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Favalli EG, Maioli G, Caporali R. Biologics or Janus Kinase Inhibitors in Rheumatoid Arthritis Patients Who are Insufficient Responders to Conventional Anti-Rheumatic Drugs. Drugs 2024; 84:877-894. [PMID: 38949688 PMCID: PMC11343917 DOI: 10.1007/s40265-024-02059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/02/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20 years, the improvement of knowledge on the pathogenesis of the disease has made available several drugs targeting key elements of the pathogenetic process, which now represent the preferred treatment option after the failure of first-line therapy with conventional drugs such as methotrexate (MTX). To this category of targeted drugs belong anti-cytokine or cell-targeted biological agents and more recently also Janus kinase inhibitors (JAKis). In the absence to date of specific biomarkers to guide the therapeutic choice in the context of true precision medicine, the choice of the first targeted drug after MTX failure is guided by treatment cost (especially after the marketing of biosimilar products) and by the clinical characteristics of the patient (age, sex, comorbidities and compliance) and the disease (presence or absence of autoantibodies and systemic or extra-articular manifestations), which may influence the efficacy and safety profile of the available products. This viewpoint focuses on the decision-making process underlying the personalized approach to RA therapy and will analyse the evidence in the literature supporting the choice of individual products and in particular the differential choice between biological drugs and JAKis.
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Affiliation(s)
- Ennio Giulio Favalli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Gabriella Maioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
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Dubovyk V, Vasileiadis GK, Fatima T, Zhang Y, Kapetanovic MC, Kastbom A, Rizk M, Söderbergh A, Zhao SS, van Vollenhoven RF, Hetland ML, Haavardsholm EA, Nordström D, Nurmohamed MT, Gudbjornsson B, Lampa J, Østergaard M, Heiberg MS, Sokka-Isler T, Gröndal G, Lend K, Hørslev-Petersen K, Uhlig T, Rudin A, Maglio C. Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study. RMD Open 2024; 10:e004227. [PMID: 38580350 PMCID: PMC11148705 DOI: 10.1136/rmdopen-2024-004227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE This report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early rheumatoid arthritis (RA). METHODS This report included 793 participants with untreated early RA from the randomised, longitudinal NORD-STAR trial, all of whom had their body mass index (BMI) assessed at baseline. Obesity was defined as BMI ≥30 kg/m2. All participants were randomised 1:1:1:1 to one of four treatment arms: active conventional treatment, certolizumab-pegol, abatacept and tocilizumab. Clinical and laboratory measurements were performed at baseline and at 8, 12, 24 and 48-week follow-up. The primary endpoint for this report was response to treatment based on Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission and Disease Activity Score with 28 joints using C-reactive protein (DAS28-CRP) <2.6 stratified by BMI. RESULTS Out of 793 people included in the present report, 161 (20%) had obesity at baseline. During follow-up, participants with baseline obesity had higher disease activity compared with those with lower BMI, despite having similar disease activity at baseline. In survival analyses, obesity was associated with a lower likelihood of achieving response to treatment during follow-up for up to 48 weeks (CDAI remission, HR 0.84, 95% CI 0.67 to 1.05; SDAI, HR 0.77, 95% CI 0.62 to 0.97; DAS28-CRP <2.6, HR 0.78, 95% CI 0.64 to 0.95). The effect of obesity on response to treatment was not influenced by the treatment arms. CONCLUSION In people with untreated early RA followed up for up to 48 weeks, obesity was associated with a lower likelihood of good treatment response, irrespective of the type of randomised treatment received. TRIAL REGISTRATION NUMBER NCT01491815.
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Affiliation(s)
- Violetta Dubovyk
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Georgios K Vasileiadis
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Tahzeeb Fatima
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Yuan Zhang
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | | | - Alf Kastbom
- Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Milad Rizk
- Rheumatology Clinic, Västmanlands Hospital, Vasteras, Sweden
| | - Annika Söderbergh
- Department of Rheumatology, Örebro University Hospital, Orebro, Sweden
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, The University of Manchester, Manchester, UK
| | - Ronald F van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Rheumatology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Espen A Haavardsholm
- Centre for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Nordström
- Department of Medicine and Rheumatology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology center, Amsterdam, The Netherlands
| | - Bjorn Gudbjornsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Jon Lampa
- Rheumatology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marte Schrumpf Heiberg
- Centre for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Tuulikki Sokka-Isler
- Department of Medicine, Jyväskylä Central Hospital, University of Eastern Finland, Jyväskylä, Finland
| | - Gerdur Gröndal
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Kristina Lend
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Rheumatology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Till Uhlig
- Centre for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Cristina Maglio
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
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Gialouri CG, Pappa M, Evangelatos G, Nikiphorou E, Fragoulis GE. Effect of body mass index on treatment response of biologic-/targeted synthetic-DMARDs in patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. A systematic review. Autoimmun Rev 2023; 22:103357. [PMID: 37150489 DOI: 10.1016/j.autrev.2023.103357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Overweight and/or obese patients with inflammatory arthritis (IA) have higher disease activity and lower chances of achieving and/or maintaining the treatment targets. Weight/obesity also appears to negatively affect the response to tumor necrosis factor (TNF) inhibitors in patients with IA, including rheumatoid arthritis -RA, psoriatic arthritis -PsA, axial spondyloarthritis -AxSpA. We conducted a systematic literature review (SLR) for the effect of weight/body-mass-index (BMI) in the efficacy of all approved b- and targeted-synthetic (ts)- DMARDs for the treatment of IA. METHODS For this PROSPERO-registered SLR, we searched PubMed, Scopus and Cohrane-Library from inception up to June 21st 2022. Clinical-trials (randomized and non-randomized) and observational studies of RA, PsA or AxSpA patients that reported the effect of weight/BMI on response (all possible outcomes) to b/ts-DMARDs were included. Risk-of-bias was assessed via RoB2-Cochrane-tool and Newcastle-Ottawa-scale for randomized and non-randomized studies, respectively. FINDINGS Out of 996 references, 75 eventually fulfilled the inclusion criteria (of which 10 studies were retrieved through manual-search). Among the included studies (TNF-inhibitors: 34, IL-12/23 inhibitors: 4, IL-23 inhibitor: 1, IL-17 inhibitors: 7, tocilizumab: 18, abatacept: 8, rituximab: 3, JAK-inhibitors: 5), most had medium RoB. Efficacy of TNF-inhibitors was affected by BMI in all forms of IA. Data are not robust to compare the effect among various TNF-inhibitors. In contrast, favorable results of IL-23 and IL-17 inhibitors did not appear to be influenced by increased BMI in PsA or AxSpA patients. Similar evidence exists for tocilizumab (in RA) and for abatacept (in RA and PsA), while no conclusion can be drawn for rituximab. More data are needed for JAK-inhibitors, although the effect of weight/BMI does not seem to be significant so far. INTERPRETATION Weight/BMI should be considered in the treatment-plan of patients with IA, with its effect being more pronounced for TNF-inhibitors compared to other b/ts-DMARDs.
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Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Medical School, National and Kapodistrian University of Athens, "Hippocration" General Hospital, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - George E Fragoulis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece.; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK..
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4
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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.
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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.
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5
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Sadeghi A, Tabatabaiee M, Mousavi MA, Mousavi SN, Abdollahi Sabet S, Jalili N. Dietary Pattern or Weight Loss: Which One Is More Important to Reduce Disease Activity Score in Patients with Rheumatoid Arthritis? A Randomized Feeding Trial. Int J Clin Pract 2022; 2022:6004916. [PMID: 35685522 PMCID: PMC9159180 DOI: 10.1155/2022/6004916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/26/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Herein, disease activity score 28 (DAS 28) was compared between patients with rheumatoid arthritis (RA) receiving the Mediterranean dietary pattern (MD) and low-fat diet. Subjects/Methods. Overweight and obese RA patients aged 15-75 y participated in this randomized feeding trial. Participants were randomized to MD (n = 51) and low-fat high-carbohydrate diet (n = 53) for 12 weeks. The control group followed their regular diet (n = 50). Participants completed the form of tender and swollen joint counts before the study enrollment and after 12 weeks to compute DAS 28. Results Weight loss was not statistically significant between the MD and LF-HC groups. DAS 28 significantly decreased in MD compared to the LF-HC group (p=0.02) and controls (p=0.001). Adjusting for the baseline variables, MD reduced DAS 28 by 76% (95% CI = -0.45, -0.2; p=0.03) after 12 weeks of intervention. The baseline serum ESR level showed 99.8% effect on DAS 28 score at the end (95% CI = 0.014, 0.035; p < 0.001). Conclusions The MD showed beneficial effects on DAS 28 compared to the LF-HC diet in patients with RA, regardless of weight loss. It is a better dietary choice for pain reduction in patients with RA. The trial is registered at Iranian Registry of Clinical Trials (IRCT20200929048876N2).
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Affiliation(s)
- Alireza Sadeghi
- Department of Internal Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Science, Zanjan, Iran
| | - Mojtaba Tabatabaiee
- Department of Internal Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Science, Zanjan, Iran
| | - Mir Ali Mousavi
- Department of General Surgery, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyedeh Neda Mousavi
- Zanjan Metaboilc Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Somayae Abdollahi Sabet
- Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Nooshin Jalili
- Department of Internal Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Science, Zanjan, Iran
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Mendoza-Vázquez G, Espinoza-Gómez F, Rocha-Muñoz AD, Gamez-Nava JI, Gonzalez-Lopez L, Salazar-Paramo M, Riebeling-Navarro C, Aceves-Aceves JA, Guzmán-Silahua S, Nava-Zavala AH. Correlation between percentage of fat mass and level of disease activity in rheumatoid arthritis. SAGE Open Med 2022; 10:20503121221085821. [PMID: 35342627 PMCID: PMC8943587 DOI: 10.1177/20503121221085821] [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: 05/12/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Controversies exist regarding the relationship between body fat and disease
activity in patients with rheumatoid arthritis. The evaluation of the
disease is critical for establishing treatment and prognosis. Fat mass could
be a predictive factor for poor prognosis in rheumatoid arthritis because of
its association with low- and high-grade inflammation. Objective: To evaluate the correlation between fat mass values and disease activity in
patients with rheumatoid arthritis. Materials and methods: This was a cross-sectional study. Eighty female patients diagnosed with
rheumatoid arthritis (American College of Rheumatology of 1987) were
evaluated. For each one, the evaluation determined fat mass using
bioelectrical impedance analysis and disease activity using the Disease
Activity Score on 28 joints (DAS28). Results: The mean age was 59.11 ± 9.92 years, with an average disease duration of
14.13 ± 10.13 years; 85% of patients showed a high body fat percentage.
Pearson’s correlation between DAS28 values and fat mass was
r = 0.035 (p = 0.76). Conclusion: The levels of DAS28 showed no correlation with fat mass percentage. Further
studies are required to clarify the factors that can modify these
levels.
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Affiliation(s)
- Guadalupe Mendoza-Vázquez
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de Colima, Colima, México
| | - Francisco Espinoza-Gómez
- Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de Colima, Colima, México
| | | | - Jorge I Gamez-Nava
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Laura Gonzalez-Lopez
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Mario Salazar-Paramo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Carlos Riebeling-Navarro
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Javier Alejandro Aceves-Aceves
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Sandra Guzmán-Silahua
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Arnulfo Hernán Nava-Zavala
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa Internacional, Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan, México.,Departamento de Inmunología y Reumatología, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, México
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7
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Predictive clinical factors in rheumatoid arthritis using disease activity and functional score. Reumatologia 2021; 59:309-312. [PMID: 34819705 PMCID: PMC8609377 DOI: 10.5114/reum.2021.110611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Rheumatoid arthritis (RA) is a chronic inflammatory arthritis that may lead to severe joint pain. There are several scores to evaluate the disease activity of RA. This study aimed to evaluate if clinical factors which representing activity scores and health assessment score. Material and methods This study was conducted prospectively by including adult patients with RA. Clinical factors and 5 RA disease activity and health assessment scores were evaluated. Each activity score was executed for clinical predictors by using multivariate linear regression analysis. Results There were 33 female adult patients in the study. The average (SD) age was 52.33 (11.11) years, while the duration of RA was 7.65 years. The DAS28 ESR had 1 predictor: RA duration with a coefficient of –0.04. For DAS28 CRP, CDAI, and SDAI scores, body mass index (BMI) and RA duration were independent factors for the scores with negative coefficient values. For the HAQ score, both age and rheumatoid duration were positively associated with the score. The coefficients of both factors were 0.02 and 0.03, respectively. Conclusions Age, RA duration, and BMI were associated with RA activity and functional score. Body mass index is a potential modifiable factor that may be associated with RA activities.
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8
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Lee SY, Ibrahim F, Tom BDM, Nikiphorou E, Williams FMK, Lempp H, Scott DL. Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial. Arthritis Res Ther 2021; 23:278. [PMID: 34736525 PMCID: PMC8567573 DOI: 10.1186/s13075-021-02653-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background Clinical trials show intensive treatment to induce remission is effective in patients with highly active rheumatoid arthritis (RA). The TITRATE trial showed that the benefits of intensive treatment also extend to moderately active RA. However, many patients failed to achieve remission or show improvements in pain and fatigue. We investigated whether baseline predictors could identify treatment non-responders. Methods The impact of obesity, depression, anxiety and illness perception on RA outcomes, including disease activity, remission, pain and fatigue were determined using a pre-planned secondary analysis of the TITRATE trial data. Results Body mass index was associated with disease activity levels and remission: obese patients had a higher overall disease activity and fewer obese patients achieved remission. Intensive management was not associated with increased remission in these patients. Obesity was also associated with increased overall pain and fatigue. Anxiety, depression and health perceptions had no discernible impact on disease activity but were associated with high levels of pain and fatigue. There was a strong association between anxiety and high pain scores; and between depression and high fatigue scores; and health perception was strongly related to both. None of the predictors had an important impact on pain and fatigue reduction in cross-sectional analysis. Conclusions Disease activity is higher in obese patients and they have fewer remissions over 12 months. Anxiety, depression and health perceptions were associated with higher pain and fatigue scores. Intensive management strategies need to account for these baseline features as they impact significantly on clinical and psychological outcomes. Trial registration ISRCTN 70160382; date registered 16 January 2014 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02653-1.
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Affiliation(s)
- Sook Yan Lee
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Brian D M Tom
- MRC Biostatistics Unit, University of Cambridge, East Forvie Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Frances M K Williams
- Twin Research & Genetic Epidemiology, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - David L Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Cutcombe Road, London, SE5 9RJ, UK
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The growing role of precision medicine for the treatment of autoimmune diseases; results of a systematic review of literature and Experts' Consensus. Autoimmun Rev 2020; 20:102738. [PMID: 33326854 DOI: 10.1016/j.autrev.2020.102738] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune diseases (AIDs) share similar serological, clinical, and radiological findings, but, behind these common features, there are different pathogenic mechanisms, immune cells dysfunctions, and targeted organs. In this context, multiple lines of evidence suggest the application of precision medicine principles to AIDs to reduce the treatment failure. Precision medicine refers to the tailoring of therapeutic strategies to the individual characteristics of each patient, thus it could be a new approach for management of AIDS which considers individual variability in genes, environmental exposure, and lifestyle. Precision medicine would also assist physicians in choosing the right treatment, the best timing of administration, consequently trying to maximize drug efficacy, and, possibly, reducing adverse events. In this work, the growing body of evidence is summarized regarding the predictive factors for drug response in patients with AIDs, applying the precision medicine principles to provide high-quality evidence for therapeutic opportunities in improving the management of these patients.
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Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients 2020; 12:nu12051456. [PMID: 32443535 PMCID: PMC7284442 DOI: 10.3390/nu12051456] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, such as polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties, featuring a protective role for RA development, while others such as red meat and salt have a harmful effect. Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression. Possible protective effects of some dietary patterns and supplements, such as the Mediterranean Diet (MD), vitamin D and probiotics, could be a possible future adjunctive therapy to standard RA treatment. Therefore, a healthy lifestyle and nutrition have to be encouraged in patients with RA.
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Affiliation(s)
- Chiara Gioia
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
| | - Bruno Lucchino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
- Correspondence: ; Tel.: +39-06-4997-4635
| | | | - Cristina Iannuccelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
| | - Manuela Di Franco
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
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11
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Toussirot E. The Interrelations between Biological and Targeted Synthetic Agents Used in Inflammatory Joint Diseases, and Obesity or Body Composition. Metabolites 2020; 10:E107. [PMID: 32183053 PMCID: PMC7175105 DOI: 10.3390/metabo10030107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity is a comorbidity that plays a role in the development and severity of inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. The relationships between obesity and adipose tissue and the treatments given for inflammatory joint diseases are bidirectional. In fact, biological agents (bDMARDs) and targeted synthetic agents (tsDMARDs) may influence body weight and body composition of treated patients, while obesity in turn may influence clinical response to these agents. Obesity is a prevalent comorbidity mainly affecting patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) with specific phenotypes. Tumour necrosis factor alpha (TNFα) inhibitors have been associated with changes in body composition by improving lean mass, but also by significantly increasing fat mass, which localized toward the abdominal/visceral region. The IL-6 inhibitor tocilizumab is associated with an increase in lean mass without change in fat mass. The clinical response to TNFα inhibitors is attenuated by obesity, an effect that is less pronounced with IL-6 inhibitors and the B-cell depletion agent rituximab. Conversely, body weight has no influence on the response to the costimulation inhibitor abatacept. These effects may be of help to the physician in personalized medicine, and may guide the therapeutic choice in obese/overweight patients.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, CHU de Besançon, Centre d’Investigation Clinique Biothérapie, Pôle Recherche, 25000 Besançon, France; ; Tel.: +33-3-81-21-89-97
- Fédération Hospitalo-Universitaire INCREASE, CHU de Besançon, 25000 Besançon, France
- CHU de Besançon, Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), 25000 Besançon, France
- Département Universitaire de Thérapeutique, Université de Bourgogne Franche-Comté, UFR des Sciences Médicales et Pharmaceutiques de Besançon, CS 71806, 25030 Besançon Cedex, France
- INSERM UMR1098, Relations Hôte Greffon Tumeurs, ingénierie cellulaire et génique, Université de Bourgogne Franche-Comté, 25000 Besançon, France
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