1
|
Conaghan P, Cohen S, Burmester G, Mysler E, Nash P, Tanaka Y, Rigby W, Patel J, Shaw T, Betts KA, Patel P, Liu J, Sun R, Fleischmann R. Benefit-Risk Analysis of Upadacitinib Compared with Adalimumab in the Treatment of Patients with Moderate-to-Severe Rheumatoid Arthritis. Rheumatol Ther 2022; 9:191-206. [PMID: 34816388 PMCID: PMC8814262 DOI: 10.1007/s40744-021-00399-5] [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: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring long-term treatment. Upadacitinib (UPA), a Janus kinase (JAK) inhibitor, is a new treatment for RA. The benefit-risk profile of a medication is best understood by evaluating the number needed to treat (NNT) and the number needed to harm (NNH). This analysis evaluated the comparative risk-benefit of UPA versus adalimumab (ADA). METHODS Post-hoc analyses were performed using data from the SELECT-COMPARE trial of UPA versus placebo (PBO) and UPA versus ADA among patients with active RA who remained on stable methotrexate (MTX) treatment and had an inadequate response; patients who failed to achieve response were rescued by predefined criteria-PBO or ADA switch to UPA, and UPA switch to ADA (all patients on PBO were switched to UPA at week 26). This analysis assessed efficacy and adverse events of special interest (AESIs) at week 26, 48, and 156 (3 years). NNT and NNH (95% confidence intervals) values were calculated between UPA versus ADA for all time points, and between UPA versus PBO for week 26. NNT and NNH values were applied to a hypothetical cohort of 100 patients to estimate the comparative efficacy and safety profiles. RESULTS UPA consistently showed greater efficacy than ADA, as evidenced by NNT values < 10 for achievement of Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) of < 2.6 and ≤ 3.2, respectively, and functional improvement. Based on indices for disease assessment other than the DAS28-CRP, remission outcomes were higher with UPA versus ADA over 26 weeks (NNTs: 7-12), 48 weeks (NNTs: 9-16), and 156 weeks (NNTs: 9-15). With the exception of herpes zoster, other AESIs demonstrated a similar risk with UPA versus ADA. CONCLUSION In patients with active RA despite MTX use, UPA demonstrated an incremental achievement of clinical outcomes compared to ADA together with a similar profile of AESIs with ADA (with the exception of herpes zoster).
Collapse
Affiliation(s)
- Philip Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, National Institute for Health Research, Leeds Biomedical Research Centre-University of Leeds, Leeds, UK
| | | | | | - Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University, Brisbane, Queensland, Australia
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - William Rigby
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jayeshkumar Patel
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA.
| | | | | | - Pankaj Patel
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA
| | - Jianzhong Liu
- AbbVie, Inc, 26525 N Riverwoods Blvd, Mettawa, North Chicago, IL, 60045, USA
| | | | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
2
|
Carpenter L, Nikiphorou E, Kiely PDW, Walsh DA, Young A, Norton S. Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis. Rheumatology (Oxford) 2021; 59:2381-2391. [PMID: 31899521 PMCID: PMC7449804 DOI: 10.1093/rheumatology/kez635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/22/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To examine secular trends in the progression of clinical and patient-reported outcomes in early RA. Methods A total of 2701 patients recruited to the Early Rheumatoid Arthritis Study or Early Rheumatoid Arthritis Network with year of diagnosis from 1986 to 2011. The 5-year progression rates for patients diagnosed at different points in time were modelled using mixed-effects regression; 1990, 2002 and 2010, were compared. Clinical markers of disease included the 28-joint count DAS and the ESR. Patient-reported markers included the HAQ, visual analogue scale of pain and global health, and the Short-Form 36. Results Statistically significant improvements in both 28-joint count DAS and ESR were seen over the 5 years in patients diagnosed with RA compared with those diagnosed earlier. By 5 years, 59% of patients with diagnosis in 2010 were estimated to reach low disease activity compared with 48% with diagnosis in 2002 and 32% with diagnosis in 1990. Whilst HAQ demonstrated statistically significant improvements, these improvements were small, with similar proportions of patients achieving HAQ scores of ≤1.0 by 5 years with a diagnosis in 1990 compared with 2010. Levels of the visual analogue scale and the Mental Component Scores of the Short-Form 36 indicated similar, statistically non-significant levels over the 5 years, irrespective of year diagnosed. Conclusion This study demonstrates improvements in inflammatory markers over time in early RA, in line with improved treatment strategies. These have not translated into similar improvements in patient-reported outcomes relating to either physical or mental health.
Collapse
Affiliation(s)
| | | | - Patrick D W Kiely
- Department of Rheumatology, St George's University Hospital NHS Foundation TrustLondon, UK.,Institute of Medical and Biomedical Education, St George's University of London, LondonUK
| | - David A Walsh
- Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Adam Young
- Postgraduate Medicine, University of Hertfordshire, Hatfield, UK
| | - Sam Norton
- Health Psychology Section, King's College LondonUK.,Centre for Rheumatic Diseases, King's College LondonUK
| |
Collapse
|
3
|
Dos Anjos LMJ, Salvador PA, de Souza ÁC, de Souza da Fonseca A, de Paoli F, Gameiro J. Modulation of immune response to induced-arthritis by low-level laser therapy. JOURNAL OF BIOPHOTONICS 2019; 12:e201800120. [PMID: 30203577 DOI: 10.1002/jbio.201800120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/02/2018] [Indexed: 06/08/2023]
Abstract
As low-level laser therapy immune cells responses are not always clarified, this study aimed to evaluate cytokines and immune cells profile after low-level laser therapy (LLLT) on arthritis-induced model. Arthritis was induced in C57BL/6 mice divided into five groups: euthanized 5 hours after inflammation induction; untreated; dexamethasone treated; LLLT at 3 Jcm-2 ; LLLT at 30 Jcm-2 . Cytokine measurements by enzyme-linked immunosorbent assay and mRNA cytokine relative levels by real-time quantitative polymerase chain reaction were performed with arthritic ankle (IL-1β, IL-6, TNF-α, IL-10 and TGF-β). Macrophages, dendritic cells, natural killer cells, lymphocytes CD4+ , CD8+ , Treg and costimulatory proteins were quantified in proximal lymph node by flow cytometry. Data showed decrease in all cytokine levels after LLLT and alteration in mRNA relative levels, depending on the energy density used. LLLT was able to increase of immune cell populations analyzed in the lymph node as well as costimulatory proteins expression on macrophages and dendritic cells. Treg TCD4+ and TCD8+ population enrichment were observed in LLLT at 3 and 30 Jcm-2 groups, respectively. Furthermore, Treg TCD8+ cells expressing higher levels of CD25 were observed at LLLT at 30 Jcm-2 group. Our results indicate that LLLT could change the inflammatory course of arthritis, tending to accelerate its resolution through immune cells photobiostimulation.
Collapse
Affiliation(s)
- Lúcia Mara J Dos Anjos
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Pollyanna A Salvador
- Departamento de Microbiologia, Parasitologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Álvaro C de Souza
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Adenilson de Souza da Fonseca
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Ciências da Saúde, Centro Universitário Serra dos Órgãos, Rio de Janeiro, Brazil
| | - Flávia de Paoli
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Jacy Gameiro
- Departamento de Microbiologia, Parasitologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| |
Collapse
|
4
|
Chiba M, Tsuji T, Nakane K, Tsuda S, Ishii H, Ohno H, Watanabe K, Ito M, Komatsu M, Sugawara T. Induction with Infliximab and a Plant-Based Diet as First-Line (IPF) Therapy for Crohn Disease: A Single-Group Trial. Perm J 2018; 21:17-009. [PMID: 29035182 DOI: 10.7812/tpp/17-009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately 30% of patients with Crohn disease (CD) are unresponsive to biologics. No previous study has focused on a plant-based diet in an induction phase of CD treatment. OBJECTIVE To investigate the remission rate of infliximab combined with a plant-based diet as first-line (IPF) therapy for CD. METHODS This was a prospective single-group trial conducted at tertiary hospitals. Subjects included consecutive adults with a new diagnosis (n = 26), children with a new diagnosis (n = 11), and relapsing adults (n = 9) with CD who were naïve to treatment with biologics. Patients were admitted and administered a standard induction therapy with infliximab (5 mg/kg; 3 infusions at 0, 2, and 6 weeks). Additionally, they received a lacto-ovo-semivegetarian diet. The primary end point was remission, defined as the disappearance of active CD symptoms at week 6. Secondary end points were Crohn Disease Activity Index (CDAI) score, C-reactive protein (CRP) concentration, and mucosal healing. RESULTS Two adults with a new diagnosis were withdrawn from the treatment protocol because of intestinal obstruction. The remission rates by the intention-to-treat and per-protocol analyses were 96% (44/46) and 100% (44/44), respectively. Mean CDAI score (314) on admission decreased to 63 at week 6 (p < 0.0001). Mean CRP level on admission (5.3 mg/dL) decreased to 0.2 (p < 0.0001). Mucosal healing was achieved in 46% (19/41) of cases. CONCLUSION IPF therapy can induce remission in most patients with CD who are naïve to biologics regardless of age or whether they have a new diagnosis or relapse.
Collapse
Affiliation(s)
- Mitsuro Chiba
- Chief of the Inflammatory Bowel Disease Section at Akita City Hospital in Japan.
| | - Tsuyotoshi Tsuji
- Chief of the Gastrointestinal Endoscopy Section at Akita City Hospital in Japan.
| | - Kunio Nakane
- Chief of the Gastroenterology Division at Akita City Hospital in Japan.
| | - Satoko Tsuda
- Gastroenterologist at Akita City Hospital in Japan.
| | - Hajime Ishii
- Gastroenterologist at Akita City Hospital in Japan.
| | - Hideo Ohno
- Gastroenterologist at Akita City Hospital in Japan.
| | | | - Mai Ito
- Gastroenterologist at Akita City Hospital in Japan.
| | - Masafumi Komatsu
- Gastroenterologist and the Director of Akita City Hospital, in Japan.
| | | |
Collapse
|
5
|
Anno S, Sugioka Y, Inui K, Tada M, Okano T, Mamoto K, Koike T. Evaluation of work disability in Japanese patients with rheumatoid arthritis: from the TOMORROW study. Clin Rheumatol 2018. [PMID: 29525846 DOI: 10.1007/s10067-018-4060-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To evaluate work disability and associated factors in patients with rheumatoid arthritis (RA) who participated in the TOMORROW study, a 10-year cohort study in Japan. Subjects in this cross-sectional analysis comprised 191 RA patients and 191 age- and sex-matched non-RA individuals. Work-related outcomes were measured using the Work Productivity and Activity Impairment questionnaire by employment status (full-time worker (FTW), employed ≥ 35 h/week; part-time worker (PTW), < 35 h/week; home worker (HW), non-employed). In addition, we assessed the EuroQol-5 Dimensions (EQ-5D) and Health Assessment Questionnaire (HAQ) to evaluate quality of life and activities of daily living. No significant differences were evident between groups in percentages of participants in each employment status (p = 0.11), percentages of absenteeism (FTW, p = 1.00; PTW, p = 0.29), presenteeism (FTW, p = 0.23; PTW, p = 0.54), overall work impairment (FTW, p = 0.23; PTW, p = 0.73), or percentage of activity impairment (AI) (FTW, p = 0.62; PTW, p = 0.60). In the HW group, percentage of AI was higher in RA patients than that in non-RA patients (p < 0.01). Among RA patients, HW showed lower EQ-5D and higher HAQ than FTW or PTW (p < 0.001 each). Higher disease activity was observed in HW than FTW (p < 0.01). In terms of the effect of biological disease-modifying anti-rheumatic drugs, no significant differences in work-related outcomes, health status, or daily activity were evident between users and non-users. No significant differences in employment status or work impairment were seen between RA and non-RA groups among paid workers. HW with RA showed more impaired daily activity and higher disease activity compared to working RA patients. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry: UMIN000003876 . Registered 1 Jun 2010.
Collapse
Affiliation(s)
- Shohei Anno
- Department of Orthopaedic Surgery, Shirahama Hamayu Hospital, 1447 Shirahamacho, Nishimurogun, Wakayama, 649-2211, Japan
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, 1447 Shirahamacho, Nishimurogun, Wakayama, 649-2211, Japan
| | - Yuko Sugioka
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tadashi Okano
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Mamoto
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tatsuya Koike
- Department of Orthopaedic Surgery, Shirahama Hamayu Hospital, 1447 Shirahamacho, Nishimurogun, Wakayama, 649-2211, Japan.
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, 1447 Shirahamacho, Nishimurogun, Wakayama, 649-2211, Japan.
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| |
Collapse
|
6
|
Ghiti Moghadam M, Vonkeman HE, Ten Klooster PM, Tekstra J, van Schaardenburg D, Starmans-Kool M, Brouwer E, Bos R, Lems WF, Colin EM, Allaart CF, Meek IL, Landewé R, Bernelot Moens HJ, van Riel PLCM, van de Laar MAFJ, Jansen TL. Stopping Tumor Necrosis Factor Inhibitor Treatment in Patients With Established Rheumatoid Arthritis in Remission or With Stable Low Disease Activity: A Pragmatic Multicenter, Open-Label Randomized Controlled Trial. Arthritis Rheumatol 2017; 68:1810-7. [PMID: 26866428 DOI: 10.1002/art.39626] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/02/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Tumor necrosis factor inhibitor (TNFi) biologic agents are an effective treatment for rheumatoid arthritis (RA). It is unclear whether patients whose disease is in remission or who have stable low disease activity need to continue use of TNFi or can stop this treatment. This study was undertaken to assess whether patients with established RA who are in remission or have stable low disease activity can effectively and safely stop their TNFi therapy. METHODS The study was designed as a pragmatic multicenter, open-label randomized controlled trial. Inclusion criteria were a diagnosis of RA according to the American College of Rheumatology 1987 classification criteria, as well as use of a TNFi for at least 1 year along with a stable dose of disease-modifying antirheumatic drugs and a Disease Activity Score in 28 joints (DAS28) of <3.2 over the 6 months preceding trial inclusion. Patients were randomized in a 2:1 ratio to either stop or continue treatment with their current TNFi. Flare was defined as a DAS28 of ≥3.2 during the 12-month follow-up period and an increase in score of ≥0.6 compared to the baseline DAS28. RESULTS In total, 531 patients were allocated to the stop group and 286 to the TNFi continuation group. At 12 months, more patients had experienced a flare in the stop group (272 [51.2%] of 531) than in the continuation group (52 [18.2%] of 286; P < 0.001). The hazard ratio for occurrence of a flare after stopping TNFi was 3.50 (95% confidence interval [95% CI] 2.60-4.72). The mean DAS28 in the stop group was significantly higher during the follow-up period compared to that in the continuation group (P < 0.001). Of the 195 patients who restarted TNFi treatment after experiencing a flare and within 26 weeks after stopping, 165 (84.6%) had regained a DAS28 of <3.2 by 6 months later, and the median time to a regained DAS28 of <3.2 was 12 weeks (95% Cl 10.7-13.3). There were more hospitalizations in the stop group than in the continuation group (6.4% versus 2.4%). CONCLUSION Stopping TNFi treatment results in substantially more flares than does continuation of TNFi in patients with established RA in remission or with stable low disease activity.
Collapse
Affiliation(s)
- Marjan Ghiti Moghadam
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | | | | | - Mirian Starmans-Kool
- Atrium Medical Center, Heerlen, The Netherlands, and Orbis Medical Center, Sittard-Geleen, The Netherlands
| | | | - Reinhard Bos
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Willem F Lems
- VU University Medical Center and Reade Medical Center, Amsterdam, The Netherlands
| | - Edgar M Colin
- Hospital Group Almelo, Almelo, The Netherlands, and Hengelo Twente Hospital Group, Hengelo, The Netherlands
| | | | - Inger L Meek
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Landewé
- Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein J Bernelot Moens
- Hospital Group Almelo, Almelo, The Netherlands, and Hengelo Twente Hospital Group, Hengelo, The Netherlands
| | | | - Mart A F J van de Laar
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Tim L Jansen
- VieCuri Medical Center, Rheumatology, Venlo, The Netherlands
| | | |
Collapse
|
7
|
Yu D, Ye X, Che R, Wu Q, Qi J, Song L, Guo X, Zhang S, Wu H, Ren G, Li D. FGF21 exerts comparable pharmacological efficacy with Adalimumab in ameliorating collagen-induced rheumatoid arthritis by regulating systematic inflammatory response. Biomed Pharmacother 2017; 89:751-760. [PMID: 28273637 DOI: 10.1016/j.biopha.2017.02.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/09/2017] [Indexed: 12/12/2022] Open
Abstract
Previous studies have reported that Fibroblast growth factor 21 (FGF21) can regulate inflammation and may play an important role in inflammatory and immune-mediated diseases, such as autoimmune diseases. Adalimumab is one of the clinically effective anti-rheumatoid arthritis (RA) drugs. The aim of this study was to compare the therapeutic efficacy of FGF21 and Adalimumab on collagen-induced arthritis (CIA) model mice. Mice with CIA were subcutaneously treated with FGF21 or Adalimumab at dose of 1mgkg-1d-1, respectively. Our results showed that FGF21 significantly alleviated the severity of arthritis by reducing cellular immune responses and exerted the similar anti-inflammatory effects with Adalimumab in decreasing the mRNA and protein expression levels of IL-2, IL-6 and IL-17. However, the expression levels of IL-1β, RANKL and IL-10 in the mice treated with FGF21 were decreased 2.2-fold, 2.5-fold and increased 4.3-fold compared with Adalimumab, respectively. However, the levels of TNF-α in the mice treated with Adalimumab were lower than those in the mice treated with FGF21. Western blotting results demonstrated that FGF21 displayed equivalent effects with Adalimumab by inhibiting NF-κB/IκBα signaling pathway. However, FGF21 could also regulate systematic inflammatory response and the mechanism maybe related to other signal pathway. In summary, FGF21 exerts comparable pharmacological efficacy with Adalimumab by regulating systematic inflammatory response, providing that FGF21 may be a promising therapeutic agent for RA patients.
Collapse
Affiliation(s)
- Dan Yu
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China
| | - Xianlong Ye
- College of Life Science, Henan Normal University, Xinxiang 453007, China
| | - Ruixiang Che
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Qiang Wu
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Jianying Qi
- College of Life Science, Henan Normal University, Xinxiang 453007, China
| | - Liying Song
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Xiaochen Guo
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Shengqi Zhang
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Hongsong Wu
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China
| | - Guiping Ren
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China.
| | - Deshan Li
- Biopharmaceutical Lab, College of Life Science, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of Agricultural Biological Functional Gene, Northeast Agricultural University, Harbin 150030, China.
| |
Collapse
|
8
|
Nikiphorou E, Carpenter L, Norton S, Morris S, MacGregor A, Dixey J, Williams P, Kiely P, Walsh DA, Young A. Can Rheumatologists Predict Eventual Need for Orthopaedic Intervention in Patients with Rheumatoid Arthritis? Results of a Systematic Review and Analysis of Two UK Inception Cohorts. Curr Rheumatol Rep 2017; 19:12. [DOI: 10.1007/s11926-017-0636-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Lesuis N, den Broeder AA, Hulscher MEJL, van Vollenhoven RF. Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists. RMD Open 2016; 2:e000195. [PMID: 27252892 PMCID: PMC4879343 DOI: 10.1136/rmdopen-2015-000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
Abstract
Objectives To assess variation in and determinants of rheumatologist guideline adherence in patients with rheumatoid arthritis (RA), in daily practice. Methods In this retrospective observational study, guideline adherence in the first year of treatment was assessed for 7 predefined parameters on diagnostics, treatment and follow-up in all adult patients with RA with a first outpatient clinic visit at the study centre, from September 2009 to March 2011. Variation in guideline adherence was assessed on parameter and rheumatologist level. Determinants for guideline adherence were assessed in patients (demographic characteristics, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide antibody (aCCP) positivity, erythrocyte sedimentation rate, erosive disease, comorbidity and the number of available disease modifying anti-rheumatic drug (DMARD) treatment options) and rheumatologists (demographic and practice characteristics, guideline knowledge and agreement, outcome expectancy, cognitive bias, thinking style, numeracy and personality). Results A total of 994 visits in 137 patients with RA were reviewed. Variation in guideline adherence among parameters was present (adherence between 21% and 72%), with referral to the physician assistant as lowest scoring and referral to a specialised nurse as highest scoring parameter. Variation in guideline adherence among rheumatologists was also present (adherence between 22% and 100%). Patient sex, the number of DMARD options, presence of erosions, comorbidity, RF/aCCP positivity, type of patient and the rheumatologists' scientific education status were associated with adherence to 1 or more guideline parameters. Conclusions Guideline adherence varied considerably among the guideline parameters and rheumatologists, showing that there is room for improvement. Guideline adherence in our sample was related to several patient and rheumatologist determinants.
Collapse
Affiliation(s)
- N Lesuis
- Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - A A den Broeder
- Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - M E J L Hulscher
- IQ Healthcare, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - R F van Vollenhoven
- Unit for Clinical Therapy Research , Inflammatory Diseases (ClinTRID), Karolinska Institute , Stockholm , Sweden
| |
Collapse
|
10
|
van Herwaarden N, van der Maas A, Minten MJM, van den Hoogen FHJ, Kievit W, van Vollenhoven RF, Bijlsma JWJ, van den Bemt BJF, den Broeder AA. Disease activity guided dose reduction and withdrawal of adalimumab or etanercept compared with usual care in rheumatoid arthritis: open label, randomised controlled, non-inferiority trial. BMJ 2015; 350:h1389. [PMID: 25858265 PMCID: PMC4391970 DOI: 10.1136/bmj.h1389] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate whether a disease activity guided strategy of dose reduction of two tumour necrosis factor (TNF) inhibitors, adalimumab or etanercept, is non-inferior in maintaining disease control in patients with rheumatoid arthritis compared with usual care. DESIGN Randomised controlled, open label, non-inferiority strategy trial. SETTING Two rheumatology outpatient clinics in the Netherlands, from December 2011 to May 2014. PARTICIPANTS 180 patients with rheumatoid arthritis and low disease activity using adalimumab or etanercept; 121 allocated to the dose reduction strategy, 59 to usual care. INTERVENTIONS Disease activity guided dose reduction (advice to stepwise increase the injection interval every three months, until flare of disease activity or discontinuation) or usual care (no dose reduction advice). Flare was defined as increase in DAS28-CRP (a composite score measuring disease activity) greater than 1.2, or increase greater than 0.6 and current score of at least 3.2. In the case of flare, TNF inhibitor use was restarted or escalated. MAIN OUTCOME MEASURES Difference in proportions of patients with major flare (DAS28-CRP based flare longer than three months) between the two groups at 18 months, compared against a non-inferiority margin of 20%. Secondary outcomes included TNF inhibitor use at study end, functioning, quality of life, radiographic progression, and adverse events. RESULTS Dose reduction of adalimumab or etanercept was non-inferior to usual care (proportion of patients with major flare at 18 months, 12% v 10%; difference 2%, 95% confidence interval -12% to 12%). In the dose reduction group, TNF inhibitor use could successfully be stopped in 20% (95% confidence interval 13% to 28%), the injection interval successfully increased in 43% (34% to 53%), but no dose reduction was possible in 37% (28% to 46%). Functional status, quality of life, relevant radiographic progression, and adverse events did not differ between the groups, although short lived flares (73% v 27%) and minimal radiographic progression (32% v 15%) were more frequent in dose reduction than usual care. CONCLUSIONS A disease activity guided, dose reduction strategy of adalimumab or etanercept to treat rheumatoid arthritis is non-inferior to usual care with regard to major flaring, while resulting in the successful dose reduction or stopping in two thirds of patients.Trial registration Dutch trial register (www.trialregister.nl), NTR 3216.
Collapse
Affiliation(s)
- Noortje van Herwaarden
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, PO Box 9011, 6500 GM, Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, PO Box 9011, 6500 GM, Netherlands
| | - Michiel J M Minten
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, PO Box 9011, 6500 GM, Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, PO Box 9011, 6500 GM, Netherlands Department of Rheumatology, Radboud University Medical Centre (UMC), Nijmegen
| | | | | | | | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek Department of Pharmacy, Radboud UMC, Nijmegen
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, PO Box 9011, 6500 GM, Netherlands
| |
Collapse
|
11
|
Abstract
Prostaglandins, particularly PGE2, are important to adult bone and joint health, but how prostaglandins act on growth plate cartilage to affect bone growth is unclear. We show that growth plate cartilage is distinct from articular cartilage with respect to cyclooxygenase (COX)-2 mRNA expression; although articular chondrocytes express very little COX-2, COX-2 expression is high in growth plate chondrocytes and is increased by IGF-I. In bovine primary growth plate chondrocytes, ATDC5 cells, and human metatarsal explants, inhibition of COX activity with nonsteroidal antiinflammatory drugs (NSAIDs) inhibits chondrocyte proliferation and ERK activation by IGF-I. This inhibition is reversed by prostaglandin E2 and prostacyclin (PGI2) but not by prostaglandin D2 or thromboxane B2. Inhibition of COX activity in young mice by ip injections of NSAIDs causes dwarfism. In growth plate chondrocytes, inhibition of proliferation and ERK activation by NSAIDs is reversed by forskolin, 8-bromoadenosine, 3',5'-cAMP and a prostacyclin analog, iloprost. The inhibition of proliferation and ERK activation by celecoxib is also reversed by 8CPT-2Me-cAMP, an activator of Epac, implicating the small G protein Rap1 in the pathway activated by iloprost. These results imply that prostacyclin is required for proper growth plate development and bone growth.
Collapse
Affiliation(s)
- Michele R Hutchison
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | | |
Collapse
|
12
|
Adding a "GRADE" to the quality appraisal of rheumatoid arthritis guidelines identifies limitations beyond AGREE-II. J Clin Epidemiol 2014; 67:1274-85. [PMID: 25240769 DOI: 10.1016/j.jclinepi.2014.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 06/02/2014] [Accepted: 07/12/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess how well treatment recommendations for rheumatoid arthritis (RA) address Grading of Recommendations Assessment, Development and Evaluation (GRADE) steps and determine whether these steps can be adequately appraised using Appraisal of Guidelines Research & Evaluation II (AGREE-II). STUDY DESIGN AND SETTING We systematically reviewed English-language treatment recommendations for the pharmacologic management of RA since 2000, assessed how well GRADE steps were addressed, rated AGREE-II quality, and compared the findings. RESULTS GRADE steps were poorly addressed by the 44 included guidelines. Few guidelines discussed study limitations and/or risk of bias (23%), inconsistency (50%), indirectness (39%), imprecision (23%), or potential for publication bias (0%). Observational evidence was cited in 96% but rarely evaluated systematically. Only one guideline considered evidence on patients' preferences for health outcomes, and few provided an explicit justification for the strength of evidence or recommendation. The five GRADE steps that overlapped with AGREE-II questions were addressed more frequently (by 54-100% of guidelines) than the 13 GRADE steps not directly assessed by AGREE-II (0-50%). Among the nine guidelines rated as "Recommended for use" by AGREE-II, 8 of 13 GRADE steps were not addressed consistently by any guideline. CONCLUSION GRADE's steps are poorly addressed by RA recommendations. AGREE-II provides a broad assessment of quality but lacks sufficient granularity to assess how well a guideline addresses GRADE's steps.
Collapse
|
13
|
Blake T, Rao V, Hashmi T, Erb N, O'Reilly SC, Shaffu S, Obrenovic K, Packham J. The perplexity of prescribing and switching of biologic drugs in rheumatoid arthritis: a UK regional audit of practice. BMC Musculoskelet Disord 2014; 15:290. [PMID: 25182696 PMCID: PMC4164745 DOI: 10.1186/1471-2474-15-290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Biologic drugs are expensive treatments used in rheumatoid arthritis (RA). Switching among them is common practice in patients who have had an inadequate response or intolerable adverse events. The National Institute of Health and Clinical Excellence (NICE) UK, which aims to curtail postcode prescribing, has provided guidance on the sequential prescription of these drugs. This study sought to evaluate the extent to which rheumatology centres across the Midlands were complying with NICE guidance on the switching of biologic drugs in RA, as well as analyse the various prescribing patterns of these drugs. METHODS Data was collected via a web-based tool on RA patients who had undergone at least one switch of a biologic drug during 2011. The standards specified in NICE technology appraisals (TA130, TA186, TA195, TA198, and TA225) were used to assess compliance with NICE guidance. Descriptive statistical analysis was performed. RESULTS There were 335 biologic drug switches in 317 patients. The most common reason given for switching to a drug was NICE guidelines (242, 72.2%), followed by Physician's choice (122, 33.4%). Lack of effect was the most common reason for discontinuing a drug (224, 67%). For patients on Rituximab, Methotrexate was used in 133 switches (76.9% of the time). Overall NICE compliance for all units was 65% (range 50 to 100%), with anti-TNFα to anti-TNFα switches for inefficacy making up the majority of non-compliant switches. CONCLUSION This study draws attention to the enigma and disparity of commissioning and prescribing of biologic drugs in RA. Currently the evidence would not support switching of a biologic drug for non-clinical purposes such as economic pressures. Flexibility in prescribing should be encouraged: biologic therapy should be individualised based on the mode of action and likely tolerability of these drugs. Further work should focus on the evidence for using particular sequences of biologic drugs.
Collapse
Affiliation(s)
- Tim Blake
- Rheumatology Department, Haywood Hospital, High Lane, Burslem, Staffordshire ST6 7AG, UK.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Epis O, Paoletti F, d'Errico T, Favalli E, Garau P, Mancarella L, Pomponio G, Sandri G, Scioscia C, Selvi E, Tirri E. Ultrasonography in the diagnosis and management of patients with inflammatory arthritides. Eur J Intern Med 2014; 25:103-11. [PMID: 24041708 DOI: 10.1016/j.ejim.2013.08.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
Collapse
Affiliation(s)
- Oscar Epis
- S.C. Reumatologia, A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
| | - Franco Paoletti
- U.O. Reumatologia, Ospedale 'S. Francesco Caracciolo', Agnone, Italy
| | - Tito d'Errico
- Ambulatiorio di Reumatologia, P.O. 'S.M.d.P degli Incurabili', Napoli, Italy
| | - Ennio Favalli
- Divisione di Reumatologia, Istituto Ortopedico G. Pini, Milano, Italy
| | - Pietro Garau
- Struttura Complessa di Reumatologia, A.O.U. Cagliari, Italy
| | | | | | - Gilda Sandri
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Italy
| | | | - Enrico Selvi
- Sezione di Reumatologia, A.O.U. Senese, Siena, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale 'S. Giovanni Bosco', Napoli, Italy
| |
Collapse
|
15
|
Carpenter T, Katz SJ. Review of a rheumatology triage system: simple, accurate, and effective. Clin Rheumatol 2013; 33:247-52. [DOI: 10.1007/s10067-013-2413-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/02/2013] [Accepted: 10/12/2013] [Indexed: 10/26/2022]
|
16
|
Gossec L, Fautrel B, Flipon É, Lecoq d'André F, Marguerie L, Nataf H, Pallot Prades B, Piperno M, Poilverd RM, Rat AC, Sadji F, Sordet C, Thevenot C, Beauvais C. Safety of biologics: elaboration and validation of a questionnaire assessing patients' self-care safety skills: the BioSecure questionnaire. An initiative of the French Rheumatology Society Therapeutic Education section. Joint Bone Spine 2013; 80:471-6. [PMID: 23972274 DOI: 10.1016/j.jbspin.2012.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biologics are known to entail specific risks (e.g. infections). Patients should possess self-care safety skills to develop appropriate behaviors in situations of risks (e.g. fever). To date, there is no adequate tool to assess these skills. OBJECTIVES To elaborate a questionnaire to measure knowledge and skills regarding safety issues, for patients treated by biologics. METHODS Three-step process. (1) A steering group of 10 rheumatologists, one pharmacist and two allied health professionals elaborated an exhaustive list of safety skills. Through a 3-round Delphi process involving the steering group, 14 patients on biologics and 14 other allied health professionals, the list of skills was reduced. (2) A corresponding series of questions and of clinical situations with multiple-choice answers were designed. (3) Preliminary validation was performed against the physician's opinion on skills, and reliability was assessed. RESULTS The list includes 24 skills e.g. how to deal with fever, planned surgery, dental care, travel, minor traumas, and immunizations. A 55-question questionnaire was constructed. Preliminary validation (62 patients) showed the questionnaire was filled in 10 minutes (median) and correlated to the physician's opinion of skills (R=0.47, P<0.0001) but not to disease status or disease duration. The median score was 75% (range 20%-96%). The questionnaire was reliable: intraclass correlation coefficient, 0.83 (95% CI: 0.63-0.93). CONCLUSION A simple (multiple-choice questionnaire) and valid tool investigating a core set of safety skills has been developed. This tool could be useful to detect further educational needs regarding biologics safety, and to assess the efficacy of oriented educational interventions.
Collapse
Affiliation(s)
- Laure Gossec
- Université Pierre et Marie Curie (UPMC) - Paris 6, GRC-UMPC 08 (EEMOIS), AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, 83, boulevard de l'hôpital, 75013 Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Norton S, Sacker A, Dixey J, Done J, Williams P, Young A. Trajectories of functional limitation in early rheumatoid arthritis and their association with mortality. Rheumatology (Oxford) 2013; 52:2016-24. [DOI: 10.1093/rheumatology/ket253] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Henrique da Mota LM, Afonso Cruz B, Viegas Brenol C, Alves Pereira I, Rezende-Fronza LS, Barros Bertolo M, Carioca Freitas MV, da Silva NA, Louzada-Junior P, Neubarth Giorgio RD, Corrêa Lima RA, Marques Bernardo W, Castelar Pinheiro GDR. Diretrizes para o tratamento da artrite reumatoide. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000200004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
19
|
Epis OM, Giacomelli L, Deidda S, Bruschi E. Tight control applied to the biological therapy of rheumatoid arthritis. Autoimmun Rev 2012; 12:839-41. [PMID: 23219770 DOI: 10.1016/j.autrev.2012.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decade, treatment strategies for rheumatoid arthritis (RA) have included the early use of disease-modifying anti-rheumatic drugs, since prompt suppression of disease activity is associated with a reduction in radiological damage. This strategy has now been incorporated into the broader concept of "tight control", defined as a treatment strategy tailored to each patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time. To pursue this goal, tight control should include careful and continuous monitoring of disease activity, and early therapeutic adjustments or switches should be considered as necessary. It is noteworthy that the key role of tight control of RA has been stressed by the recent EULAR Guidelines. This review discusses the most recent evidence concerning the role of a tight control strategy in the treatment of RA, and on how this strategy should be pursued.
Collapse
|
20
|
Singh H, Gupta V, Ray S, Kumar H, Talapatra P, Kaur M, Kumar S, Arya S, Mathur R, Ghangas N. Evaluation of disease activity in rheumatoid arthritis by Routine Assessment of Patient Index Data 3 (RAPID3) and its correlation to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI): an Indian experience. Clin Rheumatol 2012; 31:1663-9. [PMID: 22983768 DOI: 10.1007/s10067-012-2070-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/25/2012] [Accepted: 08/10/2012] [Indexed: 12/19/2022]
Abstract
Serial objective assessment of disease activity in rheumatoid arthritis (RA) is imperative to achieve remission. Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts, appears attractive for evaluation of disease activity in RA patients in a busy clinical setting. This study aims to evaluate correlation and agreement of RAPID3 with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI) in RA patients. All patients completed a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate were completed in 200 literate patients with RA to score DAS28, CDAI, and RAPID3. RAPID3 includes the three MDHAQ patient self-report RA core dataset measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range, 0-30) severity categories of high (>12), moderate (6.1-12.0), low (3.1-6.0), and near remission (≤3) were compared to DAS28 (0-10) activity categories of high (> 5.1), moderate (3.21-5.1), low (2.61-3.2), and remission (≤ 2.6), and CDAI (0-76) categories of >22, 10.1-22.0, 2.9-10.0, and ≤2.8. Statistical significance was analyzed using Spearman correlations, cross-tabulations, and kappa statistics. Comparison of RAPID3 with DAS28 and CDAI indicated Spearman rank-order correlation coefficients for DAS28 with RAPID3 of 0.910, and for CDAI with RAPID3 of 0.907, all highly significant (P < 0.001). There was substantial agreement between RAPID3 and DAS28 (kappa value = 0.634, P < 0.001) and also between RAPID3 and CDAI (kappa value = 0.690, P < 0.001). Overall, 89-94 % of patients who met DAS28 or CDAI moderate/high activity criteria met similar RAPID severity criteria and 84-88 % who met DAS28 or CDAI remission/low activity criteria also met similar RAPID criteria. RAPID3 scores provide similar quantitative information to DAS28 and CDAI, and hence, is an informative index for evaluation of disease activity in RA in busy clinical settings.
Collapse
Affiliation(s)
- H Singh
- Department of Medicine, Pt. B.D. Sharma PGIMS, DLF Colony, Rohtak, Haryana, India.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Dafydd M, Whitaker I, Murison M, Boyce D. Change in operative workload for rheumatoid disease of the hand: 1,109 procedures over 13 years. J Plast Reconstr Aesthet Surg 2012; 65:800-3. [DOI: 10.1016/j.bjps.2011.11.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/22/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
|
22
|
Bakker MF, Cavet G, Jacobs JW, Bijlsma JWJ, Haney DJ, Shen Y, Hesterberg LK, Smith DR, Centola M, van Roon JAG, Lafeber FPJG, Welsing PMJ. Performance of a multi-biomarker score measuring rheumatoid arthritis disease activity in the CAMERA tight control study. Ann Rheum Dis 2012; 71:1692-7. [PMID: 22596166 PMCID: PMC3439649 DOI: 10.1136/annrheumdis-2011-200963] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the performance of individual biomarkers and a multi-biomarker disease activity (MBDA) score in the early rheumatoid arthritis (RA) patient population from the computer assisted management in early rheumatoid arthritis (CAMERA) study. METHODS Twenty biomarkers were measured in the CAMERA cohort, in which patients were treated with either intensive or conventional methotrexate-based treatment strategies. The MBDA score was calculated using the concentrations of 12 biomarkers (SAA, IL-6, TNF-RI, VEGF-A, MMP-1, YKL-40, MMP-3, EGF, VCAM-1, leptin, resistin and CRP) according to a previously trained algorithm. The performance of the scores was evaluated relative to clinical disease activity assessments. Change in MBDA score over time was assessed by paired Wilcoxon rank sum test. Logistic regression was used to evaluate the ability of disease activity measures to predict radiographic progression. RESULTS The MBDA score had a significant correlation with the disease activity score based on 28 joints-C reactive protein (DAS28-CRP) (r=0.72; p<0.001) and an area under the receiver operating characteristic curve for distinguishing remission/low from moderate/high disease activity of 0.86 (p<0.001) using a DAS28-CRP cut-off of 2.7. In multivariate analysis the MBDA score, but not CRP, was an independent predictor of disease activity measures. Additionally, mean (SD) MBDA score decreased from 53 (18) at baseline to 39 (16) at 6 months in response to study therapy (p<0.0001). Neither MBDA score nor clinical variables were predictive of radiographic progression. CONCLUSIONS This multi-biomarker test performed well in the assessment of disease activity in RA patients in the CAMERA study. Upon further validation, this test could be used to complement currently available disease activity measures and improve patient care and outcomes.
Collapse
Affiliation(s)
- Marije F Bakker
- Correspondence to Marije F Bakker, UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht PO BOX 85500, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Nikiphorou E, Guh D, Bansback N, Zhang W, Dixey J, Williams P, Young A. Work disability rates in RA. Results from an inception cohort with 24 years follow-up. Rheumatology (Oxford) 2012; 51:385-92. [DOI: 10.1093/rheumatology/ker401] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Baharav E, Bar M, Taler M, Gil-Ad I, Karp L, Weinberger A, Weizman A. Immunomodulatory effect of sertraline in a rat model of rheumatoid arthritis. Neuroimmunomodulation 2012; 19:309-18. [PMID: 22797111 DOI: 10.1159/000339109] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/16/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Previous studies suggest that selective serotonin reuptake inhibitors (SSRIs) modulate immune system functionality. SSRIs are the preferred treatment for major depressive disorder (MDD). A high rate of MDD is observed in rheumatoid arthritis (RA) patients. The aim of this study was to evaluate immunological effects of SSRIs in a rat model of RA. METHODS Adjuvant arthritis was induced in 8-week-old Lewis rats; in the first set of experiments following the induction, 15.3 or 30.6 mg/kg of sertraline was daily injected into the ankle joint of the left rear leg. Clinical disease activity was evaluated and the findings compared with the 3 untreated legs and with control groups given methotrexate (MTX) or vehicle only at the same site. In a second set of experiments, the effect of 5, 25 and 50 mg/kg daily oral sertraline was evaluated in the same rat model. Splenocyte viability and inflammatory mediators were evaluated. RESULTS The sertraline-treated rats showed a significant reduction in clinical arthritis compared to controls, at all doses given, accompanied by a significant increase in interleukin 10 and a decrease in tumor necrosis factor-α levels and cycloxygenase-2 production, without lymphotoxicity. There was no significant difference from MTX, the first-line treatment for RA patients. Oral sertraline had a significant anti-inflammatory effect at all doses. There was no treatment × time effect. CONCLUSION The beneficial effects of sertraline in this rat model of arthritis have clinical implications for its use in humans. Large-scale clinical efficacy trials are needed.
Collapse
Affiliation(s)
- Ehud Baharav
- Laboratory of Joint Pathophysiology and Inflammation, Department of Medicine C, Rabin Medical Center, Petach Tikva, Israel.
| | | | | | | | | | | | | |
Collapse
|
25
|
Kiely PDW, Deighton C, Dixey J, Ostör AJK. Biologic agents for rheumatoid arthritis--negotiating the NICE technology appraisals. Rheumatology (Oxford) 2012; 51:24-31. [PMID: 22039226 PMCID: PMC3276292 DOI: 10.1093/rheumatology/ker321] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/10/2011] [Indexed: 12/31/2022] Open
Abstract
In England and Wales, the National Institute for Health and Clinical Excellence (NICE) has provided guidance [technology appraisals (TAs) 130, 186, 195, 198 and 225] on the use of biologic drugs for the treatment of RA. This is based on an analysis of efficacy, safety and cost-effectiveness, and has resulted in a complex management pathway that restricts freedom to prescribe biologics according to their licensed indications. Specifically, TNF antagonists are the only class of biologics that can be used first line in DMARD-inadequate responders, and only in patients with a persistent 28-joint DAS score of ≥5.1. Alternative biologic agents are denied to those with contraindications to anti-TNF drugs and are also not supported following intolerance to TNF antagonists. Rituximab is the only class of biologic permitted after TNF antagonist inefficacy, in the absence of a contraindication to its use, whereas abatacept and tocilizumab are licensed and may be a more efficacious choice at this stage in some patient groups. Furthermore, for patients who demonstrate sequential inadequate responses, treatment is restricted to one TNF antagonist, rituximab and tocilizumab, whereas abatacept is only a permitted choice when rituximab is contraindicated or has been withdrawn because of an adverse event. In this review, we discuss the treatment algorithm published by NICE, and suggest alternatives where perceived deficiencies exist.
Collapse
Affiliation(s)
- Patrick D W Kiely
- Department of Rheumatology, St Georges Healthcare NHS Trust, London SW17 0QT, UK.
| | | | | | | |
Collapse
|
26
|
van Hulst LTC, Kievit W, van Bommel R, van Riel PLCM, Fraenkel L. Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: results of a maximum difference scaling experiment. Arthritis Care Res (Hoboken) 2011; 63:1407-14. [PMID: 21748861 DOI: 10.1002/acr.20551] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Antirheumatic treatment is frequently not appropriately modified, according to American College of Rheumatology guidelines, in patients with active rheumatoid arthritis (RA) as defined by a Disease Activity Score in 28 joints (DAS28) score greater than 3.2. The objective of this study was to determine which factors most strongly influence patients' and rheumatologists' decisions to escalate care. METHODS We administered a Maximum Difference Scaling survey to 106 rheumatologists and 213 patients with RA. The survey included 58 factors related to the decision to escalate care in RA. Participants answered 24 choice tasks. In each task, participants were asked to choose the most important factor from a set of 5. We used hierarchical Bayes modeling to generate the mean relative importance score (RIS) for each factor. RESULTS For rheumatologists, the 5 most influential factors were number of swollen joints (mean ± SD RIS 5.2 ± 0.4), DAS28 score (mean ± SD RIS 5.2 ± 0.5), physician global assessment of disease activity (mean ± SD RIS 5.2 ± 0.6), worsening erosions over the last year (mean ± SD RIS 5.2 ± 0.5), and RA disease activity now compared to 3 months ago (mean ± SD RIS 5.1 ± 0.6). For patients, the 5 most important factors were current level of physical functioning (mean ± SD RIS 4.3 ± 1.1), motivation to get better (mean ± SD RIS 3.5 ± 1.4), trust in their rheumatologist (mean ± SD RIS 3.5 ± 1.6), satisfaction with current disease-modifying antirheumatic drugs (mean ± SD RIS 3.4 ± 1.4), and current number of painful joints (mean ± SD RIS 3.4 ± 1.4). CONCLUSION Factors influencing the decision to escalate care differ between rheumatologists and patients. Better communication between patients and their physicians may improve treatment planning in RA patients with active disease.
Collapse
Affiliation(s)
- L T C van Hulst
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
27
|
Gao F, Ren L, Zhang CQ, Mu FY, You YQ, Liu YH. Diagnostic value of anti-cyclic citrullinated peptide antibody for rheumatoid arthritis in a Chinese population: a meta-analysis. Rheumatol Int 2011; 32:3201-18. [PMID: 21960046 DOI: 10.1007/s00296-011-2153-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 09/10/2011] [Indexed: 11/27/2022]
Abstract
To use meta-analysis to determine the accuracy of anti-cyclic citrullinated peptide (CCP) antibody in diagnosis of patients with rheumatoid arthritis (RA) in a Chinese population, we searched MEDLINE and CNKI databases for studies published in English or Chinese between January 2000 and June 2010. Two investigators independently evaluated studies for inclusion, data extraction, and quality assessment. We used a random-effects model to combine estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). One hundred and eighteen studies met our inclusion criteria. All studies were of high quality. The summary estimates for anti-CCP antibody in the diagnosis of RA in a Chinese population were as follows: sensitivity 0.65 (95% confidence interval (CI) 0.65-0.66), specificity 0.95 (95% CI 0.95-0.96), positive likelihood ratio (LR+) 15.84 (95% CI 13.55-18.54), negative likelihood ratio (LR-) 0.33 (95% CI 0.31-0.35), and diagnostic odds ratio (DOR) 51.60 (95% CI 43.64-61.01). With high specificity and moderate sensitivity, anti-CCP antibody tests play an important role in conforming the diagnosis of RA in a Chinese population.
Collapse
Affiliation(s)
- Fei Gao
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xue Fu Road, Harbin 150086, China
| | | | | | | | | | | |
Collapse
|
28
|
Bykerk VP, Akhavan P, Hazlewood GS, Schieir O, Dooley A, Haraoui B, Khraishi M, Leclercq SA, Légaré J, Mosher DP, Pencharz J, Pope JE, Thomson J, Thorne C, Zummer M, Bombardier C. Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. J Rheumatol 2011; 39:1559-82. [PMID: 21921096 DOI: 10.3899/jrheum.110207] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part 1 is reported here. METHODS The CRA Therapeutics Committee assembled a national working group of RA clinical experts, researchers, patient consumers, and a general practitioner. Treatment questions were developed a priori based on results of a national needs assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and the grey literature. Guideline quality was assessed by 2 independent reviewers, and guideline characteristics, recommendations, and supporting evidence from observational studies and randomized controlled trials were synthesized into evidence tables. The full working group reviewed the evidence tables and developed recommendations using a modified Delphi technique. RESULTS Five overarching principles and 26 recommendations addressing general RA management strategies and treatment with glucocorticoids and traditional and biologic DMARD were developed for rheumatologists, other primary prescribers of RA drug therapies, and patients with RA. CONCLUSION These recommendations were developed based on a synthesis of international guidelines, supporting evidence, and expert consensus considering the Canadian healthcare context with the intention of promoting best practices and improving healthcare delivery for persons with RA.
Collapse
Affiliation(s)
- Vivian P Bykerk
- Mount Sinai Hospital, The Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Toronto, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Wakabayashi H, Hasegawa M, Nishioka Y, Sudo A, Nishioka K. Which subgroup of rheumatoid arthritis patients benefits from switching to tocilizumab versus etanercept after previous infliximab failure? A retrospective study. Mod Rheumatol 2011; 22:116-21. [PMID: 21710357 DOI: 10.1007/s10165-011-0485-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/31/2011] [Indexed: 01/11/2023]
Abstract
A retrospective study of 39 rheumatoid arthritis (RA) patients with an inadequate response to infliximab was conducted. The responses of subjects switching from infliximab to tocilizumab (n = 23) were compared to those of subjects switching to etanercept (n = 16). Disease activity was assessed by the Disease Activity Score 28-CRP ([C-reactive protein] DAS28-CRP), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Twenty-two patients completed 48 weeks of tocilizumab treatment, and 15 patients completed 48 weeks of etanercept treatment. In both treatment groups, 1 patient each discontinued treatment because of lack of efficacy. No serious adverse events occurred during the study, and no patients in either group withdrew due to adverse events. At week 48, there was a significant reduction from baseline in DAS28-CRP, SDAI, and CDAI values after switching to either tocilizumab or etanercept, and there was no significant difference in efficacy, as measured by the DAS28-CRP, SDAI, and CDAI, between the two treatment groups (p = 0.12, 0.76, and 0.86, respectively). These results suggest that safety and tolerability were similar for both treatments. A switch from infliximab to either tocilizumab or etanercept in patients with RA who have not responded to infliximab is a feasible, well-tolerated treatment option.
Collapse
Affiliation(s)
- Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
| | | | | | | | | |
Collapse
|
30
|
Lesko M, Young M, Higham R. Managing inflammatory arthritides: Role of the nurse practitioner and physician assistant. ACTA ACUST UNITED AC 2011; 22:382-92. [PMID: 20590962 DOI: 10.1111/j.1745-7599.2010.00525.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To review the current management of the inflammatory arthritides, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. This review examines the role of the nurse practitioner (NP) and physician assistant (PA) in the management of these chronic diseases. DATA SOURCES A review of the scientific literature and current guidelines regarding the management of inflammatory arthritides. CONCLUSIONS NPs and PAs play important roles in the interdisciplinary team involved in the treatment of patients with chronic inflammatory arthritic conditions. The management of inflammatory arthritides has evolved with the development of new treatment strategies and is focused on early intervention and minimizing progressive joint damage. NPs and PAs are ideally positioned to educate patients regarding treatment options and other important aspects of the disease process and to monitor disease activity using a number of validated instruments. IMPLICATIONS FOR PRACTICE Through active disease management, NPs and PAs can influence their patients to make better, more informed choices regarding treatment, which may optimize patient outcomes.
Collapse
Affiliation(s)
- Mary Lesko
- University Hospitals Case Medical Center, Beachwood, Ohio, USA
| | | | | |
Collapse
|
31
|
Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM, Gabriel SE. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis 2011; 70:482-7. [PMID: 21216812 DOI: 10.1136/ard.2010.135871] [Citation(s) in RCA: 368] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the impact of systemic inflammation and serum lipids on cardiovascular disease (CVD) in rheumatoid arthritis (RA). METHODS In a population-based RA incident cohort (1987 American College of Rheumatology criteria first met between 1988 and 2007), details were collected of serum lipid measures, erythrocyte sedimentation rates (ESRs), C-reactive protein (CRP) measures and cardiovascular events, including ischaemic heart disease and heart failure. Cox models were used to examine the association of lipids and inflammation with the risk of CVD and mortality, adjusting for age, sex and year of RA incidence. RESULTS The study included 651 patients with RA (mean age 55.8 years, 69% female); 67% were rheumatoid factor positive. ESR was associated with the risk of CVD (HR=1.2 per 10 mm/h increase, 95% CI 1.1 to 1.3). Similar findings, although not statistically significant, were seen with CRP (p=0.07). A significant non-linear association for total cholesterol (TCh) with risk of CVD was found, with 3.3-fold increased risk for TCh <4 mmol/l (95% CI 1.5 to 7.2) and no increased risk of CVD for TCh ≥4 mmol/l (p=0.57). Low low-density lipoprotein cholesterol (LDL <2 mmol/l) was associated with marginally increased risk of CVD (p=0.10); there was no increased risk for LDL ≥2 mmol/l (p=0.76). CONCLUSION Inflammatory measures (particularly, ESR) are significantly associated with the risk of CVD in RA. Lipids may have paradoxical associations with the risk of CVD in RA, whereby lower TCh and LDL levels are associated with increased cardiovascular risk.
Collapse
Affiliation(s)
- Elena Myasoedova
- Correspondence to Dr Sherine E Gabriel, Department of Health Sciences Research, Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Kiely P, Walsh D, Williams R, Young A. Outcome in rheumatoid arthritis patients with continued conventional therapy for moderate disease activity--the early RA network (ERAN). Rheumatology (Oxford) 2010; 50:926-31. [DOI: 10.1093/rheumatology/keq406] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
33
|
Abstract
Significant advances in our understanding of RA and its management have been made in the past decade, resulting in earlier intervention with biologic DMARDs, particularly in patients with evidence of aggressive, erosive disease. Here, one such biologic therapy, the T-cell co-stimulation modulator abatacept, is discussed, exploring clinical evidence published to date on its use in patients with very early arthritis/early RA who are MTX naïve, and in patients with established RA and an inadequate response to MTX or TNF antagonists. Data from relevant clinical trials are overviewed, discussing the clinical efficacy of abatacept in early disease, the clinical outcomes over long-term treatment in different patient populations and the effects of abatacept on structural damage. Findings from integrated safety analyses of abatacept clinical trial data, representing 10 366 patient-years of exposure are described, and clinically important safety events, including serious infections, malignancies and autoimmune events, are highlighted. It is concluded that abatacept represents an effective treatment option with an established safety profile across different patient populations, including patients with both early and erosive RA and those with established disease. Furthermore, efficacy data from studies in patients with early disease suggest that the risk–benefit profile of abatacept may be more favourable when introduced earlier in the treatment paradigm.
Collapse
Affiliation(s)
- Michael Schiff
- School of Medicine, University of Colorado, Denver, CO, USA.
| |
Collapse
|
34
|
|
35
|
Schipper LG, van Hulst LTC, Grol R, van Riel PLCM, Hulscher MEJL, Fransen J. Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome. Rheumatology (Oxford) 2010; 49:2154-64. [DOI: 10.1093/rheumatology/keq195] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Conaghan PG, Hensor EMA, Keenan AM, Morgan AW, Emery P. Persistently moderate DAS-28 is not benign: loss of function occurs in early RA despite step-up DMARD therapy. Rheumatology (Oxford) 2010; 49:1894-9. [PMID: 20542894 DOI: 10.1093/rheumatology/keq178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Current UK management of RA initially employs conventional DMARDs, with biological therapy reserved for DMARD-resistant RA patients with persistently high 28-joint disease activity score (DAS-28). The aim of this study was to examine the effect on patient-reported function of persistently moderate DAS-28 despite modern step-up DMARD therapy in an early arthritis cohort. METHODS Data were obtained from the Yorkshire Early Arthritis Register, a cohort of early (<12 months) RA patients treated with dose-escalated DMARDs. Change in HAQ exceeding the minimum clinically important difference (MCID) was determined for three values of MCID (0.22, 0.31 and 0.49). Changes in HAQ over Months 6-12 were compared between patients whose DAS-28(ESR) was persistently high (> 5.1 at 6- and/or 9-month visits and at the 12-month visit), persistently moderate (>3.2 and ≤ 5.1) or persistently low (≤ 3.2). RESULTS We selected 194 patients for this analysis. Deteriorating HAQ scores were observed in 10.9% of patients with persistently low DAS-28 compared with 21.4% (persistently moderate DAS-28) and 46.7% (persistently high DAS-28), respectively, for MCID = 0.22; 7.3, 14.3 and 20.0% for MCID = 0.31; 5.5, 10.7 and 11.1% for MCID = 0.49. CONCLUSIONS A high DAS-28 was generally associated with a greater degree of functional decline, but persistent moderate elevation of DAS-28 was associated with important functional deterioration in 10-21% of early RA patients (depending on choice of MCID) following a modern DMARD protocol. A proportion of patients with persistently moderate DAS-28 may therefore benefit from more aggressive therapy than that allowed by current UK recommendations.
Collapse
Affiliation(s)
- Philip G Conaghan
- Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK.
| | | | | | | | | | | |
Collapse
|
37
|
Schipper LG, Fransen J, den Broeder AA, Van Riel PLCM. Time to achieve remission determines time to be in remission. Arthritis Res Ther 2010; 12:R97. [PMID: 20487520 PMCID: PMC2911884 DOI: 10.1186/ar3027] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/14/2010] [Accepted: 05/20/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Though remission is currently a treatment goal in patients with rheumatoid arthritis (RA), the number of patients who achieve and sustain remission in daily practice is still small. It is suggested that early remission will be associated with sustainability of remission. The aim was to study the association between time-to-remission and sustainability of remission in a cohort of early RA patients treated according to daily practice. METHODS For this study, three-year follow-up data were used from the Nijmegen RA Inception Cohort of patients included between 1985 and 2005 (N=753). Patients were included upon diagnosis (ACR criteria), were systematically evaluated at three-monthly visits and treated according to daily practice. Remission was defined according to the Disease Activity Score (DAS)<1.6 and the ACR remission criteria. Remission of at least 6 months duration was regarded as sustained remission. Predictors for time-to-remission were identified by Cox-regression analyses. The relation between time-to-remission and sustained remission was analyzed using longitudinal binary regression. RESULTS N=398 (52%) patients achieved remission with a median time-to-remission of 12 months. Male gender, younger age and low DAS at baseline were predictive to reach remission rapidly. There were n=142 (36%) patients experiencing sustained remission, which was determined by a shorter time-to-remission only. The relationship between time-to-remission and sustained remission was described by a significant odds ratio (1.11) (1.10 to 1.12-95% CI) that was constant over the whole period 1985 to 2005. Results obtained with the ACR remission criteria were similar. CONCLUSIONS A shorter time-to-remission is related to sustainability of remission, supporting striving for early remission in patients with RA.
Collapse
Affiliation(s)
- Lydia G Schipper
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, Nijmegen, 6500 HB, The Netherlands
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, Nijmegen, 6500 HB, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek Nijmegen, Hengstdal 3, Nijmegen, 6522 JV, The Netherlands
| | - Piet LCM Van Riel
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, Nijmegen, 6500 HB, The Netherlands
| |
Collapse
|
38
|
Woodburn J, Hennessy K, Steultjens MP, McInnes IB, Turner DE. Looking through the 'window of opportunity': is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis? J Foot Ankle Res 2010; 3:8. [PMID: 20478038 PMCID: PMC2883976 DOI: 10.1186/1757-1146-3-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 05/17/2010] [Indexed: 12/23/2022] Open
Abstract
Over the past decade there have been significant advances in the clinical understanding and care of rheumatoid arthritis (RA). Major paradigm changes include earlier disease detection and introduction of therapy, and 'tight control' of follow-up driven by regular measurement of disease activity parameters. The advent of tumour necrosis factor (TNF) inhibitors and other biologic therapies have further revolutionised care. Low disease state and remission with prevention of joint damage and irreversible disability are achievable therapeutic goals. Consequently new opportunities exist for all health professionals to contribute towards these advances. For podiatrists relevant issues range from greater awareness of current concepts including early referral guidelines through to the application of specialist skills to manage localised, residual disease activity and associated functional impairments. Here we describe a new paradigm of podiatry care in early RA. This is driven by current evidence that indicates that even in low disease activity states destruction of foot joints may be progressive and associated with accumulating disability. The paradigm parallels the medical model comprising early detection, targeted therapy, a new concept of tight control of foot arthritis, and disease monitoring. 'Podiatrists are experts on foot disorders: both patients and rheumatologists can profit from the involvement of a podiatrist' - Korda and Balint, 2004 [1].
Collapse
Affiliation(s)
- James Woodburn
- Musculoskeletal Rehabilitation Research Group, Institute of Applied Health Research, School of Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | | | | | | | | |
Collapse
|
39
|
Deighton C, Rudolf M. How does rheumatoid arthritis need to be managed? Clin Med (Lond) 2010; 10:151-3. [PMID: 20437987 PMCID: PMC4952088 DOI: 10.7861/clinmedicine.10-2-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Fransen J, van Riel PLCM. The Disease Activity Score and the EULAR response criteria. Rheum Dis Clin North Am 2010; 35:745-57, vii-viii. [PMID: 19962619 DOI: 10.1016/j.rdc.2009.10.001] [Citation(s) in RCA: 249] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Disease Activity Score (DAS), its modified version the DAS28, and the DAS-based European League Against Rheumatism (EULAR) response criteria are well-known measures of disease activity in rheumatoid arthritis (RA). The DAS is a clinical index of RA disease activity that combines information from swollen joints, tender joints, the acute phase response, and general health. The EULAR response criteria classify individual patients as non-, moderate, or good responders, depending on the extent of change and the level of disease activity reached. The DAS, DAS28, and EULAR response criteria have been validated extensively. For daily practice, it has been shown that a tight control strategy, including measurement of disease activity using the DAS and planned adjustment of antirheumatic medication, is an effective strategy for RA. This article summarizes the development and validation of the DAS and DAS28 and their use in clinical trials and practice for the clinician.
Collapse
Affiliation(s)
- Jaap Fransen
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO Box 9101, NL-6500HB Nijmegen, The Netherlands.
| | | |
Collapse
|
41
|
Abstract
Inflammatory rheumatic diseases are generally multifaceted disorders and, therefore, measurement of multiple outcomes is relevant to most of these diseases. Developments in outcome measures in the rheumatic diseases are promoted by the development of successful treatments. Outcome measurement will increasingly deal with measurement of low levels of disease activity and avoidance of disease consequences. It is an advantage for patient management and knowledge transfer if the same outcomes are used in practice and in trials. Continuous measures of change are generally the most powerful and, therefore, are preferred as primary outcomes in trials. For daily clinical practice, outcome measures should reflect the patients' state and have to be easily derivable. The objective of this review is to describe recent developments in outcome measures for inflammatory rheumatic diseases for trials and clinical practice, with an emphasis on rheumatoid arthritis.
Collapse
Affiliation(s)
- Jaap Fransen
- Radboud University Nijmegen Medical Centre, Department of Rheumatology, 6500HB Nijmegen, The Netherlands.
| | | |
Collapse
|
42
|
Kumar A, Sugunaraj JP, Kumar A, Gupta R, Kumar U. Correlation of time to institution of disease modifying antirheumatic drugs with radiological outcome in rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2009. [DOI: 10.1016/s0973-3698(10)60188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|