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Guaracha-Basáñez GA, Contreras-Yáñez I, Ortiz Haro AB, Pascual-Ramos V. Patients Journey Before Early Rheumatoid Arthritis Diagnosis Contributes to disease's Activity Level: A Real-Life Study. J Clin Rheumatol 2024:00124743-990000000-00228. [PMID: 38949663 DOI: 10.1097/rhu.0000000000002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION The help-seeking process in rheumatoid arthritis (RA) patients is challenging, and its study is limited in Latin America. The study describes the real-life journey before patients' incorporation into an early arthritis clinic (EAC) and its impact on baseline and 1-year cumulative disease activity levels. PATIENTS AND METHODS The patient's journey was assessed through a questionnaire that captured the patient's path from the first disease-related symptom to the initial assessment in the EAC. A disease activity (28 joints evaluated)-erythrocyte sedimentation rate (DAS28-ESR) score >5.1 defined a high-disease activity level. The mean of individual consecutive DAS28-ESR scores summarized cumulative DAS28-ESR. Multiple logistic regression analysis identified factors associated with a DAS28-ESR score >5.1 at the first assessment. Linear regression analysis assessed the impact of general practitioner (GP)-first consultant and time on disease-modifying antirheumatic drugs (DMARDs) on baseline and cumulative DAS28-ESR scores. RESULTS Through January 2023, the EAC had 241 RA patients, among whom 209 (86.7%) completed the patients' journey questionnaire (PJQ) and 176 (84.2%) at least 1 year of follow-up. A GP was the first consultant in 76.6% of the patients, and only 12.4% were prescribed DMARDs. Patients had additional evaluations with either rheumatologists (38.6%) or other specialists (31.6%), and half of them were initiated DMARDs. GP-first consultant (adjusted odds ratio: 2.314, 95% confidence interval: 1.190-4.500, p = 0.013) and time on DMARDs (adjusted odds ratio: 0.738, 95% confidence interval: 0.585-0.929, p = 0.010) were associated with baseline DAS28-ESR score >5.1. The B coefficient magnitudes for GP-first consultant and time on DMARDs to predict cumulative DAS28 progressively decreased during the first year of follow-up. CONCLUSIONS Patients' journey before recent-onset RA diagnosis predicts first-year disease activity levels.
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Affiliation(s)
- Guillermo A Guaracha-Basáñez
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán, Mexico City, Mexico
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Sepriano A, van Dijk B, Ramiro S, van der Helm-van Mil A, Combe B, van Schaardenburg D, de Wit M, Kent A, Mateus E, Landewé R. Distinction and prognosis of early arthritis phenotypes: an analysis in three European cohorts. RMD Open 2023; 9:e003611. [PMID: 37914180 PMCID: PMC10626756 DOI: 10.1136/rmdopen-2023-003611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The objective of this study is to evaluate whether there are differences in the long-term prognosis across various phenotypes of early arthritis (EA). METHODS Three EA cohorts (Reade, Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) and Early Arthritis Clinic (EAC)) were analysed. Clinical data were collected up to 24 years. Hands and feet radiographs were scored according to the Sharp van der Heijde (SvdH) method. Latent class analysis was applied to determine the EA phenotypes at baseline. Each class received a label reflecting its most prominent features. Prognostic outcomes included Health Assessment Questionnaire (HAQ), Short Form 36 (SF36) and SvdH score. The association between class membership and outcomes over time was tested in multivariable models. RESULTS In total, 390 (Reade), 798 (ESPOIR) and 3991 (EAC) patients were analysed separately. Two classes with symmetrical polyarthritis emerged; one of these labelled as autoimmune inflammatory polyarthritis (AIPA), had high likelihood of acute phase reactants (APR) elevation and autoantibody positivity, while the other (mild-inflammatory polyarthritis; MIPA) had not. A third class had oligoarthritis of upper limbs (OAUL) and could be subdivided into autoimmune OAUL and mild-inflammatory OAUL. A fifth class had oligoarthritis of lower limbs. The SvdH scores were worse in patients with APR/autoantibodies (AIPA) than in those without (MIPA). No clinically meaningful differences across classes in HAQ or SF36 over time were found. CONCLUSION Radiographic progression over time primarily occurs in EA patients with APR/autoantibodies. The absence of these markers, however, does not necessarily translate into better long-term function and quality of life. Clinicians should not only aim at preventing joint damage, but look beyond structural progression in order to further improve the lives of people with EA.
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Affiliation(s)
- Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | | | | | | | - Maarten de Wit
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Alison Kent
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Elsa Mateus
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Robert Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands
- Rheumatology, Zuyderland Medical Centre, Heerlen, Netherlands
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Ruyssen-Witrand A, Guernec G, Dupont J, Lapuyade D, Lioté F, Vittecoq O, Degboé Y, Constantin A. Ten-year radiographic and functional outcomes in rheumatoid arthritis patients in remission compared to patients in low disease activity. Arthritis Res Ther 2023; 25:207. [PMID: 37864239 PMCID: PMC10588022 DOI: 10.1186/s13075-023-03176-7] [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: 06/02/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND To compare the 10-year structural and functional prognosis between patients in sustained remission versus patients in sustained low disease activity (LDA) in early rheumatoid arthritis (RA). METHODS We included 256 patients from the ESPOIR cohort who fulfilled the 2010 ACR/EULAR criteria for RA and who were in sustained remission using the Simple Disease Activity Index (SDAI) score (n = 48), in sustained LDA (n = 139) or in sustained moderate to high disease activity (MDA or HDA, n = 69) over 10 years. The mTSSs progression over 10 years and the 10-year HAQ-DI scores were compared between the 3 groups. A longitudinal latent process mixed model was used to assess the independent effect of SDAI status over time on 10-year mTSS progression and HAQ-DI at 10 years. RESULTS Patients in sustained remission group were younger, had lower baseline HAQ-DI and mTSS scores and were less exposed to glucocorticoids, methotrexate or biologic disease-modifying anti-rheumatic drugs over 10 years. Patients in sustained remission had lower 10-year structural progression (variation of mTSS in the remission group: 4.06 (± 4.75) versus 14.59 (± 19.76) in the LDA group and 21.04 (± 24.08), p < 0.001 in the MDA or HDA groups) and lower 10-year HAQ-DI scores (10-year HAQ-DI in the remission group: 0.14 (± 0.33) versus 0.53 (± 0.49) in the LDA group and 1.20 (± 0.62) in the MDA or HDA groups, p < 0.001). The incidence of serious adverse events over 10 years was low, about 3.34/100 patient years, without any difference between the three groups. CONCLUSION RA patients in sustained SDAI remission have better long-term structural and functional outcomes in comparison to patients in sustained LDA.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS "Pharmacologie En Population cohorteS Et biobanqueS, Purpan Teaching Hospital, University of Toulouse 3, 1 Place du Dr Baylac, 31059, Toulouse, Cedex 9, France.
| | - Gregory Guernec
- Inserm, Centre d'Epidémiologie Et de Recherche en Santé Des Populations, UMR1295, Inserm, Toulouse, France
| | - Julia Dupont
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
| | - Diane Lapuyade
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
| | - Frédéric Lioté
- Université Paris Cité and Inserm UMR1132 Bioscar Hôpital Lariboisière and Service de Rhumatologie, Hôpital Saint-Joseph, Paris, France
| | - Olivier Vittecoq
- Department of Rheumatology and CIC-CRB1404, Normandie Univ, UNIROUEN, Rouen University Hospital, 76000, Rouen, France
| | - Yannick Degboé
- Rheumatology Center, Toulouse University Hospital, INFINITY, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse 3, Toulouse, France
| | - Arnaud Constantin
- Rheumatology Center, Toulouse University Hospital, INFINITY, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse 3, Toulouse, France
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Fautrel B. Biologics in rheumatoid arthritis: a lifetime treatment or possibility of drug holidays? Nat Rev Rheumatol 2023; 19:611-612. [PMID: 37525010 DOI: 10.1038/s41584-023-01005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Bruno Fautrel
- Department of Rheumatology, Sorbonne University AP-HP, Paris, France.
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Le Quellec A, Guyard T, Carvajal Alegria G, Ruyssen-Witrand A, Fautrel B, Flipo RM, Garrigues F, Saraux A. Prevalence and predictors of atlanto-axial subluxation in rheumatoid arthritis after 12-years' follow-up (ESPOIR Cohort). Rheumatology (Oxford) 2023; 62:2692-2699. [PMID: 36440910 DOI: 10.1093/rheumatology/keac672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/19/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Anterior atlanto-axial subluxation (AAS), defined as an anterior atlanto-dental interval ≥3 mm, can occur in RA and carries a risk of severe neurological impairments. Our objective was to determine the prevalence and predictors of radiographic aAAS after 12 years' follow-up of patients with early polyarthritis. METHODS We studied patients enrolled in the early polyarthritis cohort ESPOIR (Study and Monitoring of Early Undifferentiated Arthritis) between 2002 and 2005 (at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA, and no previous exposure to glucocorticoids or DMARDs). All patients still in the cohort after 12 years had dynamic cervical-spine radiographs taken then read by two blinded observers. To evaluate how well combinations of tests performed at baseline and 10 years predicted aAAS after 12 years, univariate analysis and multiple logistic regression procedure were applied. RESULTS Of 323 patients followed for 12 years, 15 (4.6%; 95% CI 2.8, 6.4) had aAAS. Among baseline variables, only IgA RFs were associated (P < 0.05) with aAAS (sensitivity 60%, specificity 75%). Among data collected after 10 years, oral CS therapy during the 10-year interval, treatment by DMARDs, CRP (mg/dl) and positive tests for RFs were associated with aAAS after 12 years, but only CRP and RFs remained in a model of logistic regression (combination predicted aAAS with a sensitivity of 60% for a specificity of 90%). CONCLUSION In conclusion, the prevalence of aAAS after 12 years was 4.6% in the ESPOIR cohort, with no patients having severe aAAS. Although some factors were found to be statistically associated to AAS, the event is too rare to allow a clinical relevance.
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Affiliation(s)
| | | | | | - Adeline Ruyssen-Witrand
- Centre de Rhumatologie, CHU Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, University of Toulouse 3, Toulouse, France
| | - Bruno Fautrel
- Sorbonne Université - APHP, Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France
- INSERM U1136, Paris, France
| | | | | | - Alain Saraux
- Service de Rhumatologie, CHU Brest, Brest, France
- Université de Bretagne Occidentale, INSERM (U1227), LabEx IGO, Brest, France
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Leon L, Madrid-Garcia A, Lopez-Viejo P, González-Álvaro I, Novella-Navarro M, Freites Nuñez D, Rosales Z, Fernandez-Gutierrez B, Abasolo L. Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease. RMD Open 2023; 9:rmdopen-2022-002842. [PMID: 36889800 PMCID: PMC10008455 DOI: 10.1136/rmdopen-2022-002842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed. METHODS A longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. RESULTS The study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01). CONCLUSIONS In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.
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Affiliation(s)
- Leticia Leon
- IdISSC and Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain .,Health Sciences, Universidad Camilo Jose Cela, Villafranca del Castillo, Spain
| | | | | | | | | | | | - Zulema Rosales
- Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Lydia Abasolo
- IdISSC and Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
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Juge P, Granger B, Debray M, Ebstein E, Louis‐Sidney F, Kedra J, Doyle TJ, Borie R, Constantin A, Combe B, Flipo R, Mariette X, Vittecoq O, Saraux A, Carvajal‐Alegria G, Sibilia J, Berenbaum F, Kannengiesser C, Boileau C, Sparks JA, Crestani B, Fautrel B, Dieudé P. A Risk Score to Detect Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol 2022; 74:1755-1765. [PMID: 35583934 PMCID: PMC9828082 DOI: 10.1002/art.42162] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients at high risk of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) would benefit from being identified before the onset of respiratory symptoms; this can be done by screening patients with the use of chest high-resolution computed tomography (HRCT). Our objective was to develop and validate a risk score for patients who have subclinical RA-ILD. METHODS Our study included a discovery population and a replication population from 2 prospective RA cohorts (ESPOIR and TRANSLATE2, respectively) without pulmonary symptoms who had received chest HRCT scans. All patients were genotyped for MUC5B rs35705950. After multiple logistic regression, a risk score based on independent risk factors for subclinical RA-ILD was developed in the discovery population and tested for validation in the replication population. RESULTS The discovery population included 163 patients with RA, and the replication population included 89 patients with RA. The prevalence of subclinical RA-ILD was 19.0% and 16.9%, respectively. In the discovery population, independent risk factors for subclinical RA-ILD were presence of the MUC5B rs35705950 T allele (odds ratio [OR] 3.74 [95% confidence interval (95% CI) 1.37, 10.39]), male sex (OR 3.93 [95% CI 1.40, 11.39]), older age at RA onset (for each year, OR 1.10 [95% CI 1.04, 1.16]), and increased mean Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (for each unit, OR 2.03 [95% CI 1.24, 3.42]). We developed and validated a derived risk score with receiver operating characteristic areas under the curve of 0.82 (95% CI 0.70-0.94) for the discovery population and 0.78 (95% CI 0.65-0.92) for the replication population. Excluding MUC5B rs35705950 from the model provided a lower goodness of fit (likelihood ratio test, P = 0.01). CONCLUSION We developed and validated a risk score that could help identify patients at high risk of subclinical RA-ILD. Our findings support an important contribution of MUC5B rs35705950 to subclinical RA-ILD risk.
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Affiliation(s)
- Pierre‐Antoine Juge
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Benjamin Granger
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Santé Publique et Information Médicale, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐5013ParisFrance
| | - Marie‐Pierre Debray
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Radiologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Esther Ebstein
- Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | | | - Joanna Kedra
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Service de Rhumatologie, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐75013ParisFrance
| | - Tracy J. Doyle
- Division of Pulmonary and Critical Care Medicine, Department of MedicineBrigham and Women's HospitalBostonMassachusetts
| | - Raphaël Borie
- Université de Paris, INSERM UMR 1152, F‐75018, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Arnaud Constantin
- Université Toulouse III–Paul Sabatier, INSERM UMR 1043, F‐31024, and Service de Rhumatologie, Hôpital Purpan, F‐31024ToulouseFrance
| | - Bernard Combe
- Université de Montpellier and Departement de Rhumatologie, Hôpital Lapeyronie, F‐34000MontpellierFrance
| | - René‐Marc Flipo
- Université de Lille, and Service de Rhumatologie, Hôpital Salengro, F‐59000LilleFrance
| | - Xavier Mariette
- Université Paris‐Saclay, INSERM UMR 1184, CEA, F‐94270, and Service de Rhumatologie, Hôpital BicêtreAP‐HP, F‐94270Le Kremlin BicêtreFrance
| | - Olivier Vittecoq
- Rouen University Hospital, Service de Rhumatologie, CIC‐CRB 1404, F‐76000, and Normandy University, UNIROUEN, INSERM, U1234, FR‐76000RouenFrance
| | - Alain Saraux
- Université de Bretagne Occidentale, INSERM UMR 1227, F‐29200, and Service de Rhumatologie, Hôpital de la Cavale Blanche, F‐2900BrestFrance
| | - Guillermo Carvajal‐Alegria
- Université de Bretagne Occidentale, INSERM UMR 1227, F‐29200, and Service de Rhumatologie, Hôpital de la Cavale Blanche, F‐2900BrestFrance
| | - Jean Sibilia
- Université de Strasbourg, INSERM UMR S1109, F‐67000, and Service de Rhumatologie, RESO: Centre de Reference des Maladies Autoimmunes Systémiques Rares Est Sud‐Ouest, Hôpital De Hautepierre, F‐67000StrasbourgFrance
| | - Francis Berenbaum
- Sorbonne Université, CRSA, INSERM UMR 938, F‐75012, Service de Rhumatologie, Hôpital Saint‐AntoineAP‐HP, F‐75012ParisFrance
| | - Caroline Kannengiesser
- Université de Paris, INSERM UMR 1152, F‐75018, Département de Génétique Moléculaire, Hôpital Bichat‐Claude BernardAP‐HP, FR‐75018ParisFrance
| | - Catherine Boileau
- Département de Génétique Moléculaire, Hôpital Bichat‐Claude Bernard, AP‐HP, FR‐75018, Université de Paris, INSERM UMR 1148, F‐75018ParisFrance
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical SchoolBostonMassachusetts
| | - Bruno Crestani
- Université de Paris, INSERM UMR 1152, F‐75018, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Bruno Fautrel
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Service de Rhumatologie, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐75013ParisFrance
| | - Philippe Dieudé
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
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Sun Y, Liu J, Xin L, Wen J, Zhou Q, Chen X, Ding X, Zhang X. Factors influencing the Sharp score of 1057 patients with rheumatoid arthritis and anemia: a retrospective study. J Int Med Res 2022; 50:3000605221088560. [PMID: 35345929 PMCID: PMC8969521 DOI: 10.1177/03000605221088560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This study examined the relationship of the Sharp score with demographic factors and clinical immune-inflammatory markers in patients with anemia in rheumatoid arthritis (RA). Methods The clinical data of 1057 patients with RA and anemia and 1006 patients with RA without anemia were retrospectively analyzed. Spearman’s correlation coefficient analysis, association rule analysis, and logistic regression were used to study the relationships between the Sharp score and influencing factors in patients with RA and anemia. Results The incidence of anemia was 51.24% (1057/2063), and mild anemia accounted for 81.93% (866/1057) of cases. Spearman’s correlation coefficient and association rule analyses revealed that the Sharp score of patients with RA and anemia was correlated with immune-inflammatory response and anemia. Logistic regression analysis illustrated that advanced age (>60 years), female, low serum iron levels, C-reactive protein positivity, and immunoglobulin A positivity were risk factors for a high Sharp score (>28.25) in patients with RA and anemia. Conclusion The Sharp score is closely related to clinical disease activity and anemia, and it should be considered in the treatment strategy of patients with RA and anemia.
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Affiliation(s)
- Yanqiu Sun
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Jian Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Ling Xin
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Jianting Wen
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Qin Zhou
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Xiaolu Chen
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Xiang Ding
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Xianheng Zhang
- Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei 230012, Anhui Province, China
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Abstract
Inflammatory bowel diseases [IBD] such as Crohn's disease [CD] and ulcerative colitis [UC] are complex conditions presenting with a wide range of phenotypes. Given major variation in disease severity and outcomes as well as response to existing therapies, a personalised treatment approach stands the chance of improving the overall disease outcome as well as minimising potentially harmful side effects. However, disease activity or distribution at the point of diagnosis are poor predictors of future disease outcome. Hence, the urgent need to develop biomarkers that could either predict the overall disease course [i.e., disease prognostic biomarkers] or the response to individual therapies [i.e., disease predictive biomarkers]. Despite the widely accepted need for such biomarkers to improve the management of IBD patients, their development has proven to be challenging for a number of reasons. Based on our own experience in this field, we perform a reality check on existing evidence, discuss main challenges, and outline future perspectives.
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Affiliation(s)
- Matthias Zilbauer
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cambridge University Hospitals, Addenbrooke's, Cambridge, UK
| | - Robert Heuschkel
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cambridge University Hospitals, Addenbrooke's, Cambridge, UK
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[Innovative strategies for treatment of rheumatoid arthritis]. Z Rheumatol 2022; 81:118-124. [PMID: 34997270 DOI: 10.1007/s00393-021-01144-7] [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: 12/05/2021] [Indexed: 10/19/2022]
Abstract
Besides excellent guidelines and newly developed highly effective drugs, evidence-based strategic use of these new drugs has especially contributed to enormous advances in rheumatoid arthritis treatment, apparent especially since 2000. Currently, the treat-to-target (T2T) strategy has proven to be the most successful in several studies and systematic reviews. The target is to achieve remission, which should be reached and sustained for an optimal outcome (i.e. stable over a long time period). If the initial disease-modifying antirheumatic drug (DMARD) treatment fails, the best strategy for continuing treatment is controversial, with swap or switch being open to debate (change within a class of drugs or change in the mechanism of action). Recent studies seem to indicate that switching to another mechanism of action is the most successful approach. A hotly discussed topic is the question whether DMARD treatment can or should be tapered when sustained remission has been achieved? Many patients wish for a reduction of drugs in cases of stable remission; however, the stable disease control might become destabilized by tapering. The main priority is the reduction or tapering of glucocorticoid treatment. When the decision for reduction of DMARD treatment is made together with the patient, a complete cessation bears a high risk of a flare, therefore, a careful step by step reduction of DMARD treatment should be preferred. In the case of a running combination, the question whether the conventional DMARD (mostly methotrexate), the biological (b)DMARD or targeted synthetic (ts)DMARD should be reduced first, must be decided on an individual basis. Most patients prefer to first reduce methotrexate and transfer to a monotherapy.
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