | | | - Marinka Twilt
- Alberta Children’s Hospital Research Institute,Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Rae S M Yeung
- Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Susanne M Benseler
- Alberta Children’s Hospital Research Institute,Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands,European Reference Network RITA (rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | - Nico Wulffraat
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands,European Reference Network RITA (rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | | | - Maarten J IJzerman
- Correspondence to: Maarten J. IJzerman, Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands. E-mail:
| |
Collapse
|
185
|
Zhao JL, Liu X, Nan Li J, Ru Liu M, Rottier E, Zhao Y, Zeng XF. Implementation of the treat-to-target approach and treatment satisfaction in patients with rheumatoid arthritis: perspectives of Chinese rheumatologists. Clin Rheumatol 2022; 41:2659-2668. [PMID: 35579773 DOI: 10.1007/s10067-022-06187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the implementation of treat-to-target (T2T) and treatment satisfaction from Chinese rheumatologists' perspectives. METHODS This retrospective analysis of a cross-sectional database collected from rheumatologists and their adult patients with RA in China using Adelphi Real World Disease Specific Programme™ methodology. Multivariate logistic regression models were used to evaluate factors associated with T2T use, achievement of T2T goals, and physician treatment satisfaction. RESULTS Sixty physicians provided data for 600 patients, of whom 39.0% (234/600) were being treated using T2T, and 64.9% (366/564) had achieved their T2T goal. Physicians were satisfied with treatment in 74.3% (445/599) of patients. Patients with a higher pain score were more likely to be managed using T2T (odds ratio (OR) 1.25; p = 0.017), but less likely to have achieved the T2T goal (OR 0.76; p = 0.004). T2T use was more likely if patients had a longer time since diagnosis (> 2 vs ≤ 2 years; OR 1.61; p = 0.031) or received targeted synthetic or biologic disease-modifying antirheumatic drugs (tsDMARDs or bDMARDs; OR 6.90; p < 0.001). T2T goal achievement was more likely for patients with higher body mass index (≥ 24 vs < 24 kg/m2; OR 2.73; p = 0.001) or full-time employment (OR 2.11; p = 0.005). Physician treatment satisfaction was more likely if the T2T goal was achieved (OR 4.78; p < 0.001) or tsDMARDs or bDMARDs were used (OR 2.58; p = 0.017), and less likely if pain scores were higher (OR 0.79; p = 0.019). CONCLUSIONS T2T implementation in China is suboptimal. Our findings provide insight into T2T implementation and physician treatment satisfaction, supporting T2T use in Chinese RA clinical practice. Key Points • T2T implementation in China is currently suboptimal. • Patients with greater pain were more likely to be managed using T2T but were less likely to have achieved their T2T goals. • Physician treatment satisfaction was associated with T2T goal achievement.
Collapse
Affiliation(s)
- Jiu Liang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. .,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xin Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Jin Nan Li
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Meng Ru Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Elke Rottier
- Autoimmune Franchise, Adelphi Real World, Bollington, Cheshire, UK
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiao Feng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| |
Collapse
|
186
|
Koh JH, Lee Y, Kim HA, Kim J, Shin K. Comparison of remission criteria in patients with rheumatoid arthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs: results from a nationwide registry. Ther Adv Musculoskelet Dis 2022; 14:1759720X221096363. [PMID: 35586514 PMCID: PMC9109493 DOI: 10.1177/1759720x221096363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD) are widely used for treatment of rheumatoid arthritis (RA), enabling patients to better achieve remission. Objective The objective of the study was to investigate and compare remission rates in RA patients treated with different b/tsDMARDs during the period 2013-2019. Design A longitudinal observational analysis was performed on data from a nationwide RA registry. Methods Remission rates in the KOBIO-RA registry were defined by a disease activity score in 28 joints (DAS28), clinical disease activity index (CDAI), simplified disease activity index (SDAI), and Boolean-based assessment. After initiating treatment with b/tsDMARDs, yearly remission rates in response to b/tsDMARDs, either all or as subgroups (tumor necrosis factor-α inhibitors, tocilizumab, abatacept, and Janus kinase inhibitors), were investigated for 5 years. Sustained remission was defined as remission maintained for two consecutive years. Results Patients (N = 1805) who completed at least one follow-up visit were analyzed (mean age = 55 years; 83.2% female). At month 12, 56.0% of patients achieved remission based on DAS28-C-reactive protein (CRP), 36.2% on DAS28-erythrocyte sedimentation rate (ESR), 10.4% on CDAI, 12.7% on SDAI, and 12.9% on Boolean criteria. Sustained remission rates were 62%, 40%, 13%, 11%, and 8% for the DAS28-CRP, DAS28-ESR, Boolean, SDAI, and CDAI remission criteria, respectively. Remission rates using the DAS28 definition varied most among the b/tsDMARD subgroups. Conclusion Assessment of sustained remission using the CDAI, SDAI, or Boolean criteria is more stringent, yet congruous with the DAS28-based criteria in RA patients treated with b/tsDMARDs.
Collapse
Affiliation(s)
- Jung Hee Koh
- Division of Rheumatology, Department of
Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The
Catholic University of Korea, Seoul, Korea
| | | | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University
School of Medicine, Suwon, Korea
| | - Jinhyun Kim
- Division of Rheumatology, Department of
Internal Medicine, College of Medicine, Chungnam National University,
Daejeon, Korea
| | - Kichul Shin
- Department of Internal Medicine, College of
Medicine, Seoul National University, Seoul, Korea
- Division of Rheumatology, Department of
Internal Medicine, Seoul Metropolitan Government – Seoul Boramae Medical
Center, 20 Boramae-ro-5-gil, Dongjak-gu, Seoul 07061, Korea
| |
Collapse
|
187
|
Fitton J, Melville A, Naraghi K, Nam J, Dass S, Emery P, Buch MH. Single-centre experience of refractory rheumatoid arthritis. Rheumatol Adv Pract 2022; 6:rkac057. [PMID: 35937776 PMCID: PMC9348550 DOI: 10.1093/rap/rkac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim was to evaluate the proportion of RA patients who are refractory to multiple targeted therapies (TTs) in a real-world cohort of patients in a tertiary rheumatology referral centre, to describe patterns of drug sequencing associated with the development of refractory RA (RefRA) and to identify whether there is a subgroup of RefRA patients in whom successive drugs have shown primary lack of efficacy. Methods Patients at a single centre were defined as refractory if they had failed two or more classes of TT and were identified from a dedicated TT clinic database. Reasons for drug failure were recorded, and patients were categorized pragmatically as having mild [failure of two biologic DMARD (bDMARD) classes], moderate [failure of at least three bDMARD classes] or severe [failure of at least two bDMARD classes and JAK inhibitor] refractory disease. Results One hundred and seventy-two patients were identified as RefRA (>10% of our TT-exposed cohort); median [interquartile range (IQR)] TT exposures of four (two), 81.5% female, 82% seropositive, mean (s.d.) age of 63 (12.3) years. Detailed analysis of 60 patients showed a median (IQR) disease duration of 22 (10.75) years, median (IQR) time from diagnosis to initiation of first TT of 5 (10) years, and mean (s.d.) baseline DAS28CRP before starting first-line TT of 5.91 (0.84). Among RefRA patients, 15% were severely refractory, and 6% had demonstrated no clinical response to any TT. Conclusion A small proportion of patients have true RefRA. Most patients fail multiple therapies owing to a combination of inefficacy and adverse events.
Collapse
Affiliation(s)
- John Fitton
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- NIHR Leeds Biomedical Research Centre
| | - Andrew Melville
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- NIHR Leeds Biomedical Research Centre
| | - Kamran Naraghi
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- NIHR Leeds Biomedical Research Centre
| | - Jacqueline Nam
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- NIHR Leeds Biomedical Research Centre
| | - Shouvik Dass
- Department of Rheumatology, Leeds Teaching Hospitals NHS Trust , Leeds
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- NIHR Leeds Biomedical Research Centre
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital
- Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust , Manchester, UK
| |
Collapse
|
188
|
Silvagni E, Zandonella Callegher S, Mauric E, Chiricolo S, Schreiber N, Tullio A, Zabotti A, Scirè CA, Dejaco C, Sakellariou G. Musculoskeletal ultrasound for treating rheumatoid arthritis to target-a systematic literature review. Rheumatology (Oxford) 2022; 61:4590-4602. [PMID: 35512175 PMCID: PMC9707059 DOI: 10.1093/rheumatology/keac261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE We aimed to systematically review the literature to retrieve evidence on the diagnostic and prognostic value of musculoskeletal ultrasound for a treat to target (T2T) approach in RA. METHODS Eight research questions were developed addressing the role of ultrasound (including different ultrasound scores and elementary lesions) for diagnosis, monitoring and prognosis of RA. PubMed and EMBASE were searched (2005-2020). Articles on RA and reporting data on musculoskeletal ultrasound were included and extracted according to the underlying questions, and risk of bias assessed according to the study design. RESULTS Out of 4632 records, 60 articles were included. Due to clinical heterogeneity, meta-analysis was not possible. Ultrasound better predicted disease relapses with respect to clinical examination in patients in remission, while both methods performed similarly in predicting response to therapy, achievement of remission and radiographic progression. Ultrasound was superior to clinical examination in diagnosing joint involvement using another imaging modality, such as magnetic resonance imaging, as reference. Limited ultrasound scores performed like more extensive evaluations for the detection of joint inflammation and for outcome prediction. Higher ultrasound scores of synovitis were linked to poor outcomes at all disease stages, but a specific cut-off distinguishing between low- and high-risk groups did not emerge. CONCLUSIONS These data confirm the pivotal role of ultrasound when evaluating synovial inflammation and when identifying RA patients at higher risk of relapse. Further research is needed to better define the role of ultrasound in a T2T management strategy in moderately-to-highly active RA.
Collapse
Affiliation(s)
| | | | - Eleonora Mauric
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, PV, Italy
| | - Sofia Chiricolo
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, PV, Italy
| | | | | | - Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Academic Hospital ‘Santa Maria della Misericordia’, Udine, UD
| | - Carlo Alberto Scirè
- Rheumatology Unit, School of Medicine and Surgery, University of Milano-Bicocca,Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, BZ,Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Garifallia Sakellariou
- Correspondence to: Garifallia Sakellariou, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Maugeri, 10, 27100 Pavia, Italy.
| |
Collapse
|
189
|
Hill J, Harrison J, Christian D, Reed J, Clegg A, Duffield SJ, Goodson N, Marson T. The prevalence of comorbidity in rheumatoid arthritis: a systematic review and meta-analysis. Br J Community Nurs 2022; 27:232-241. [PMID: 35522453 DOI: 10.12968/bjcn.2022.27.5.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This systematic review and meta-analysis estimates the prevalence of common comorbid health disorders in adults with rheumatoid arthritis (RA). A multi-database search strategy was undertaken. Screening, data extraction and quality assessment were carried out by two independent reviewers. A meta-analysis and meta-regression were used to generate a pooled prevalence estimate and identify relevant moderators. After study selection, 33 studies (74633 participants) were included in the meta-analysis. Some 31 studies were judged to be of low risk of bias, and two studies were judged to be at moderate risk of bias. The three most common comorbidities in RA were anxiety disorders (62.1%, 95% Cl: 43.6%; 80.6%), hypertension (37.7%, 95% Cl: 29.2%; 46.2%) and depression (32.1%, 95% Cl: 21.6%; 42.7%). There was substantial statistically significant heterogeneity for all comorbidities (I2 ≥77%). Meta-regression identified that the covariate of mean age (unit increase) had a statistically significant effect on the prevalence of hypertension (+2.3%, 95% Cl: 0.4%; 4.2%), depression (-0.5%, 95% Cl: -0.6%; -0.4%) and cancer (0.5%, 95% Cl: 0.2%; 0.8%) in adults with RA. A country's income was identified to have a statistically significant effect on the prevalence of depression, with low-to moderate-income countries having 40% (95% Cl: 14.0%; 66.6%) higher prevalence than high-income countries. No studies consider health inequalities. It is concluded that comorbidities are prevalent among people with RA, particularly those associated with mental health and circulatory conditions. Provision of health services should reflect the importance of such multimorbidity and the consequences for quality and length of life.
Collapse
Affiliation(s)
- James Hill
- Senior Research Fellow in Evidence Synthesis, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Joanna Harrison
- Research Fellow in Evidence Synthesis & Summary, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Danielle Christian
- Research Associate, Stroke Research Team, University of Central Lancashire
| | - Janet Reed
- Library Customer Services Manager, Heriot-Watt University, Edinburgh
| | - Andrew Clegg
- Professor of Health Services Research, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Stephen J Duffield
- Senior Analyst - Methods and Standards, National Institute for Health and Care Excellence, Manchester
| | - Nicola Goodson
- Consultant Rheumatologist and Senior Lecturer, University Hospital Aintree, Liverpool
| | - Tony Marson
- Professor of Neurology, University of Liverpool
| |
Collapse
|
190
|
Appleton CT, Hegele RA. Preventing cardiovascular events in patients with inflammatory arthritis: are we missing the mark? Can J Cardiol 2022; 38:1138-1140. [DOI: 10.1016/j.cjca.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022] Open
|
191
|
Spijk-de Jonge MJ, Weijers JM, Teerenstra S, Elwyn G, van de Laar MA, van Riel PL, Huis AM, Hulscher ME. Patient involvement in rheumatoid arthritis care to improve disease activity-based management in daily practice: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:1244-1253. [PMID: 34465495 DOI: 10.1016/j.pec.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effect of an intervention to improve disease activity-based management of RA in daily clinical practice by addressing patient level barriers. METHODS The DAS-pass strategy aims to increase patients' knowledge about DAS28 and to empower patients to be involved in treatment (decisions). It consists of an informational leaflet, a patient held record and guidance by a specialized rheumatology nurse. In a Randomized Controlled Trial, 199 RA patients were randomized 1:1 to intervention or control group. Outcome measures were patient empowerment (EC-17; primary outcome), attitudes towards medication (BMQ), disease activity (DAS28) and knowledge about DAS28. RESULTS Our strategy did not affect EC-17, BMQ, or DAS28 use. However it demonstrated a significant improvement of knowledge about DAS28 in the intervention group, compared to the control group. The intervention had an additional effect on patients with low baseline knowledge compared to patients with high baseline knowledge. CONCLUSION The DAS-pass strategy educates patients about (the importance of) disease activity-based management, especially patients with low baseline knowledge. PRACTICE IMPLICATIONS The strategy supports patient involvement in disease activity-based management of RA and can be helpful to reduce inequalities between patients in the ability to be involved in shared decision making.
Collapse
Affiliation(s)
- Marieke J Spijk-de Jonge
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Julia M Weijers
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Section Biostatistics, Nijmegen, The Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Mart Afj van de Laar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands
| | - Piet Lcm van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Bernhoven, Department of Rheumatology, Uden, The Netherlands
| | - Anita Mp Huis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marlies Ejl Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
192
|
de Thurah A, Bosch P, Marques A, Meissner Y, Mukhtyar CB, Knitza J, Najm A, Østerås N, Pelle T, Knudsen LR, Šmucrová H, Berenbaum F, Jani M, Geenen R, Krusche M, Pchelnikova P, de Souza S, Badreh S, Wiek D, Piantoni S, Gwinnutt JM, Duftner C, Canhão HM, Quartuccio L, Stoilov N, Prior Y, Bijlsma JW, Zabotti A, Stamm TA, Dejaco C. 2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Ann Rheum Dis 2022; 81:1065-1071. [PMID: 35470160 DOI: 10.1136/annrheumdis-2022-222341] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD). OBJECTIVE To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD. METHODS A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting. RESULTS Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible.The level of agreement to each statement ranged from 8.5 to 9.8/10. CONCLUSION The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice.
Collapse
Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philipp Bosch
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria
| | - Andrea Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal.,Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet University College and Hospital, Oslo, Norway
| | - Tim Pelle
- Department of Rheumatic Diseases, Radboud University, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hana Šmucrová
- Institute of Rheumatology, Centre of Medical Rehabilitation, Praha, Czech Republic
| | | | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK.,Patient Research Partner, EULAR, London, UK
| | - Sara Badreh
- Patient Research Partner, EULAR, Stockholm, Sweden
| | - Dieter Wiek
- Patient Research Partner, EULAR, Bonn, Germany
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck/Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helena M Canhão
- Comprehensive Research Center, CHRC, EpicDoC Unit, CEDOC-NOVA Medical School-NOVA University of Lisbon, Portugal, Lisboa, Portugal
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Nikolay Stoilov
- Faculty of Medicine, University Hospital St. Ivan Rilski, Medical University of Sofia, Sofia, Bulgaria
| | - Yeliz Prior
- Centre for Health Sciences Research, School of Health and Society, University of Salford, Salford, UK
| | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.,Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Bruneck, Italy
| |
Collapse
|
193
|
Xu Z, Wang Y, Liu Z, Zhang R, Zhou Y, Yu J, Lan J, Liang W, Liu G, Qu X, Chen J, Su Z, Yu S, Cheng Y, Wang W, Ren Q, Deng Q, Zhao Y, Yang H. A randomized, crossover, phase I clinical study to evaluate bioequivalence and safety of tofacitinib and Xeljanz® in Chinese healthy subjects. Int Immunopharmacol 2022; 109:108780. [PMID: 35461158 DOI: 10.1016/j.intimp.2022.108780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Tofacitinib is an oral Janus kinase (JAK) inhibitor that has been marketed and approved in the USA for the clinical treatment of rheumatoid arthritis, psoriasis and other inflammatory and autoimmune diseases. A phase I clinical trial was conducted to compare the bioequivalence and safety of tofacitinib (Chia Tai Tianqing Pharmaceutical Group Co., Ltd.) and Xeljanz® (Pfizer Inc.) in healthy Chinese subjects, providing basis for the clinical application of tofacitinib. METHODS Healthy Chinese subjects (N = 32) were randomly assigned to two groups at a 1:1 ratio. Subjects orally took 5 mg tofacitinib or Xeljanz® per cycle in random sequence. Blood samples were collected at 15 sampling points per cycle, and plasma drug concentrations of tofacitinib or Xeljanz® were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and statistical analysis for the pharmacokinetic (PK) parameters. Subjects' physical indicators were monitored during the whole process to evaluate drug safety. RESULTS The adjusted geometric mean ratios (GMRs) of the peak concentration (Cmax), area under the curve (AUC) from time zero to the last measurable concentration (AUC0-t) and AUC from time zero to observed infinity (AUC0-∞) were all within the range of 80-125%. The other PK parameter values were similar. The above values were all meeting the bioequivalence criteria with well safety. CONCLUSION The pharmacokinetic parameters and safety profile of tofacitinib were similar to those of Xeljanz® in healthy Chinese subjects. Therefore, tofacitinib can be considered bioequivalent to Xeljanz®, and the findings of this trial will promote the clinical application of tofacitinib.
Collapse
Affiliation(s)
- Zhongnan Xu
- Department of Clinical Research Center, Chia Tai Tianqing Pharmaceutical Group Co., Ltd, Nanjing, Jiangsu, China
| | - Yanli Wang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhengzhi Liu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | | | - Yannan Zhou
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jing Yu
- Ansiterui Medical Technology Consulting Co., Ltd, Changchun, Jilin, China
| | - Jing Lan
- Wuxi Apptec Co., Ltd, Shanghai, China
| | | | - Guangwen Liu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xinyao Qu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jiahui Chen
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhengjie Su
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Shuang Yu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yang Cheng
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Wanhua Wang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Qing Ren
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Qiaohuan Deng
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | | | - Haimiao Yang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China.
| |
Collapse
|
194
|
Zeng X, Zheng M, Liu T, Bahabayi A, Song S, Alimu X, Kang R, Lu S, Song Y, Liu C. Cytotoxic T Lymphocytes Expressing GPR56 are Up-regulated in the Peripheral Blood of Patients with Active Rheumatoid Arthritis and Reflect Disease Progression. Immunol Invest 2022; 51:1804-1819. [PMID: 35404706 DOI: 10.1080/08820139.2022.2058403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aims to elucidate the changes in the percentage of GPR56 and/or granzyme B (GZMB) positive cells in rheumatoid arthritis (RA) CD4 and CD8 T lymphocytes, and to explore their clinical value in diagnosing and reflecting the progression of RA. METHODS The percentages of GPR56 and/or GZMB positive cells were analyzed in peripheral blood (PB) and spleen T cells in a collagen-induced arthritis (CIA) model established in DBA/1 mice. The percentages of GPR56+ and/or GZMB+ cells were further analyzed in PBs from RA patients and healthy controls. Correlation analysis was performed between clinical indicators and GPR56+, GZMB+, and GPR56+ GZMB+ T cells. Receiver operating characteristic (ROC) curves were used to evaluate the value of GPR56 and GZMB in differentiating active and stable remitting RA. RESULTS GPR56+ levels were increased in CD4 and CD8 T cells in the PB of CIA mice. The percentages of GPR56+ and GZMB+ cells were increased in both CD4 and CD8 T cell subsets in patients with active RA. GPR56+, GZMB+, and GPR56+ GZMB+ cells were positively correlated with rheumatoid factor and DAS28. ROC analysis revealed that AUCs for GPR56+, GZMB+, and GPR56+ GZMB+ cell percentages to distinguish active RA from stable remission RA were 0.7106, 0.6941, 0.7024, with cut-off values of 16.35, 16.40, 14.80 in CD4 + T cells, and 0.8031, 0.8086, 0.8196 with cut-off values 60.25, 62.15, 40.15 in CD8 + T cells, respectively. CONCLUSIONS GPR56+ and/or GZMB+ T cells are up-regulated in patients with active RA and reflect their condition. The detection of GPR56 and GZMB is helpful for RA disease assessment.
Collapse
Affiliation(s)
- Xingyue Zeng
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Mohan Zheng
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Tianci Liu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Ayibaota Bahabayi
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Shi Song
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Xiayidan Alimu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Rui Kang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Songsong Lu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Ying Song
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chen Liu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| |
Collapse
|
195
|
Feist E, Baraliakos X, Behrens F, Thaçi D, Klopsch T, Plenske A, Blindzellner LK, Klaus P, Meng T, Löschmann PA. Effectiveness of Etanercept in Rheumatoid Arthritis: Real-World Data from the German Non-interventional Study ADEQUATE with Focus on Treat-to-Target and Patient-Reported Outcomes. Rheumatol Ther 2022; 9:621-635. [PMID: 35113363 PMCID: PMC8964852 DOI: 10.1007/s40744-021-00418-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND For rheumatoid arthritis (RA), the treat-to-target concept suggests attaining remission or at least low disease activity (LDA) after 12 weeks. OBJECTIVES This German, prospective, multicenter, non-interventional study aimed to determine the proportion of patients with RA who achieved their treat-to-target aim after 12 and 24 weeks of etanercept (ETN) treatment in a real-life setting, as opposed to patients achieving their therapeutic target at a later timepoint (week 36 or 52). METHODS A total of 824 adults with a confirmed diagnosis of RA without prior ETN treatment were included. Remission and LDA were defined as DAS28 < 2.6 and DAS28 ≤ 3.2, respectively. RESULTS The proportion of patients achieving remission was 24% at week 12 and 31% at week 24. The proportion of patients achieving LDA was 39% at week 12 and 45% at week 24. The proportion of patients achieving remission or LDA further increased beyond week 24 up to week 52. Improvement in pain and reduction in concomitant glucocorticoid treatment were observed. Improvements in patient-reported outcomes were also seen in patients who did not reach remission or LDA. No new safety signals were detected. CONCLUSIONS A considerable proportion of patients with RA attained the target of remission or LDA after 12 weeks of ETN treatment. Even beyond that timepoint, the proportion of patients achieving treatment targets continued to increase up to week 52. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02486302.
Collapse
Affiliation(s)
- Eugen Feist
- Department of Rheumatology, Helios Fachklinik, Sophie-von-Boetticher-Straße 1, 39245, Vogelsang-Gommern, Germany.
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany.
- Otto-von-Guericke University, Magdeburg, Germany.
| | | | - Frank Behrens
- CIRI/Rheumatology and Fraunhofer IME, Institute for Translational Medicine and Pharmacology, Goethe University Hospital, Frankfurt/Main, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | | | | | | | | | | |
Collapse
|
196
|
Fleischmann R, Hayes K, Ahn SW, Wan GJ, Panaccio M, Karlsson D, Furst DE. Post Hoc Analysis of Predictors of Clinical Response to Repository Corticotropin Injection in Persistently Active Rheumatoid Arthritis. Rheumatol Ther 2022; 9:649-661. [PMID: 35184268 PMCID: PMC8964897 DOI: 10.1007/s40744-022-00429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A phase IV clinical trial confirmed the safety and efficacy of repository corticotropin injection (RCI, Acthar® Gel) in patients with refractory rheumatoid arthritis (RA) that was nonresponsive to standard-of-care therapies. The objective of this post hoc analysis was to identify baseline demographics and clinical characteristics that may be predictors of response to RCI. METHODS The phase IV trial was a two-part, randomized, placebo-controlled withdrawal study. Post hoc analysis was conducted with the open-label portion of the trial data, in which all 258 subjects received RCI (80 U) twice weekly for 12 weeks. Responders were subjects who achieved low disease activity (LDA) by a Disease Activity Score with 28-joint count and erythrocyte sedimentation rate (DAS28-ESR) of < 3.2 at week 12. Responders were compared with nonresponders by assessing the proportion of subjects in each group for demographics and clinical characteristics, including weight, disease duration, medical history including osteoarthritis and unrelated joint conditions, hemoglobin A1c, C-reactive protein, ESR, DAS28-ESR, Clinical Disease Activity Index (CDAI), depression, anxiety, tender joint count (TJC), and swollen joint count (SJC). Bivariate analysis followed by multiple logistic regression analysis were conducted to identify significant baseline predictors for the outcome of achieving LDA by week 12. RESULTS Bivariate analysis showed that RCI responders had significantly lower baseline TJC (p = 0.0310), SJC (p = 0.0018), ESR (p = 0.0487), and CDAI (p = 0.0112) and shorter RA disease duration (p = 0.0446). Subjects were less likely to achieve LDA if they had osteoarthritis (p < 0.0001), other joint-related conditions unrelated to RA (p < 0.0001), anemia (p = 0.0132), depression (p = 0.0006), or prior or concomitant use of targeted-synthetic or biologic disease-modifying antirheumatic drugs (p < 0.0001). Multiple logistic regression analysis revealed that, of the above, only ongoing osteoarthritis (p = 0.0272) or other joint-related conditions (p = 0.0193) were significant negative predictors of RCI response. CONCLUSIONS These results identify specific patient characteristics that may be considered predictors of positive or negative clinical response to RCI.
Collapse
Affiliation(s)
- Roy Fleischmann
- University of Texas Southwestern Medical Center, Metroplex Clinical Research Center, 8144 Walnut Hill Lane, Dallas, TX, 75231, USA.
| | - Kyle Hayes
- Mallinckrodt Pharmaceuticals, Hampton, NJ, USA
| | | | | | | | | | - Daniel E Furst
- David Geffen School of Medicine, Division of Rheumatology, University of California, Los Angeles, CA, USA
| |
Collapse
|
197
|
Mamaril-Davis JC, Aguilar-Salinas P, Avila MJ, Villatoro-Villar M, Dumont TM. Perioperative management of disease-modifying antirheumatic drugs for patients undergoing elective spine surgery: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:815-829. [PMID: 35132461 DOI: 10.1007/s00586-021-07080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In preparation for surgery, patients being treated with disease-modifying antirheumatic drugs (DMARDs) are recommended to either continue or withhold therapy perioperatively. Some of these drugs have known effects against bone healing, hence the importance of adequately managing them before and after surgery. OBJECTIVE We aim to assess the current evidence for managing conventional synthetic and/or biologic DMARDs in the perioperative period for elective spine surgery. METHODS A systematic review of four databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included manuscripts were methodically scrutinized for quality, postoperative infections, wound healing characteristics, bone fusion rates, and clinical outcomes. RESULTS Six studies were identified describing the management of conventional synthetic and/or biologic DMARDs. There were 294 DMARD-treated patients described undergoing various spine surgeries such as craniovertebral junction fusions. Three of the studies involved exclusive continuation of DMARDs in the perioperative window; one study involved exclusive discontinuation of DMARDs in the perioperative window; and two studies involved continuation or discontinuation of DMARDs perioperatively. Of patients that continued DMARDs in the perioperative period, 13/50 patients (26.0%) had postoperative surgical site infections or wound dehiscence, 2/19 patients (10.5%) had delayed wound healing, and 32/213 patients (15.0%) had secondary revision surgeries. A fusion rate of 14/19 (73.6%) was described in only one study for patients continuing DMARDs perioperatively. CONCLUSIONS The available published data may suggest a higher risk of wound healing concerns and lower than average bone fusion, although this may be under-reported given the current state of the literature.
Collapse
Affiliation(s)
- James C Mamaril-Davis
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | - Pedro Aguilar-Salinas
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | - Mauricio J Avila
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | | | - Travis M Dumont
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA.
| |
Collapse
|
198
|
Fernández Sánchez SP, Rodríguez Muñoz F, Laiz A, Castellví I, Magallares B, Corominas H. Impact of the COVID-19 pandemic on rheumatology nursing consultation. REUMATOLOGIA CLINICA 2022; 18:231-235. [PMID: 34088653 PMCID: PMC8169321 DOI: 10.1016/j.reumae.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has brought major changes to the model of patient care in Rheumatology. Our aim was to compare the change in the care delivered in a rheumatology nursing consultation before and during the pandemic. MATERIAL AND METHODS Descriptive and observational study. Patient care was registered before and during the COVID-19 outbreak. The variables collected were age, sex, prevalent rheumatic disease, type of visit and reason for consultation. RESULTS 254 consecutive patients were included before the COVID-19 pandemic for 20 days and 251 patients during COVID-19 for 10 working days. The mean age was 61 years before and 57 during the pandemic. Of both groups, 74% were women. The most frequently attended pathologies before and during COVID-19 were rheumatoid arthritis and spondyloarthropathies. Scheduled face-to-face visits decreased during COVID-19 (46.5% versus 1.6%), with an increased number of phone scheduled visits (2.8% versus 52.2%) and spontaneous consultations either by phone or e-mail (28.3% versus 45%). The type of scheduled visits during COVID-19 were for stable diseases (20% versus 37%) and monitoring (12% versus 38%). The reason for spontaneous consultation increased during COVID-19 and were mainly doubts regarding prevention measures and treatment optimization (13.8% versus 31.1%). CONCLUSIONS The first wave of COVID-19 brought to rheumatology nursing consultation a global increase in all activities in the number of visits per day, in the number of stable patient controls, in monitoring and answering patient concerns.
Collapse
Affiliation(s)
- Susana P Fernández Sánchez
- Servicio de Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fermín Rodríguez Muñoz
- Enfermería de Consultas Externas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Laiz
- Servicio de Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ivan Castellví
- Servicio de Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Berta Magallares
- Servicio de Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Héctor Corominas
- Servicio de Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| |
Collapse
|
199
|
Bartold PM, Ivanovski S. P4 Medicine as a model for precision periodontal care. Clin Oral Investig 2022; 26:5517-5533. [PMID: 35344104 PMCID: PMC9474478 DOI: 10.1007/s00784-022-04469-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022]
Abstract
Objectives P4 Medicine is based on a proactive approach for clinical patient care incorporating the four “pillars” of prediction, prevention, personalization, and participation for patient management. The purpose of this review is to demonstrate how the concepts of P4 medicine can be incorporated into the management of periodontal diseases (particularly periodontitis) termed P4 periodontics. Methods This is a narrative review that used current literature to explore how P4 periodontics can be aligned with the 2018 Classification of Periodontal Diseases, current periodontal treatment paradigms, and periodontal regenerative technologies. Results The proposed model of P4 periodontics is highly aligned with the 2018 Classification of Periodontal Diseases and represents a logical extension of this classification into treatment paradigms. Each stage of periodontitis can be related to a holistic approach to clinical management. The role of “big data” in future P4 periodontics is discussed and the concepts of a treat-to-target focus for treatment outcomes are proposed as part of personalized periodontics. Personalized regenerative and rejuvenative periodontal therapies will refocus our thinking from risk management to regenerative solutions to manage the effects of disease and aging. Conclusions P4 Periodontics allows us to focus not only on early prevention and intervention but also allow for personalized late-stage reversal of the disease trajectory and the use of personalized regenerative procedures to reconstruct damaged tissues and restore them to health. Clinical Significance P4 Periodontics is a novel means of viewing a holistic, integrative, and proactive approach to periodontal treatment.
Collapse
Affiliation(s)
- P Mark Bartold
- University of Queensland, 1 Milton Avenue, Beaumont, South Australia, 5066, Australia.
| | - Sašo Ivanovski
- University of Queensland, 1 Milton Avenue, Beaumont, South Australia, 5066, Australia
| |
Collapse
|
200
|
Huang H, Xie W, Geng Y, Fan Y, Wang Y, Zhao J, Zhang Z. Towards a Better Implementation of Treat-to-Target Strategy in Rheumatoid Arthritis: A Comparison of Two Real-World Cohorts. Rheumatol Ther 2022; 9:907-917. [PMID: 35347662 PMCID: PMC8960103 DOI: 10.1007/s40744-022-00441-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/04/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Treat-to-target (T2T) strategy has been the core of rheumatoid arthritis (RA) management for over a decade, although it implementation has varied distinctly in real practices. We report here our investigation of the differences in disease activity and target achievement of two patient cohorts with different T2T implementations. Methods Data of the CENTRA (Collaboratively intENsive Treat-to-target in RA) and TARRA (Treat-to-TARget in RA) cohorts were used. The CENTRA cohort is a RA cohort prospectively followed up by a fixed team with tight control, while the TARRA is a longitudinal observational cohort followed up by a rheumatologist with casual control. Patients from the two cohorts were matched 1:3 by propensity score matching. The primary outcome was the Simplified Disease Activity Index (SDAI) at the 1-year follow-up. Results Included in this analysis were 102 patients from the CENTRA cohort and 271 patients from the TARRA cohort. Both groups were comparable in terms of age, gender, disease course, and seropositivity. At the end of the 1-year follow-up, the SDAI of patients in the CENTRA cohort was significantly lower than that of patients in the TARRA cohort (2.1 vs. 3.4; p < 0.001). A similar result was obtained based on the generalized estimating equation (GEE) model (p = 0.009). In addition, more patients in the CENTRA cohort achieved SDAI-defined remission compared to the TARRA cohort [72 (70.6%) vs. 134 (49.4%); p < 0.001]. Conclusion Patients with RA may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with those with a casual T2T strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00441-0.
Collapse
Affiliation(s)
- Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China.
| |
Collapse
|