1
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Mochizuki T, Koenuma N, Yano K, Ikari K, Hiroshima R, Okazaki K. Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission. Mod Rheumatol 2024; 34:329-333. [PMID: 37267207 DOI: 10.1093/mr/road041] [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: 01/05/2023] [Revised: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the effects of intensive treatment on joint damage in patients with rheumatoid arthritis (RA) showing progression of joint damage and low disease activity or remission. METHODS Eighty-nine patients who had change in the van der Heijde modified total Sharp score (TSS) of >0.5 points at baseline when compared with the score 1 year ago were enrolled and categorized into two groups to receive intensive (intensive group) or current (current group) treatment. The intensive and current groups were compared for change (Δ) from baseline to 1 year of erosion score, joint space narrowing score, and TSS. RESULTS The ΔTSS values at 1 year in the intensive and current groups were 0.67 ± 1.09 and 1.79 ± 1.70, respectively (P < 0.001). In the intensive and current groups, the ΔTSS ≤ 0.5 at 1 year were 66.7% and 32.4%, respectively (P = 0.010). CONCLUSIONS The intensive treatment was more effective at suppressing joint damage than the current treatment. The progression of joint damage is an important target to consider for intensive treatment.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopaedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Naoko Koenuma
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Hiroshima
- Department of Orthopaedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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2
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Park DJ. Importance of Time-integrated Cumulative Parameters for Radiographic Progression Prediction of Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2022; 29:129-131. [PMID: 37475971 PMCID: PMC10324923 DOI: 10.4078/jrd.2022.29.3.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 07/22/2023]
Affiliation(s)
- Dong-Jin Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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3
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Larid G, Vix J, Garlantezec R, Loppin E, Gervais E. Increased remission with fewer corticosteroids and more biologics in rheumatoid arthritis at 7-year follow-up in real-life conditions. Sci Rep 2022; 12:2563. [PMID: 35169251 PMCID: PMC8847581 DOI: 10.1038/s41598-022-06584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Remission in rheumatoid arthritis (RA) is an important therapeutic target that is not easy to achieve in real-life conditions. Some prognostic factors have been identified but the literature is variable. The objectives of this study were to evaluate the remission rate and the maintenance of remission in patients with RA over 7 years of follow-up in real-life conditions and to identify prognostic factors of long-term remission. Patients with RA seen at the Poitiers University Hospital were identified and clinical and biological data were collected. Data were analysed after 1 year and 7 years. Twice as many patients were in remission at 7 years than at 1 year of follow-up. 48.6% of patients who were not in remission at 1 year obtained remission at 7 years of follow-up. Patients achieving remission were more often receiving coprescription of csDMARDs and bDMARDs. Patients not in remission at 7 years were given more corticosteroids at higher doses. After 7 years of follow-up, low initial disease activity and use of csDMARDs and bDMARDs appeared to be independent positive predictive factors. Once obtained at one year, remission was maintained for 76% of our patients. As a conclusion, modern management of RA, whatever disease duration, leads to remission rates similar to those of early RA after 7 years of follow-up.
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Affiliation(s)
- Guillaume Larid
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France.,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France
| | - Justine Vix
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | | | - Elodie Loppin
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | - Elisabeth Gervais
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France. .,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France.
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4
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Duarte C, Ferreira RJO, Santos EJF, da Silva JAP. Treating-to-target in rheumatology: Theory and practice. Best Pract Res Clin Rheumatol 2021; 36:101735. [PMID: 34980566 DOI: 10.1016/j.berh.2021.101735] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite its inclusion in current treatment recommendations, adherence to the treat-to-target strategy (T2T) is still poor. Among the issues are the definition(s) of target, especially the caveats of the patient global assessment (PGA), included in all recommended definitions of remission. The PGA is poorly related to inflammation, especially at low levels of disease activity, rather being a measure of the disease impact. Up to 60% of all patients otherwise in remission still score PGA at >1 and as high as 10. These patients (PGA-near-remission) are exposed to overtreatment if current recommendations are strictly followed and will continue to endure significant impact, unless adjuvant measures are implemented. A proposed method to overcome both these risks is to systematically pursue two targets: one focused on the disease process (the biological target) and another focused on the symptoms and impact (the impact target), the dual-target strategy. Candidate instruments to define each of these targets are discussed.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo J F Santos
- Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Viseu Higher School of Health, Viseu, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal.
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5
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Sun X, Li R, Cai Y, Al-Herz A, Lahiri M, Choudhury MR, Hidayat R, Suryana BPP, Kaneko Y, Fujio K, Van Hung N, Pandya S, Pang LK, Katchamart W, Sigdel KR, Paudyal B, Narongroeknawin P, Chevaisrakul P, Sun F, Lu Y, Ho C, Yeap SS, Li Z. Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 15:100240. [PMID: 34528015 PMCID: PMC8365438 DOI: 10.1016/j.lanwpc.2021.100240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/15/2021] [Accepted: 07/19/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Clinical remission is an attainable goal for Rheumatoid Arthritis (RA). However, data on RA remission rates from multinational studies in the Asia-Pacific region are limited. We conducted a cross-sectional multicentric study to evaluate the clinical remission status and the related factors in RA patients in the Asia-Pacific region. METHODS RA patients receiving standard care were enrolled consecutively from 17 sites in 11 countries from APLAR RA SIG group. Data were collected on-site by rheumatologists with a standardized case-report form. Remission was analyzed by different definitions including disease activity score using 28 joints (DAS28) based on ESR and CRP, clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean remission definition, and clinical deep remission (CliDR). Logistic regression was used to determine related factors of remission. FINDINGS A total of 2010 RA patients was included in the study, the overall remission rates were 62•3% (DAS28-CRP), 35•5% (DAS28-ESR), 30•8% (CDAI), 26•5% (SDAI), 24•7% (Boolean), and 17•1% (CliDR), respectively, and varied from countries to countries in the Asia-Pacific region. Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prescription rate was low (17•9%). Compared to patients in non-remission, patients in remission had higher rates of b/tsDMARDs usage and lower rates of GC usage. The favorable related factors were male sex, younger age, fewer comorbidities, fewer extra-articular manifestations (EAM), and use of b/tsDMARDs, while treatment with GC was negatively related to remission. INTERPRETATION Remission rates were low and varied in the Asia-Pacific region. Treatment with b/tsDMARDs and less GC usage were related to higher remission rate. There is an unmet need for RA remission in the Asia-Pacific region.
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Affiliation(s)
- Xing Sun
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South St., Beijing 100044, China
| | - Ru Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South St., Beijing 100044, China
| | - Yueming Cai
- Department of Rheumatology & Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Adeeba Al-Herz
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Manjari Lahiri
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Minhaj Rahim Choudhury
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Rudy Hidayat
- Department of Internal Medicine, Cipto Mangunkusumo National Hospital Faculty of Medicine, Universitas Indonesia, Jakarta
| | - Bagus Putu Putra Suryana
- Rheumatology Division, Internal Medicine Department, Brawijaya University - Saiful Anwar Hospital, Indonesia
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nguyen Van Hung
- Department of Rheumatology, Bach Mai Hospital, Giai Phong Road, Dong Da District, Hanoi, Vietnam
| | - Sapan Pandya
- Vedanta institute of medical sciences and VS hospital, Ahmedabad, India
| | - Leong Khai Pang
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Keshav Raj Sigdel
- Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Buddhi Paudyal
- Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Pongthorn Narongroeknawin
- Division of Rheumatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Parawee Chevaisrakul
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yu Lu
- School of Mathematical Science, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Carmen Ho
- Division of Rheumatology, Dept of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, Selangor
| | - Zhanguo Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South St., Beijing 100044, China
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6
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Ferreira RJO, Fautrel B, Saraux A, Gaujoux‐Viala C, Rat A, Guillemin F, Silva JAP, Dougados M, Gossec L. Patient Global Assessment of Disease Activity and Radiographic Progression in Early Arthritis: Three‐Year Results From the ESPOIR Cohort. Arthritis Care Res (Hoboken) 2021; 73:1300-1305. [DOI: 10.1002/acr.24237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/21/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Ricardo J. O. Ferreira
- Centro Hospitalar e Universitário de Coimbra and Nursing School of Coimbra (ESEnfC) Coimbra Portugal
| | - Bruno Fautrel
- Institut Pierre Louis d’Epidémiologie et de Santé Publique INSERM Sorbonne Université and AP‐HP Pitié Salpêtrière Hospital, and CRI IMIDIATE Clinical Research Network Paris France
| | - Alain Saraux
- CHU Brest and UMR1227, Lymphocytes B et Autoimmunité INSERM Université de Bretagne occidentale Brest France
| | | | - Anne‐Christine Rat
- EA 4360 APEMAC Université de Lorraine, Nancy, France, and CHU Caen Caen France
| | - Francis Guillemin
- EA 4360 APEMAC Université de Lorraine, and Inserm CIC 1433 Epidémiologie clinique CHRU de Brabois Nancy France
| | - José A. P. Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Maxime Dougados
- Paris Descartes University Hôpital Cochin Assistance Publique Hôpitaux de Paris, and INSERM (U1153), Paris, France: Clinical epidemiology and biostatistics PRES Sorbonne Paris‐Cité Paris France
| | - Laure Gossec
- Institut Pierre Louis d’Epidémiologie et de Santé Publique INSERM Sorbonne Université, and AP‐HP Pitié Salpêtrière Hospital Paris France
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7
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Comparison of the effects of baricitinib and tocilizumab on disease activity in patients with rheumatoid arthritis: a propensity score matching analysis. Clin Rheumatol 2021; 40:3143-3151. [PMID: 34136969 DOI: 10.1007/s10067-021-05815-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to compare the effects of baricitinib, a Janus kinase inhibitor, and tocilizumab, a monoclonal anti-interleukin-6 receptor antibody, on disease activity in patients with rheumatoid arthritis (RA), and to investigate the influence of inflammation on improvement in patient global assessment (PGA) of disease activity. METHODS This study was performed based on data from a multicenter registry, and included 284 and 113 patients treated with tocilizumab and baricitinib, respectively, who were observed for longer than 24 weeks. Propensity score matching was performed to address potential treatment-selection bias. To assess the influence of inflammation on PGA, patients were divided into two groups based on whether or not they achieved improvement in C-reactive protein (CRP, an objective marker of inflammation) at 24 weeks. RESULTS A total of 48 matched pairs of patients were identified. Compared to treatment with tocilizumab, baricitinib showed a similar improvement in tender and swollen joint count and serum CRP levels, and a significantly greater improvement in PGA at 24 weeks. As a result, the baricitinib group had a significantly higher proportion of patients who achieved Boolean remission at 24 weeks. In subgroups of patients who did not achieve 50% or 70% CRP improvement, significant decreases from baseline to 24 weeks were observed in PGA in patients treated with baricitinib, but not in those treated with tocilizumab. CONCLUSION Compared to tocilizumab, baricitinib significantly improved PGA despite similar effects on inflammation in patients with RA. Moreover, the influence of inflammation on PGA improvement differed between baricitinib and tocilizumab. Key-points • Baricitinib and tocilizumab had similar effects on inflammation in RA patients. • Baricitinib improved patient global assessment (PGA) more than tocilizumab. • Baricitinib had a higher Boolean remission rate than tocilizumab at 24 weeks. • Influence of inflammation on PGA improvement differed between the two drugs.
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8
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Ferreira RJO, Welsing PMJ, Jacobs JWG, Gossec L, Ndosi M, Machado PM, van der Heijde D, Da Silva JAP. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients. Ann Rheum Dis 2021; 80:293-303. [PMID: 33023964 DOI: 10.1136/annrheumdis-2020-217171] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional outcome of rheumatoid arthritis (RA). METHODS Meta-analyses using individual patient data from randomised controlled trials testing the efficacy of biological agents on radiographic and functional outcomes at ≥2 years. Remission states were defined by 4 variants of the ACR/EULAR Boolean definition: (i) tender and swollen 28-joint counts (TJC28/SJC28), C reactive protein (CRP, mg/dL) and PGA (0-10=worst) all ≤1 (4V-remission); (ii) the same, except PGA >1 (4V-near-remission); (iii) 3V-remission (i and ii combined; similar to 4V, but without PGA); (iv) non-remission (TJC28 >1 and/or SJC28 >1 and/or CRP >1). The most stringent class achieved at 6 or 12 months was considered. Good radiographic (GRO) and functional outcome (GFO) were defined as no worsening (ie, change in modified total Sharp score (ΔmTSS) ≤0.5 units and ≤0.0 Health Assessment Questionnaire-Disability Index points, respectively, during the second year). The pooled probabilities of GRO and GFO for the different definitions of remission were estimated and compared. RESULTS Individual patient data (n=5792) from 11 trials were analysed. 4V-remission was achieved by 23% of patients and 4V-near-remission by 19%. The probability of GRO in the 4V-near-remission group was numerically, but non-significantly, lower than that in the 4V-remission (78 vs 81%) and significantly higher than that for non-remission (72%; difference=6%, 95% CI 2% to 10%). Applying 3V-remission could have prevented therapy escalation in 19% of all participants, at the cost of an additional 6.1%, 4.0% and 0.7% of patients having ΔmTSS >0.0, >0.5 and >5 units over 2 years, respectively. The probability of GFO (assessed in 8 trials) in 4V-near-remission (67%, 95% CI 63% to 71%) was significantly lower than in 4V-remission (78%, 74% to 81%) and similar to non-remission (69%, 66% to 72%). CONCLUSION 4V-near-remission and 3V-remission have similar validity as the original 4V-remission definition in predicting GRO, despite expected worse prediction of GFO, while potentially reducing the risk of overtreatment. This supports further exploration of 3V-remission as the target for immunosuppressive therapy complemented by patient-oriented targets.
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Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Rheumatology, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Mwidimi Ndosi
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North west UniversityHealthcare NHS Trust, London, UK
| | | | - Jose A P Da Silva
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal .,Clínica Universitária de Reumatologia, and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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9
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Ramírez J, Inciarte-Mundo J, Cuervo A, Celis R, Ruiz-Esquide V, Castellanos-Moreira R, Ponce A, Gómez-Puerta JA, Sanmartí R, Cañete JD. Comparable long-term outcomes between DAS28-ESR remission criteria and ACR/EULAR definitions in patients with established rheumatoid arthritis. Clin Rheumatol 2021; 40:2665-2672. [PMID: 33506371 DOI: 10.1007/s10067-021-05603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/15/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare long-term clinical, immunological, and radiographic outcomes between five sets of remission criteria (four clinical and one ultrasound (US)-based) in a cohort of RA patients in a clinical care setting. METHODS RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were made, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. Five concepts were used to define remission: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and Power Doppler score (PD)=0. RESULTS Eighty-seven patients with DAS28-ESR<2.6 were included. One-third fulfilled SDAI (33.3%), CDAI (31%), and Boolean (35.6%) remission criteria, and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly-lower mSHS erosion progression (p=0.014) at 5 years. CONCLUSIONS Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes in SDAI, CDAI, and Boolean definitions in a clinical care setting. US remission remained the closest to structural damage abrogation. Key Points • This study provides real world data on long-term outcomes of five clinical and imaging remission criteria in rheumatoid arthritis. • DAS28-ESR remission criteria had comparable radiographic progression and clinical prognosis than more stringent criteria in clinical practice. • US-based remission was closest to structural damage abolishment.
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Affiliation(s)
- Julio Ramírez
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain.
| | - José Inciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Andrea Cuervo
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Raquel Celis
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Raul Castellanos-Moreira
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Andrés Ponce
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - José A Gómez-Puerta
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Raimon Sanmartí
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Juan D Cañete
- Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
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10
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Leu Agelii M, Andersson M, Jones BL, Sjöwall C, Kastbom A, Hafström I, Forslind K, Gjertsson I. Disease activity trajectories in rheumatoid arthritis: a tool for prediction of outcome. Scand J Rheumatol 2020; 50:1-10. [PMID: 32856510 DOI: 10.1080/03009742.2020.1774646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Predicting treatment response and disease progression in rheumatoid arthritis (RA) remains an elusive endeavour. Identifying subgroups of patients with similar progression is essential for understanding what hinders improvement. However, this cannot be achieved with response criteria based on current versus previous Disease Activity Scores, as they lack the time component. We propose a longitudinal approach that identifies subgroups of patients while capturing their evolution across several clinical outcomes simultaneously (multi-trajectories). Method: For exploration, the RA cohort BARFOT (n = 2829) was used to identify 24 month post-diagnosis simultaneous trajectories of 28-joint Disease Activity Score and its components. Measurements were available at inclusion (0), 3, 6, 12, 24, and 60 months. Multi-trajectories were found with latent class growth modelling. For validation, the TIRA-2 cohort (n = 504) was used. Radiographic changes, assessed by the modified Sharp van der Heijde score, were correlated with trajectory membership. Results: Three multi-trajectories were identified, with 39.6% of the patients in the lowest and 18.9% in the highest (worst) trajectory. Patients in the worst trajectory had on average eight tender and six swollen joints after 24 months. Radiographic changes at 24 and 60 months were significantly increased from the lowest to the highest trajectory. Conclusion: Multi-trajectories constitute a powerful tool for identifying subgroups of RA patients and could be used in future studies searching for predictive biomarkers for disease progression. The evolution and shape of the trajectories in TIRA-2 were very similar to those in BARFOT, even though TIRA-2 is a newer cohort.
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Affiliation(s)
- M Leu Agelii
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden
| | - Mle Andersson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University , Lund, Sweden.,Spenshult Research and Development Center , Halmstad, Sweden
| | - B L Jones
- Department of Psychiatry, University of Pittsburgh Medical Center , Pittsburgh, PA, USA
| | - C Sjöwall
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University , Linköping, Sweden
| | - A Kastbom
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University , Linköping, Sweden
| | - I Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Karolinska University Hospital , Stockholm, Sweden
| | - K Forslind
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University , Lund, Sweden.,Department of Research and Education, Skånevård Sund, Region Skåne, Helsingborg´s Hospital , Helsingborg, Sweden
| | - I Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden
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11
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Ferreira RJO, Carvalho PD, Ndosi M, Duarte C, Chopra A, Murphy E, van der Heijde D, Machado PM, da Silva JAP. Impact of Patient's Global Assessment on Achieving Remission in Patients With Rheumatoid Arthritis: A Multinational Study Using the METEOR Database. Arthritis Care Res (Hoboken) 2020; 71:1317-1325. [PMID: 30821895 DOI: 10.1002/acr.23866] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There is an ongoing debate about excluding patient's global assessment (PtGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at determining the influence of PtGA on RA disease states, exploring differences across countries, and understanding the association between PtGA, measures of disease impact (symptoms), and markers of disease activity (inflammation). METHODS Cross-sectional data from the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology international database were used. We calculated the proportion of patients failing American College of Rheumatology/European League Against Rheumatism Boolean-based remission (4-variable remission) solely due to PtGA (PtGA-near-remission) in the overall sample and in the most representative countries (i.e., those with >3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of PtGA, grouped in predominantly inflammatory impact factors (28 tender joint counts, 28 swollen joint counts, and C-reactive protein level) and disease impact factors (pain and function). RESULTS This study included 27,768 patients. Excluding PtGA from the Boolean-based definition (3-variable remission) increased the remission rate from 5.8% to 15.8%. The rate of PtGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One-third of the patients in PtGA-near-remission group scored PtGA >4 of 10. Pain and function were the main correlates of PtGA, with inflammation-related variables contributing less to the model (R2 = 0.57). CONCLUSION PtGA is moderately related to joint inflammation overall, but only weakly so in low levels of disease activity. A considerable proportion of patients otherwise in biologic remission still perceive high PtGA, putting them at risk of excessive immunosuppressive treatment.
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Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra, and Nursing School of Coimbra, Coimbra, Portugal
| | | | - Mwidimi Ndosi
- University of the West of England and University Hospitals Bristol, Bristol, UK
| | - Cátia Duarte
- Centro Hospitalar e Universitário de Coimbra, Coimbra Institute for Clinical and Biomedical Research, and University of Coimbra, Coimbra, Portugal
| | | | | | | | - Pedro M Machado
- University College London, Northwick Park Hospital, and London North West University Healthcare NHS Trust, London, UK
| | - José A P da Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra Institute for Clinical and Biomedical Research, and University of Coimbra, Coimbra, Portugal
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12
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Baker KF, Skelton AJ, Lendrem DW, Scadeng A, Thompson B, Pratt AG, Isaacs JD. Predicting drug-free remission in rheumatoid arthritis: A prospective interventional cohort study. J Autoimmun 2019; 105:102298. [PMID: 31280933 PMCID: PMC6891251 DOI: 10.1016/j.jaut.2019.06.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many patients with rheumatoid arthritis (RA) achieve disease remission with modern treatment strategies. However, having achieved this state, there are no tests that predict when withdrawal of therapy will result in drug-free remission rather than flare. We aimed to identify predictors of drug-free remission in RA. METHODS The Biomarkers of Remission in Rheumatoid Arthritis (BioRRA) Study was a unique, prospective, interventional cohort study of complete and abrupt cessation of conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs). Patients with RA of at least 12 months duration and in clinical and ultrasound remission discontinued DMARDs and were monitored for six months. The primary outcome was time-to-flare, defined as disease activity score in 28 joints with C-reactive protein (DAS28-CRP) ≥ 2.4. Baseline clinical and ultrasound measures, circulating inflammatory biomarkers, and peripheral CD4+ T cell gene expression were assessed for their ability to predict time-to-flare and flare/remission status by Cox regression and receiver-operating characteristic (ROC) analysis respectively. RESULTS 23/44 (52%) eligible patients experienced an arthritis flare after a median (IQR) of 48 (31.5-86.5) days following DMARD cessation. A composite score incorporating five baseline variables (three transcripts [FAM102B, ENSG00000228010, ENSG00000227070], one cytokine [interleukin-27], one clinical [Boolean remission]) differentiated future flare from drug-free remission with an area under the ROC curve of 0.96 (95% CI 0.91-1.00), sensitivity 0.91 (0.78-1.00) and specificity 0.95 (0.84-1.00). CONCLUSION We provide proof-of-concept evidence for predictors of drug-free remission in RA. If validated, these biomarkers could help to personalize immunosuppressant withdrawal: a therapy paradigm shift with ensuing patient and economic benefits.
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Affiliation(s)
- Kenneth F Baker
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew J Skelton
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Bioinformatics Support Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dennis W Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adam Scadeng
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ben Thompson
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Arthur G Pratt
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John D Isaacs
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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13
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Einarsson JT, Willim M, Ernestam S, Saxne T, Geborek P, Kapetanovic MC. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a Nationwide Study in Sweden. Rheumatology (Oxford) 2019. [PMID: 29538755 DOI: 10.1093/rheumatology/key054] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives The aims of this national study in Sweden of patients with RA were to: examine the prevalence of sustained remission (SR), that is, remission lasting for at least 6 months; compare the prevalence of SR in patients with early RA and established RA; study the timing of onset of and time spent in SR; and study possible predictors of SR. Methods Adult patients with RA included in the Swedish Rheumatology Quality registry were studied. The registry was searched for patients fulfilling remission criteria: DAS28-ESR, Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and ACR/EULAR remission for at least 6 months. Early RA was defined as symptom duration ⩽6 months at inclusion in the Swedish Rheumatology Quality. Results Of 29 084 patients, 12 193 (41.9%) reached DAS28 SR at some time point during follow-up compared with 6445 (22.2%), 6199 (21.3%) and 5087 (17.5%) for CDAI, SDAI and ACR/EULAR SR, respectively. SR was more common in early RA (P < 0.001). The median time from symptom onset to SR was 1.9, 2.4, 2.4 and 2.5 years according to DAS28, CDAI, SDAI and ACR/EULAR criteria, respectively. Lower age, male sex and milder disease characteristics were associated with SR. Conclusion The majority of patients in this nationwide study never reached SR. Patients with early RA are more likely to reach SR than patients with established RA.
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Affiliation(s)
- Jon T Einarsson
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Minna Willim
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Sofia Ernestam
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Centre of Rheumatology, Stockholm County Council, Stockholm, Sweden
| | - Tore Saxne
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Pierre Geborek
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
| | - Meliha C Kapetanovic
- Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Skåne University Hospital, Lund, Sweden
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14
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Einarsson JT, Willim M, Saxne T, Geborek P, Kapetanovic MC. Secular trends of sustained remission in rheumatoid arthritis, a nationwide study in Sweden. Rheumatology (Oxford) 2019; 59:205-212. [DOI: 10.1093/rheumatology/kez273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/03/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The aim of this study of patients with RA in Sweden was to investigate secular trends in achieving sustained remission (SR), i.e. DAS28 <2.6 on at least two consecutive occasions and lasting for at least 6 months.
Methods
All adult RA patients registered in the Swedish Rheumatology Quality register through 2012, with at least three registered visits were eligible, a total of 29 084 patients. Year of symptom onset ranged from 1955, but for parts of the analysis only patients with symptom onset between 1994 and 2009 were studied. In total, 95% of patients fulfilled the ACR 1987 classification criteria for RA. Odds of reaching SR for each decade compared with the one before were calculated with logistic regression and individual years of symptom onset were compared with life table analysis.
Results
Of patients with symptom onset in the 1980s, 1990s and 2000s, 35.0, 43.0 and 45.6% reached SR, respectively (P < 0.001 for each increment), and the odds of SR were higher in every decade compared with the one before. The hazard ratio for reaching SR was 1.15 (95% CI 1.14, 1.15) for each year from 1994 to 2009 compared with the year before. Five years after symptom onset in 2009, 45.3% of patients had reached SR compared with 15.9% in 1999.
Conclusion
There is a clear secular trend towards increased incidence of SR in patients with RA in Sweden. This trend most likely reflects earlier diagnosis and treatment start, and adherence to national and international guidelines recommending the treat to target approach.
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Affiliation(s)
- Jon T Einarsson
- Department of Clinical Sciences, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Minna Willim
- Department of Clinical Sciences, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Tore Saxne
- Department of Clinical Sciences, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pierre Geborek
- Department of Clinical Sciences, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Meliha C Kapetanovic
- Department of Clinical Sciences, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
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15
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Xie W, Li J, Zhang X, Sun X, Zhang Z. Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018. Int J Rheum Dis 2019; 22:1670-1678. [PMID: 31297977 DOI: 10.1111/1756-185x.13651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/21/2019] [Accepted: 06/13/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - Ji Li
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - Xiaohui Zhang
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - Xiaoying Sun
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
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16
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Carvalho PD, Ferreira RJ, Landewé R, Vega-Morales D, Salomon-Escoto K, Veale DJ, Chopra A, da Silva JA, Machado PM. Association of 17 Definitions of Remission with Functional Status in a Large Clinical Practice Cohort of Patients with Rheumatoid Arthritis. J Rheumatol 2019; 47:20-27. [DOI: 10.3899/jrheum.181286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 12/30/2022]
Abstract
Objective.To compare the association between different remission criteria and physical function in patients with rheumatoid arthritis followed in clinical practice.Methods.Longitudinal data from the METEOR database were used. Seventeen definitions of remission were tested: American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based; Simplified/Clinical Disease Activity Index (SDAI/CDAI); and 14 Disease Activity Score (DAS)-based definitions. Health Assessment Questionnaire (HAQ) ≤ 0.5 was defined as good functional status. Associations were investigated using generalized estimating equations. Potential confounders were tested and sensitivity analyses performed.Results.Data from 32,915 patients (157,899 visits) were available. The most stringent definition of remission was the ACR/EULAR Boolean-based definition (1.9%). The proportion of patients with HAQ ≤ 0.5 was higher for the most stringent definitions, although it never reached 100%. However, this also meant that, for the most stringent criteria, many patients in nonremission had HAQ ≤ 0.5. All remission definitions were associated with better function, with the strongest degree of association observed for the SDAI (adjusted OR 3.36, 95% CI 3.01–3.74).Conclusion.The 17 definitions of remission confirmed their validity against physical function in a large international clinical practice setting. Achievement of remission according to any of the indices may be more important than the use of a specific index. A multidimensional approach, targeted at wider goals than disease control, is necessary to help all patients achieve the best possible functional status.
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17
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Forslind K, Eberhardt K, Svensson B. Repair of Erosions in Patients with Rheumatoid Arthritis. J Rheumatol 2019; 46:670-675. [DOI: 10.3899/jrheum.180557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 02/01/2023]
Abstract
Objective.The aim of this study was to examine the occurrence of repair in a cohort of conventionally treated patients with early rheumatoid arthritis over 8 years.Methods.There were 395 patients included in the BARFOT study having radiographs of hands and feet at inclusion, and at 1, 2, 5, and 8 years, which were chronologically scored for erosions by the Sharp/van der Heijde method. An erosion with repair was defined as an erosion that has become partially or totally filled, with or without sclerosis.Results.Erosions with repair were observed in 64 patients (16%) at 1 year, 113 (29%) at 2 years, 142 (36%) at 5 years, and 200 (51%) at 8 years. At the 1-year visit, 13% of the patients with at least 1 new erosion showed repair versus 3% of the patients with no new erosions (p = 0.001). At 2, 5, and 8 years the corresponding figures were 22% and 6%, 28% and 8%, and 39% and 11%, respectively (all p = 0.001). The sum of all repaired erosions correlated strongly with the sum of all erosions and with the sum of all erosion scores (ρ = 0.79 and 0.77). Presence of rheumatoid factor (RF) and anticyclic citrullinated peptide antibodies (anti-CCP) was significantly associated with both new erosions and repair.Conclusion.Repair was more common than previously described. The frequency of repair increased over time and was associated with the number of erosions. RF- and anti-CCP–positivity, patient age, and presence of erosions at baseline were independent predictors of repair.
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18
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Hafström I, Ajeganova S, Andersson MLE, Bala SV, Bergman S, Bremander A, Forslind K, Malm K, Svensson B. A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis - results of clinical relevance. Open Access Rheumatol 2019; 11:207-217. [PMID: 31565006 PMCID: PMC6744369 DOI: 10.2147/oarrr.s218448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care. PATIENTS AND METHODS BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992-2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality. RESULTS In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and co-morbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed. CONCLUSION A register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.
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Affiliation(s)
- Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Correspondence: Ingiäld HafströmRheumatology Unit, R92, Karolinska University Hospital, 141 86Stockholm, SwedenTel +46 73 699 6235Email
| | - Sofia Ajeganova
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria LE Andersson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
| | - Sidona-Valentina Bala
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Medicine, Section of Rheumatology, Helsingborg’s Hospital, Helsingborg, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Bremander
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kristina Forslind
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Research and Education, Skånevård Sund, Region Skåne, Helsingborg´s Hospital, Helsingborg, Sweden
| | - Karina Malm
- Spenshult Research and Development Center, Halmstad, Sweden
- Rheumatology, Capio Movement, Halmstad, Sweden
| | - Björn Svensson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
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19
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Yu C, Jin S, Wang Y, Jiang N, Wu C, Wang Q, Tian X, Li M, Zeng X. Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis. Clin Rheumatol 2018; 38:727-738. [PMID: 30341703 DOI: 10.1007/s10067-018-4340-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 01/14/2023]
Abstract
This systematic review and meta-analysis aim to evaluate the remission rate of patients with rheumatoid arthritis (RA) in real-world studies and to summarize potential predictors of remission in RA. Studies reporting remission rate in patients with RA were searched from MEDLINE, EMBASE, and Scopus databases. Two reviewers independently assessed all studies according to eligibility criteria and extracted data. Generally, observational studies reporting remission rate in adult (≥ 18 years) patients with RA were included. Quality assessments were performed using the Newcastle-Ottawa Scale. Pooled analyses of remission rate were conducted using a random-effects model and data were analyzed in subgroups to identify potential source of heterogeneity. Sensitivity analyses were performed by serially excluding each study. Potential predictors of remission were summarized. Thirty-one studies with ~ 82,450 RA patients in total were included. Using the DAS28 remission criteria, the pooled 3-, 6-, 12-, and 24-month remission rates were 17.2%, 16.3%, 21.5%, and 23.5%, respectively. Subgroup analyses showed that 11.7% and 13.8% of TNFi inadequate responders reached remission after 6- and 12-month use of non-TNFi biologics. Predictors of remission included male, higher education level, and lower baseline disease activity, while initial use of corticosteroids was negative predictors of remission. Sustained remission was rare regardless of different criteria used. Remission was a reachable target in real-world studies, while attention should also be paid to achieve sustained remission.
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Affiliation(s)
- Chen Yu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Shangyi Jin
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Nan Jiang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China. .,Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China. .,Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China.
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Jacobs BM, Giovannoni G, Schmierer K. No Evident Disease Activity—More Than a Risky Ambition? JAMA Neurol 2018; 75:781-782. [DOI: 10.1001/jamaneurol.2018.0829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin Meir Jacobs
- BartsMS, The Blizard Institute (Neuroscience), Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Gavin Giovannoni
- BartsMS, The Blizard Institute (Neuroscience), Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Klaus Schmierer
- BartsMS, The Blizard Institute (Neuroscience), Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
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Bugatti S, Sakellariou G, Luvaro T, Greco MI, Manzo A. Clinical, Imaging, and Pathological Suppression of Synovitis in Rheumatoid Arthritis: Is the Disease Curable? Front Med (Lausanne) 2018; 5:140. [PMID: 29868592 PMCID: PMC5962817 DOI: 10.3389/fmed.2018.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 12/18/2022] Open
Abstract
The management of patients with rheumatoid arthritis (RA) has witnessed a dramatic revolution in recent years, and disease remission has become an increasingly achievable outcome. Rheumatologists are now facing the urgent question of whether, once remission has been achieved and stably maintained, drugs can be tapered, and even discontinued. The concept of disease remission however encompasses progressive layers of complexity, all of which need to be disentangled before considering RA as a “curable” condition. As the synovial membrane represents the ultimate target of the pathological process of RA, a critical issue remains whether disease remission coincides with true suppression of inflammation and definitive tissue “healing.” In this short review, we will provide a critical summary of recent studies investigating the possibility of controlling RA synovitis at the clinical, imaging or pathological level. Potential advantages and limitations of these perspectives in the definition of remission are also discussed.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Terenzj Luvaro
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Maria Immacolata Greco
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Antonio Manzo
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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22
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Van den Bosch F, Mease PJ, Sieper J, Baeten DL, Xia Y, Chen S, Pangan AL, Song IH. Long-term efficacy and predictors of remission following adalimumab treatment in peripheral spondyloarthritis: 3-year results from ABILITY-2. RMD Open 2018. [PMID: 29531780 PMCID: PMC5845429 DOI: 10.1136/rmdopen-2017-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objectives Describe efficacy and safety of 3 years of adalimumab treatment in patients with peripheral spondyloarthritis (pSpA) and identify predictors of remission. Methods Patients with pSpA were randomised to adalimumab 40 mg every other week or placebo for 12 weeks; a 144-week open-label extension followed (NCT01064856). Remission was assessed by the Peripheral SpA Response Criteria (PSpARC) and Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID). Logistic regression analyses were performed to determine predictors of remission at 1 and 3 years and sustained remission (≥24 consecutive weeks). Results In 165 patients, ASDAS ID was achieved by 47% at 1 year and 39% at 3 years; 36% and 33% achieved PSpARC remission, respectively. Sustained ASDAS ID and PSpARC remission were achieved by 52% (86/165) and 42% (70/165) of patients, respectively. Achieving ASDAS ID at week 12 significantly predicted 1 year (OR, 8.64 (95% CI 2.97 to 25.14)), 3 year (OR, 36.12 (95% CI 2.29 to 569.08)) and sustained ASDAS ID (OR, 8.01 (95% CI 2.47 to 25.97)); achieving PSpARC remission at week 12 consistently predicted 1 year (OR, 6.47 (95% CI 1.91 to 21.95)), 3 years (OR, 15.66 (95% CI 4.19 to 58.56)) and sustained PSpARC remission (OR, 20.27 (95% CI 5.37 to 76.46)). No baseline variables consistently predicted 1-year or 3-year remission or sustained remission. The safety profile of adalimumab was consistent with observations in other SpA disease indications. Conclusions In patients with pSpA, early response to adalimumab, but not baseline demographics or disease characteristics, was a better predictor of long-term remission.
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Affiliation(s)
| | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology, and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominique L Baeten
- Department of Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Yinglin Xia
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Su Chen
- Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois, USA
| | - Aileen L Pangan
- Immunology Clinical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - In-Ho Song
- Immunology Clinical Development, AbbVie Inc., North Chicago, Illinois, USA
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Ferreira RJO, Duarte C, Ndosi M, de Wit M, Gossec L, da Silva JAP. Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice-Based Call for a Paradigm Change. Arthritis Care Res (Hoboken) 2018; 70:369-378. [PMID: 28544615 DOI: 10.1002/acr.23284] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS This was a cross-sectional, single-center study including consecutive ambulatory RA patients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
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Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Cátia Duarte
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
| | | | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, and VU University Medical Centre, Amsterdam, The Netherlands
| | - Laure Gossec
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - J A P da Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
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24
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Ramírez J, Narváez JA, Ruiz-Esquide V, Hernández-Gañán J, Cuervo A, Inciarte-Mundo J, Hernández MV, Sampayo-Cordero M, Pablos JL, Sanmartí R, Cañete JD. Clinical and sonographic biomarkers of structural damage progression in RA patients in clinical remission: A prospective study with 12 months follow-up. Semin Arthritis Rheum 2017; 47:303-309. [DOI: 10.1016/j.semarthrit.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/12/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022]
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25
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Ferreira RJO, Dougados M, Kirwan JR, Duarte C, de Wit M, Soubrier M, Fautrel B, Kvien TK, da Silva JAP, Gossec L. Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients. Rheumatology (Oxford) 2017; 56:1573-1578. [PMID: 28859325 DOI: 10.1093/rheumatology/kex211] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. Methods We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ⩽1), near-remission (tender and swollen joint counts, and CRP are all ≤1 but PGA >1) and non-remission. Physical and psychological domains were assessed using the RA Impact of Disease 0-10 (numeric rating scale) as explanatory factors of PGA. Univariable and multivariable linear regression analyses were performed to explain PGA. Results A total of 1588 patients (79.1% females) were analysed. The mean disease duration was 13.0 years (s.d. 9.8) and the 28-joint DAS with four variables was 3.2 (s.d. 1.4). Near-remission [mean PGA 3.6 (s.d. 1.9)] was more frequent (19.1%) than remission (12.3%). Scores of RA Impact of Disease domains were similar in near-remission and non-remission patients. In near-remission, PGA was explained (R2adjusted = 0.55) by pain (β = 0.29), function (β = 0.23), physical well-being (β = 0.19) and fatigue (β = 0.15). Conclusion Near-remission was more frequent than remission. These patients, despite having no signs of significant inflammation, report an impact of disease similar to the non-remission patients. PGA in near-remission seems to be driven by physical rather than psychological domains. Selecting the best therapy for these patients requires a better understanding of the meaning of PGA, both globally and in individual patients.
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Affiliation(s)
- Ricardo J O Ferreira
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Maxime Dougados
- Faculty of Medicine, Paris Descartes University.,Department of Rheumatology, AP-HP, Hôpital Cochin.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - John R Kirwan
- Academic Rheumatology Unit, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Cátia Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Clínica Universitária de Reumatologia, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maarten de Wit
- Patient Research Partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland.,Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martin Soubrier
- Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand
| | - Bruno Fautrel
- Faculty of Medicine, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS).,Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris.,CRI IMIDIATE, French Clinical Research Infrastructure Network, Toulouse, France
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - José A P da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Clínica Universitária de Reumatologia, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Laure Gossec
- Faculty of Medicine, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS).,Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris
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26
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Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis 2017; 9:249-262. [PMID: 28974987 PMCID: PMC5613855 DOI: 10.1177/1759720x17720366] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022] Open
Abstract
Sustained remission is an ultimate treatment goal in the management of patients with rheumatoid arthritis (RA). Historically the frequency of sustained remission was low but the frequency of achieved sustained remission is increasing over time. The last years’ clinical studies of tight control targeted treatment and intervention trials of early use of intensive strategy suggest that these treatment strategies are associated with higher rates of sustained remission. Achievement of sustained remission, in particular but not limited to early sustained remission, can provide tapering and stopping disease-modifying antirheumatic drugs (DMARDs). With new treatment strategies drug-free sustained remission is becoming an achievable goal. Sustained remission is associated with improved outcomes in regard to function, patient-reported outcomes and survival. Drug-free sustained remission is characterized by normalized function ability and survival. Sustained remission and, in particular, drug-free sustained remission offer hope that early identification of patients with arthritis, early improved novel treatments and treatment with target to achieve remission may potentially transform the progressive course of RA disease and disrupt RA chronicity. In this review we summarize the recent evidence on sustained remission in patients with RA, treatment strategies to achieve sustained remission, management of patients in sustained remission and significance of sustained remission from the patient perspective.
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Affiliation(s)
- Sofia Ajeganova
- Leids Universitair Medisch Centrum, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Tom Huizinga
- Leiden University Medical Center, Leiden, The Netherlands
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27
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Konijn NPC, van Tuyl LHD, Boers M, den Uyl D, ter Wee MM, Kerstens P, Voskuyl AE, van Schaardenburg D, Nurmohamed MT, Lems WF. Do Short and Sustained Periods of American College of Rheumatology/European League Against Rheumatism Remission Predict Functional and Radiographic Outcome in Early Rheumatoid Arthritis Patients With Low Overall Damage Progression? Arthritis Care Res (Hoboken) 2017; 69:989-996. [DOI: 10.1002/acr.23112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/15/2016] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Nicole P. C. Konijn
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Lilian H. D. van Tuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Debby den Uyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Marieke M. ter Wee
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Pit Kerstens
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, and Westfriesgasthuis; Hoorn The Netherlands
| | - Alexandre E. Voskuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Amsterdam The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, and Academic Medical Center; Amsterdam The Netherlands
| | - Michael T. Nurmohamed
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center and Reade; Amsterdam The Netherlands
| | - Willem F. Lems
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center and Reade; Amsterdam The Netherlands
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Hirano F, Yokoyama W, Yamazaki H, Amano K, Kawakami A, Hayashi T, Tamura N, Yasuda S, Dobashi H, Fujii T, Ito S, Kaneko Y, Matsui T, Okuda Y, Saito K, Suzuki F, Yoshimi R, Sakai R, Koike R, Kohsaka H, Miyasaka N, Harigai M. Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy. Mod Rheumatol 2016; 27:811-819. [DOI: 10.1080/14397595.2016.1265726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fumio Hirano
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Waka Yokoyama
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Hayato Yamazaki
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Atsushi Kawakami
- Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taichi Hayashi
- Department of Rheumatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Bunkyō, Japan
| | - Shinsuke Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan,
| | - Takao Fujii
- Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Minato, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan
| | - Yasuaki Okuda
- Department of Internal Medicine, Center for Rheumatic Diseases, Dohgo Spa Hospital, Matsuyama, Japan
| | - Kazuyoshi Saito
- The First Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Fumihito Suzuki
- Department of Rheumatology, Soka Municipal Hospital, Saitama, Japan
| | - Ryusuke Yoshimi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ryoko Sakai
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Ryuji Koike
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Nobuyuki Miyasaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
| | - Masayoshi Harigai
- Department of Pharmacovigilance
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyō, Japan
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Svensson B, Andersson M, Forslind K, Ajeganova S, Hafström I. Persistently active disease is common in patients with rheumatoid arthritis, particularly in women: a long-term inception cohort study. Scand J Rheumatol 2016; 45:448-455. [PMID: 27095008 DOI: 10.3109/03009742.2016.1147595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite improved treatment strategies for rheumatoid arthritis (RA), some patients do not respond satisfactorily. The aim of this study was to investigate the course and outcome of early RA diagnosed during the 1990s and followed for 8 years with a focus on those who did not respond well to treatment. METHOD This study included 640 patients (66% women) who were enrolled in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) RA inception cohort between the years 1993 and 1999. The 28-joint count Disease Activity Score (DAS28) < 2.6 criteria were used to assess remission. Persistent disease (PD) was defined as absence of remission at all predefined follow-up visits at 1, 2, 5, and 8 years. Function was assessed by Health Assessment Questionnaire (HAQ) and Signals of Functional Impairment (SOFI) scores and radiological joint damage by the Sharp/van der Heijde score (SHS). RESULTS Of the 640 patients, 214 (37%) had PD (43% of the women and 25% of the men). Over the 8 years of follow-up, patients with PD had significantly worse mean values for patient's global health measured on a visual analogue scale (VAS patGH), VAS pain, HAQ, SOFI, and SHS compared with those in the non-PD group. Multivariate logistic regression analyses revealed that female gender, current smoking, disease activity at baseline, and absence of remission at 6 months independently predicted PD. CONCLUSIONS Of the patients who entered the early RA inception cohort, 37% suffered a PD course over 8 years. The consequences of PD with regard to general health, pain, function, and joint damage were considerable. Of note, PD was more common in women than in men.
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Affiliation(s)
- B Svensson
- a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden
| | - Mle Andersson
- a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden.,b Spenshult Research and Development Centre , Halmstad , Sweden
| | - K Forslind
- a Department of Clinical Sciences , Section of Rheumatology, Lund University , Lund , Sweden.,c Section of Rheumatology, Department of Medicine , Helsingborgs Lasarett , Helsingborg , Sweden
| | - S Ajeganova
- d Department of Rheumatology , Karolinska Institutet at Karolinska University Hospital , Huddinge , Sweden
| | - I Hafström
- d Department of Rheumatology , Karolinska Institutet at Karolinska University Hospital , Huddinge , Sweden
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Katayama K, Okubo T, Sato T, Kamiya K, Fukai R, Abe S, Ito H, Makino Y, Kamishima T. One-year maintenance with routine assessment of patient index data 3-based remission may inhibit radiographic progression in patients with rheumatoid arthritis treated with routine clinical therapy: A retrospective comparison of radiographic outcome and its prognostic factors between maintained remissions with patient-reported outcome index and physician-oriented disease activity indices. Mod Rheumatol 2016; 26:817-827. [PMID: 26915909 DOI: 10.3109/14397595.2016.1158766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We investigated whether the maintenance of routine assessment of patient index data 3 (RAPID3) remission for one year (RAPID3-MR) may predict good radiographic outcomes. We also compared radiographic progression to prognostic factors among patients with RAPID3-MR, with the maintenance of clinical disease activity index remission for one year (CDAI-MR) or with the maintenance of 28 joint count disease activity score remission for one year (DAS28-MR). METHODS Of 1220 patients with available clinical data, 92 with RAPID3-MR, 80 with RAPID3-NMR (not satisfying RAPID3-MR), 45 with CDAI-MR, and 75 with DAS28-MR were retrospectively investigated. CDAI and DAS28 for clinical outcomes and the modified total Sharp score (mTSS) for radiographic joint damage were investigated for at least one year. RESULTS RAPID3, CDAI, DAS28, and their categories remained unchanged or significantly improved in RAPID3-MR patients but significantly deteriorated in RAPID3-NMR patients. The mean annual ΔmTSS was significantly lower in RAPID3-MR patients (0.12 ± 0.55) than in RAPID3-NMR patients (0.54 ± 1.27) (p = 0.025). There was no significant difference among RAPID3-MR patients, CDAI-MR patients (0.06 ± 0.85), and DAS28-MR patients (0.11 ± 0.89). The baseline mTSS (p = 0.038) and monotherapy with nonbiological disease-modifying antirheumatic drugs (p = 0.033) were good prognostic factors in RAPID3-MR patients. CONCLUSIONS One-year RAPID3 remission maintenance may predict good radiographic outcomes.
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Affiliation(s)
- Kou Katayama
- a Katayama Orthopedic Rheumatology Clinic , Hokkaido , Japan
| | - Takanobu Okubo
- a Katayama Orthopedic Rheumatology Clinic , Hokkaido , Japan
| | - Toshikazu Sato
- a Katayama Orthopedic Rheumatology Clinic , Hokkaido , Japan
| | - Kiyomi Kamiya
- a Katayama Orthopedic Rheumatology Clinic , Hokkaido , Japan
| | | | - Satomi Abe
- c Department of Orthopedic Surgery , Asahikawa Medical University , Hokkaido , Japan
| | - Hiroshi Ito
- c Department of Orthopedic Surgery , Asahikawa Medical University , Hokkaido , Japan
| | - Yuichi Makino
- d Department of Medicine, Division of Metabolism and Biosystemic Science , Asahikawa Medical University , Hokkaido , Japan , and
| | - Tamotsu Kamishima
- e Faculty of Health Science , Hokkaido University , Hokkaido , Japan
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Rannio T, Asikainen J, Kokko A, Hannonen P, Sokka T. Early Remission Is a Realistic Target in a Majority of Patients with DMARD-naive Rheumatoid Arthritis. J Rheumatol 2016; 43:699-706. [DOI: 10.3899/jrheum.141480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 12/28/2022]
Abstract
Objective.We analyzed remission rates at 3 and 12 months in patients with rheumatoid arthritis (RA) who were naive for disease-modifying antirheumatic drugs (DMARD) and who were treated in a Finnish rheumatology clinic from 2008 to 2011. We compared remission rates and drug treatments between patients with RA and patients with undifferentiated arthritis (UA).Methods.Data from all DMARD-naive RA and UA patients from the healthcare district were collected using software that includes demographic and clinical characteristics, disease activity, medications, and patient-reported outcomes. Our rheumatology clinic applies the treat-to-target principle, electronic monitoring of patients, and multidisciplinary care.Results.Out of 409 patients, 406 had data for classification by the 2010 RA criteria of the American College of Rheumatology/European League Against Rheumatism. A total of 68% were female, and mean age (SD) was 58 (16) years. Respectively, 56%, 60%, and 68% were positive for anticyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), and RF/anti-CCP, and 19% had erosive disease. The median (interquartile range) duration of symptoms was 6 (4–12) months. A total of 310 were classified as RA and 96 as UA. The patients with UA were younger, had better functional status and lower disease activity, and were more often seronegative than the patients with RA. The 28-joint Disease Activity Score (3 variables) remission rates of RA and UA patients at 3 months were 67% and 58% (p = 0.13), and at 12 months, 71% and 79%, respectively (p = 0.16). Sustained remission was observed in 57%/56% of RA/UA patients. Patients with RA used more conventional synthetic DMARD combinations than did patients with UA. None used biological DMARD at 3 months, and only 2.7%/1.1% of the patients (RA/UA) used them at 12 months (p = 0.36).Conclusion.Remarkably high remission rates are achievable in real-world DMARD-naive patients with RA or UA.
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Kojima M, Kojima T, Suzuki S, Takahashi N, Funahashi K, Asai S, Yoshioka Y, Terabe K, Asai N, Takemoto T, Ishiguro N. Patient-reported outcomes as assessment tools and predictors of long-term prognosis: a 7-year follow-up study of patients with rheumatoid arthritis. Int J Rheum Dis 2015; 20:1193-1200. [DOI: 10.1111/1756-185x.12789] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Masayo Kojima
- Department of Public Health Nagoya City University Graduate School of Medical Science; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Sadao Suzuki
- Department of Public Health Nagoya City University Graduate School of Medical Science; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Yutaka Yoshioka
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Nobuyuki Asai
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Toki Takemoto
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery and Rheumatology; Nagoya University Hospital; Nagoya University School of Medicine; Nagoya Japan
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McBain H, Shipley M, Olaleye A, Moore S, Newman S. A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial. Ann Rheum Dis 2015; 75:1343-9. [PMID: 26290587 DOI: 10.1136/annrheumdis-2015-207768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/25/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the effectiveness of a patient-initiated disease-modifying antirheumatic drugs (DMARD) self-monitoring service for people with rheumatoid (RA) or psoriatic arthritis (PsA) on methotrexate. METHODS A two-arm, single-centre, randomised controlled trial assessing superiority in relation to healthcare use, clinical and psychosocial outcomes. Participants were 100 adults with either RA or PsA on a stable dose of methotrexate, randomly assigned to usual care or the patient-initiated service. Intervention participants were trained how to understand and interpret their blood tests and use this information to initiate care from their clinical nurse specialist (CNS). The primary outcome was the number of outpatient visits to the CNS during the trial period. Differences between groups were analysed using Poisson regression models. Secondary outcomes were collected at baseline and after the third and sixth blood tests. Disease activity was measured using either the Disease Activity Score in 28 joints or Psoriatic Arthritis Response Criteria (PsARC), pain and fatigue using a visual numeric scale and the Health Assessment Question-II, Hospital Anxiety and Depression Scale and SF12 were completed to assess disability, mood and quality of life, respectively. Differences between groups over time on secondary outcomes were analysed using multilevel models. RESULTS The patient-initiated DMARD self-monitoring service was associated with 54.55% fewer visits to the CNS (p<0.0001), 6.80% fewer visits to the rheumatologist (p=0.23) and 38.80% fewer visits to the general practitioner (p=0.07), compared with control participants. There was no association between trial arm and any of the clinical or psychosocial outcomes. CONCLUSIONS The results suggest that a patient-initiated service that incorporates patients' self-monitoring DMARD therapy can lead to significant reductions in healthcare use, while maintaining clinical and psychosocial well-being. TRIAL REGISTRATION NUMBER ISRCTN21613721.
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Affiliation(s)
- Hayley McBain
- School of Health Sciences, City University London, London, UK East London Foundation Trust, London, UK
| | - Michael Shipley
- Department of Rheumatology, University College London Hospital, London, UK
| | - Abigail Olaleye
- Department of Rheumatology, University College London Hospital, London, UK
| | - Samantha Moore
- Department of Rheumatology, University College London Hospital, London, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
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Jurgens MS, Jacobs JWG, Boers M, van der Goes MC, van der Veen MJ, Lafeber FPJG, Bijlsma JWJ. Alternative Ways to Quantify Sustained Remission: Applying the Continuity Rewarded Score and Patient Vector Graph. Arthritis Care Res (Hoboken) 2015; 67:1471-4. [PMID: 25708452 DOI: 10.1002/acr.22565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/22/2014] [Accepted: 02/03/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although the Computer Assisted Management in Early Rheumatoid Arthritis Trial-II (CAMERA-II) showed favorable clinical effects in the most intensive methotrexate (MTX)-based strategy with prednisone (MTX ± prednisone) compared to that with placebo (MTX + placebo), this beneficial difference was only seen in 1 of the 3 analyses of remission. Our objective was to investigate whether the Continuity Rewarded (ConRew) score and a simple sum score would better reveal differences regarding remission between the 2 treatment arms of CAMERA-II. Furthermore, we investigated whether the patient vector graph, which plots on patient level, would add visual information on remission compared to a conventional box plot only, which displays data on the group level. METHODS The ConRew method, which awards continuous periods of remission with a higher score, was applied, in addition to a simple sum score of remission periods of 4 weeks. A patient vector graph was compared with box plots. RESULTS Both the mean ± SD simple sum score and the ConRew score of remission were significantly higher (favorable) in the MTX + prednisone strategy group versus the MTX + placebo group, respectively: 9 ± 7 versus 12 ± 8; P = 0.003, and 23 ± 16 versus 17 ± 14; P = 0.004. The patient vector graphs show a visual pattern of more and longer periods of remission in the MTX + prednisone strategy and visually add information to the box plots. CONCLUSION The simple sum of remission periods, the ConRew score, and the patient vector graph add understanding and discrimination to the analysis of the remission outcome in CAMERA-II.
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Affiliation(s)
- Maud S Jurgens
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Maarten Boers
- VU University Medical Center, Amsterdam, The Netherlands
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Albrecht K, Callhoff J, Schneider M, Zink A. High variability in glucocorticoid starting doses in patients with rheumatoid arthritis: observational data from an early arthritis cohort. Rheumatol Int 2015; 35:1377-84. [DOI: 10.1007/s00296-015-3229-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/29/2015] [Indexed: 01/01/2023]
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Kuriya B, Xiong J, Boire G, Haraoui B, Hitchon C, Pope J, Thorne JC, Tin D, Keystone EC, Bykerk V. Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis--results from the Canadian Early Arthritis Cohort (CATCH). J Rheumatol 2014; 41:2161-6. [PMID: 25274902 DOI: 10.3899/jrheum.140137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence and predictive factors of sustained remission in an early rheumatoid arthritis (ERA) population. Predictive factors of sustained remission in ERA are unknown. We hypothesized that a short time to remission is an important predictor of sustained clinical remission. METHODS Patients in the Canadian Early Arthritis Cohort were included. Remission was defined by Boolean-based American College of Rheumatology/European League Against Rheumatism clinical trial and clinical practice definitions and Simplified Disease Activity Index (SDAI). Logistic regression analysis identified predictors of sustained remission and influence of time to remission. RESULTS Of 1840 patients, 633 (34%) achieved clinical trial remission, 759 (41%) clinical practice remission, and 727 (39%) SDAI remission. Over half of those meeting remission criteria achieved sustained remission based on clinical trial (55%), clinical practice (60%), and/or SDAI (58%). Corticosteroid use and lack of initial disease-modifying antirheumatic drug (DMARD) were associated with decreased probability of sustained remission, while initial combination DMARD increased this probability. Female sex, greater pain, and longer time to first remission made sustained remission less likely. CONCLUSION Female sex, greater pain, and lack of initial DMARD therapy reduced the probability of sustained remission. A shorter time to remission is related to sustainability and supports striving for early remission.
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Affiliation(s)
- Bindee Kuriya
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University.
| | - Juan Xiong
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Gilles Boire
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Boulos Haraoui
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Carol Hitchon
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Janet Pope
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - John Carter Thorne
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Diane Tin
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Edward C Keystone
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
| | - Vivian Bykerk
- From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University
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Kafaja S, Furst DE. Rheumatoid arthritis: are current research-based guidelines clinically relevant? J Rheumatol 2014; 41:1569-70. [PMID: 25086136 DOI: 10.3899/jrheum.140352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Daniel E Furst
- Carl M. Pearson Professor of Rheumatology, Director of Therapeutic Research, Department of Rheumatology, David Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave., Room 32-59, Los Angeles, California 90095-1670, USA.
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Barnabe C, Homik J, Barr SG, Martin L, Maksymowych WP. The effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy. J Rheumatol 2014; 41:1607-13. [PMID: 25028371 DOI: 10.3899/jrheum.131451] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Predictors of remission in rheumatoid arthritis (RA) have been defined in cross-sectional analyses using the 28-joint Disease Activity Score (DAS28), but not with newer composite disease activity measures or using the more clinically relevant state of sustained remission. We have evaluated predictors of remission using cross-sectional and longitudinal durations of disease state, and by applying additional definitions of remission [American College of Rheumatology/European League Against Rheumatism Boolean, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI)]. METHODS Individuals in the Alberta Biologics Pharmacosurveillance Program were classified for the presence of remission (point and/or sustained > 1 yr) by each of the 4 definitions. Multivariate models were constructed including all available variables in the dataset and refined to optimize model fit and predictive ability to calculate OR for remission. RESULTS Nonsmoking status independently predicted point remission by all definitions (OR range 1.20-2.71). Minority ethnicity decreased odds of remission by DAS28 (OR 0.13) and CDAI (OR 0.09) definitions. Male sex was associated with DAS28 remission (OR 2.85), whereas higher baseline physician global (OR 0.67) and erythrocyte sedimentation rate values (OR 0.98) decreased odds of DAS28 remission. Higher baseline patient global score (OR 0.77) and swollen joint counts (OR 0.93) were negative predictors for CDAI remission. Higher baseline Health Assessment Questionnaire (OR 0.62) reduced odds for remission by the SDAI definition, and educational attainment increased these odds (OR 2.13). Sustained remission was negatively predicted by baseline physician global for the DAS28 (OR 0.80), and higher tender joint count (OR 0.96) for the CDAI. CONCLUSION We demonstrate the influence of duration of remission state and remission definition on defining independent predictors for remission in RA requiring anti-tumor necrosis factor therapy. These predictors offer improved applicability for modern rheumatology practice.
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Affiliation(s)
- Cheryl Barnabe
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
| | - Joanne Homik
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Susan G Barr
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Liam Martin
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Walter P Maksymowych
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
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Ruyssen-Witrand A, Guernec G, Nigon D, Tobon G, Jamard B, Rat AC, Vittecoq O, Cantagrel A, Constantin A. Aiming for SDAI remission versus low disease activity at 1 year after inclusion in ESPOIR cohort is associated with better 3-year structural outcomes. Ann Rheum Dis 2014; 74:1676-83. [DOI: 10.1136/annrheumdis-2013-204906] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/06/2014] [Indexed: 11/03/2022]
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Hmamouchi I, Combe B, Fautrel B, Rincheval N, Lukas C. Prevalence and concordance of early and sustained remission assessed by various validated indices in the early arthritis "ESPOIR" cohort. Joint Bone Spine 2014; 81:409-15. [PMID: 24703402 DOI: 10.1016/j.jbspin.2014.02.007] [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: 11/18/2013] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the prevalence of remission in early arthritis, to evaluate the concordance across different criteria sets in defining this state, and to look for predictive factors for early and sustained remission. METHODS Patients from the ESPOIR cohort were followed-up every 6months. We analysed early remission and sustained remission in 3 groups of patients: patients having rheumatoid arthritis (RA) according to 2010 ACR/EULAR criteria, undifferentiated arthritis (UA), and the whole cohort. Remission was defined according to ACR/EULAR criteria, 28 Joint Disease Activity Score (DAS28<2.6), and Simplified Disease Activity Index (SDAI≤3.3). Agreement was evaluated by k-coefficient. Predictive factors for sustained remission at 1, 3 and 5year in RA patients were analyzed. RESULTS Eight hundred and nineteen patients were included. Early remission rates in the RA/UA/ESPOIR groups were observed in respectively 29.2% (181/682), 51.4% (55/123) and 32.7% (239/813) of patients by DAS28; 15.7%, 29.1% and 18% by SDAI; and 11.2%, 29.1% and 12.8% by ACR/EULAR criteria. Agreement between classifications of remission was low for DAS28 vs. ACR/EULAR (k=0.44), high for SDAI vs. ACR/EULAR (k=0.78), and moderate for SDAI vs. DAS28 (k=0.54). Lower baseline disease activity scores, non-menopausal status and younger age were the best predictive factors for sustained remission, with consistent results across the 3 definitions of remission. CONCLUSION Our study showed that the rate of early and sustained remission in early arthritis is dependent on the definition used, with a variable degree of agreement across criteria sets, but with consistent predictive factors of favourable outcome in patients finally diagnosed with RA.
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Affiliation(s)
- Ihsane Hmamouchi
- Department of Rheumatology, Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France; Mohammed V-Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology, Rabat, Morocco.
| | - Bernard Combe
- Department of Rheumatology, Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France
| | - Bruno Fautrel
- UFR de médecine, université-Pierre-et-Marie-Curie-Paris-VI, 75013 Paris, France
| | - Nathalie Rincheval
- Department of Rheumatology, Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France
| | - Cédric Lukas
- Department of Rheumatology, Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France
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