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Bugatti S, De Stefano L, Gandolfo S, Ciccia F, Montecucco C. Autoantibody-negative rheumatoid arthritis: still a challenge for the rheumatologist. THE LANCET. RHEUMATOLOGY 2023; 5:e743-e755. [PMID: 38251565 DOI: 10.1016/s2665-9913(23)00242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 01/23/2024]
Abstract
Increased research over the past 30 years has greatly improved the understanding of the pathophysiological mechanisms and clinical aspects of autoantibody-positive rheumatoid arthritis, resulting in improved management and outcomes. In contrast, the subset of rheumatoid arthritis that does not have autoantibodies (such as rheumatoid factor and anti-citrullinated protein autoantibodies) remains less well defined in its pathogenic mechanisms. Autoantibody-negative rheumatoid arthritis continues to pose diagnostic challenges, might respond differently to therapies, and appears to be burdened with different comorbidities and outcomes. The clear separation of rheumatoid arthritis according to serotypes is still a subject of uncertainty and controversy, and studies specifically focused on comparing rheumatoid arthritis and rheumatoid arthritis-like arthritides that do not have autoantibodies remain scarce. The purpose of this Review is to summarise the peculiarities that make autoantibody-negative rheumatoid arthritis different from its autoantibody-positive counterpart, with the aim of generating debate and stimulating further research on this challenging condition.
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Affiliation(s)
- Serena Bugatti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Ludovico De Stefano
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Saviana Gandolfo
- UOSD di Reumatologia, Ospedale San Giovanni Bosco, Naples, Italy
| | - Francesco Ciccia
- Dipartimento di Medicina di Precisione, Università della Campania L Vanvitelli, Naples, Italy
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Long-Term Efficacy of Tumor Necrosis Factor Inhibitors for the Treatment of Methotrexate-Naïve Rheumatoid Arthritis: Systematic Literature Review and Meta-Analysis. Adv Ther 2019; 36:721-745. [PMID: 30637590 DOI: 10.1007/s12325-018-0869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Synthesis of evidence on the long-term use of first-line biologic therapy in patients with early rheumatoid arthritis (RA) is required. We compared the efficacy of up to 5 years' treatment with first-line tumor necrosis factor inhibitors (TNFis) versus other treatment strategies in this population. METHODS Previous systematic reviews, PubMed and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) involving treatment of methotrexate-naïve RA patients with first-line TNFis. Literature was synthesized qualitatively, and a meta-analysis conducted to evaluate American College of Rheumatology (ACR) responses, clinical remission defined by any standard measure, and Health Assessment Questionnaire Disability Index (HAQ) at Years 2 and/or 5. RESULTS Ten RCTs involving 4306 patients [first-line TNFi, n = 2234; other treatment strategies (control), n = 2072] were included in the meta-analysis. Three studies were double-blind for the first 2 years, while seven were partly/completely open label during this period. Five studies reported data at Year 5; all were open label at this time point. At Year 2, ACR50 response, ACR70 response and remission rates were significantly improved with first-line TNFi versus control in double-blind RCTs [log-odds ratio (OR) 0.32 [95% confidence interval (CI) 0.02, 0.62; p = 0.035], log-OR 0.48 (95% CI 0.20, 0.77; p = 0.001), and log-OR 0.44 (95% CI 0.13, 0.74; p = 0.005), respectively], but not in open-label studies. No significant between-group differences were observed in mean HAQ at Year 2 in double-blind or open-label RCTs or in ACR response or remission outcomes at Year 5. CONCLUSION In double-blind studies, 2-year efficacy outcomes were significantly improved with first-line TNFi versus other treatment strategies in patients with MTX-naïve RA. No significant differences in these outcomes were observed when data from open-label RCTs were considered on their own. Further data on the efficacy of TNFi therapy over ≥ 2 years in patients with methotrexate-naïve RA are required. Plain language summary available for this article.
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Calvo Alén J, Pérez T, Romero Yuste S, Ferraz-Amaro I, Alegre Sancho JJ, Pinto Tasende JA, Maceiras Pan F, Quevedo JC, Hernández-Hernández MV, Hidalgo Calleja C, San Martín Álvarez A, Sánchez MIT, Sanmartí R. Efficacy and Safety of Combined Therapy With Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Systematic Literature Review. ACTA ACUST UNITED AC 2018; 16:324-332. [PMID: 30241955 DOI: 10.1016/j.reuma.2018.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.
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Affiliation(s)
- Jaime Calvo Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, España.
| | - Trinidad Pérez
- Servicio de Reumatología, Hospital de León, León, España
| | - Susana Romero Yuste
- Servicio de Reumatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - Iván Ferraz-Amaro
- Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España
| | | | | | | | - Juan Carlos Quevedo
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | | | | | - Alejandro San Martín Álvarez
- Sección Reumatología, Clínica HLA Vistahermosa, Alicante, España; Sección Reumatología, Hospital HLA, Denia, España
| | | | - Raimon Sanmartí
- Servicio de Reumatología, Hospital Universitari Clínic, Barcelona, España
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Jayashree S, Nirekshana K, Guha G, Bhakta-Guha D. Cancer chemotherapeutics in rheumatoid arthritis: A convoluted connection. Biomed Pharmacother 2018; 102:894-911. [PMID: 29710545 DOI: 10.1016/j.biopha.2018.03.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy is one of the most popular therapeutic strategies to treat cancer. However, cancer chemotherapeutics have often been associated with impairment of the immune system, which might consequently lead to an augmented risk of autoimmune disorders, such as rheumatoid arthritis. Though the accurate mechanistic facets of rheumatoid arthritis induction have not been interpreted yet, a conglomeration of genetic and environmental factors might promote its etiology. What makes the scenario more challenging is that patients with rheumatoid arthritis are at a significantly elevated risk of developing various types of cancer. It is intriguing to note that diverse cancer chemotherapy drugs are also commonly used to treat symptoms of rheumatoid arthritis. However, a colossal multitude of such cancer therapeutics has demonstrated highly varied results in rheumatoid arthritis patients, including both beneficial and adverse effects. Herein, we attempt to present a holistic account of the variegated modalities of this complex tripartite cross-talk between cancer, rheumatoid arthritis and chemotherapy drugs in order to decode the sinuous correlation between these two appalling pathological conditions.
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Affiliation(s)
- S Jayashree
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - K Nirekshana
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - Gunjan Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
| | - Dipita Bhakta-Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
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Li X, Young JG, Toh S. Estimating Effects of Dynamic Treatment Strategies in Pharmacoepidemiologic Studies with Time-varying Confounding: A Primer. CURR EPIDEMIOL REP 2017; 4:288-297. [PMID: 29204332 PMCID: PMC5710813 DOI: 10.1007/s40471-017-0124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Pharmacoepidemiologists are often interested in estimating the effects of dynamic treatment strategies, where treatments are modified based on patients' evolving characteristics. For such problems, appropriate control of both baseline and time-varying confounders is critical. Conventional methods that control confounding by including time-varying treatments and confounders in an outcome regression model may not have a causal interpretation, even when all baseline and time-varying confounders are measured. This problem occurs when time-varying confounders are, themselves, affected by past treatment. We review alternative analytic approaches that can produce valid inferences in the presence of such confounding. We focus on the parametric g-formula and inverse probability weighting of marginal structural models, two examples of Robins' g-methods. RECENT FINDINGS Unlike standard outcome regression methods, the parametric g-formula and inverse probability weighting of marginal structural models can estimate the effects of dynamic treatment strategies and appropriately control for measured time-varying confounders affected by prior treatment. Few applications of g-methods exist in the pharmacoepidemiology literature, primarily due to the common use of administrative claims data, which typically lack detailed measurements of time-varying information, and the limited availability of or familiarity with tools to help perform the relatively complex analysis. These barriers may be overcome with the increasing availability of data sources containing more detailed time-varying information and more accessible learning tools and software. SUMMARY With appropriate data and study design, g-methods can improve our ability to make causal inferences on dynamic treatment strategies from observational data in pharmacoepidemiology.
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Affiliation(s)
- Xiaojuan Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Mary J, De Bandt M, Lukas C, Morel J, Combe B. Triple Oral Therapy Versus Antitumor Necrosis Factor Plus Methotrexate (MTX) in Patients with Rheumatoid Arthritis and Inadequate Response to MTX: A Systematic Literature Review. J Rheumatol 2017; 44:773-779. [PMID: 28412710 DOI: 10.3899/jrheum.160643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE For patients with rheumatoid arthritis (RA) who have an inadequate response to methotrexate (MTX), the relative effectiveness of the combination of conventional disease-modifying antirheumatic drugs (DMARD) compared with the combination of tumor necrosis factor (TNF) inhibitors and MTX, as second-line therapy, is uncertain. The aim of this study was to compare the efficacy and tolerance of triple oral DMARD therapy versus anti-TNF agents associated with MTX in patients with RA after MTX failure. METHODS We performed a systematic search of the literature up to November 2015 in MEDLINE, Embase, the Cochrane library, and abstracts from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) meetings from 2006 to 2015. Articles were included if they were of randomized controlled trials of patients receiving triple oral combination therapy (TT; MTX + sulfasalazine + hydroxychloroquine) compared with anti-TNF agents plus MTX. Treatment effects were examined by disease activity [Disease Activity Score in 28 joints (DAS28)], ACR and EULAR response criteria, structural damage by the modified total Sharp score, and functional disability by the Health Assessment Questionnaire (HAQ). RESULTS Our search identified 263 articles; only 5 fulfilled the selection criteria. Analysis of ACR and EULAR response criteria, DAS28, and modified Sharp scores favored anti-TNF agents combined with MTX. Functional disability (HAQ) and rates of adverse events did not differ between treatments. CONCLUSION In patients with RA in whom MTX has failed, the addition of a TNF antagonist to MTX may be a valid option, with better clinical outcomes and better radiographic results in the presence of poor prognostic factors. In the absence of poor prognostic factors and/or with contraindications to biologic agents, TT retains its place in the therapeutic strategy for RA in a currently restricted economic context.
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Affiliation(s)
- Julia Mary
- From the Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), Fort-de-France, Martinique, French West Indies; Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535, Montpellier, France. .,B. Combe has received honoraria from BMS, Lilly, Merck, Pfizer, Roche-Chugai, and UCB. J. Morel has received honoraria from Abbvie, BMS, Merck, and Pfizer. C. Lukas has received honoraria from BMS, Merck, Pfizer, Roche-Chugai, UCB, Nordic Pharma, and Abbvie. .,J. Mary, MD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), and Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; M. De Bandt, MD, PhD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital); C. Lukas, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; J. Morel, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; B. Combe, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535.
| | - Michel De Bandt
- From the Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), Fort-de-France, Martinique, French West Indies; Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535, Montpellier, France.,B. Combe has received honoraria from BMS, Lilly, Merck, Pfizer, Roche-Chugai, and UCB. J. Morel has received honoraria from Abbvie, BMS, Merck, and Pfizer. C. Lukas has received honoraria from BMS, Merck, Pfizer, Roche-Chugai, UCB, Nordic Pharma, and Abbvie.,J. Mary, MD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), and Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; M. De Bandt, MD, PhD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital); C. Lukas, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; J. Morel, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; B. Combe, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535
| | - Cédric Lukas
- From the Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), Fort-de-France, Martinique, French West Indies; Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535, Montpellier, France.,B. Combe has received honoraria from BMS, Lilly, Merck, Pfizer, Roche-Chugai, and UCB. J. Morel has received honoraria from Abbvie, BMS, Merck, and Pfizer. C. Lukas has received honoraria from BMS, Merck, Pfizer, Roche-Chugai, UCB, Nordic Pharma, and Abbvie.,J. Mary, MD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), and Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; M. De Bandt, MD, PhD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital); C. Lukas, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; J. Morel, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; B. Combe, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535
| | - Jacques Morel
- From the Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), Fort-de-France, Martinique, French West Indies; Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535, Montpellier, France.,B. Combe has received honoraria from BMS, Lilly, Merck, Pfizer, Roche-Chugai, and UCB. J. Morel has received honoraria from Abbvie, BMS, Merck, and Pfizer. C. Lukas has received honoraria from BMS, Merck, Pfizer, Roche-Chugai, UCB, Nordic Pharma, and Abbvie.,J. Mary, MD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), and Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; M. De Bandt, MD, PhD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital); C. Lukas, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; J. Morel, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; B. Combe, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535
| | - Bernard Combe
- From the Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), Fort-de-France, Martinique, French West Indies; Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535, Montpellier, France.,B. Combe has received honoraria from BMS, Lilly, Merck, Pfizer, Roche-Chugai, and UCB. J. Morel has received honoraria from Abbvie, BMS, Merck, and Pfizer. C. Lukas has received honoraria from BMS, Merck, Pfizer, Roche-Chugai, UCB, Nordic Pharma, and Abbvie.,J. Mary, MD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital), and Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; M. De Bandt, MD, PhD, Rheumatology Department, CHU Martinique (Pierre Zobda-Quitman Hospital); C. Lukas, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; J. Morel, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535; B. Combe, MD, PhD, Rheumatology Department, CHU Montpellier, Lapeyronie Hospital, Montpellier University, UMR5535
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Hua C, Daien CI, Combe B, Landewe R. Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis. RMD Open 2017; 3:e000406. [PMID: 28155923 PMCID: PMC5237764 DOI: 10.1136/rmdopen-2016-000406] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To update the evidence pertaining to the diagnosis, prognosis and classification of patients with early arthritis (EA), and to inform the 2016 European League Against Rheumatism (EULAR) recommendations for the management of patients with EA. METHODS MEDLINE, EMBASE and Cochrane databases were searched up to October 2015. The first part of the systematic literature review (SLR) involved a search for studies investigating the recognition and referral of EA. The second part involved a search for studies to identify the place of laboratory and imaging tests in establishing a diagnosis and a prognosis in patients with EA. RESULTS Regarding the issue of referral of patients with EA (1643 hits), 4 studies were included. These studies were in support of early referral for patients with EA. Regarding the issue of diagnosis and prognosis of patients with EA (11 435 hits), 88 studies were included, evaluating mainly the value of rheumatoid factor (RF) and anticitrullinated-peptide antibodies (ACPAs). Sensitivity of these antibodies for a RA diagnosis in patients with EA was moderate (40-80%). Specificity was higher, notably for ACPAs (frequently >80%). ACPAs also showed better prognostic performance than RF (negative predictive values around 80%). We confirmed that structural damage on baseline X-rays is predictive of further radiographic progression in patients with EA. Regarding other imaging modalities, data are sparse. CONCLUSIONS This SLR highlights the importance of early referral for patients with EA and confirms that RF and mainly ACPAs as well as a search for structural X-rays changes may help in the diagnosis and prognosis of patients with EA.
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Affiliation(s)
- Charlotte Hua
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Claire I Daien
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Bernard Combe
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology , Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre , Heerlen , The Netherlands
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8
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Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Álvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernández L, Smolen JS, Skingle D, Szekanecz Z, Kvien TK, van der Helm-van Mil A, van Vollenhoven R. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2016. [PMID: 27979873 DOI: 10.1136/annrheumdis-2016-210602 10.1136/annrheumdis-2016-210602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. METHODS In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. RESULTS The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. CONCLUSIONS These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.
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Affiliation(s)
- Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Claire I Daien
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Charlotte Hua
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose María Álvaro-Gracia
- Biological Therapies Unit, Servicio de Reumatología. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
| | - Margôt Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Catalin Codreanu
- Department of Rheumatology, Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Richard Conway
- Department of Rheumatology, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Maxime Dougados
- Medicine Faculty, APHP, Rheumatology B Department, Paris Descartes University, Cochin Hospital, Paris, France
| | - Paul Emery
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianfranco Ferraccioli
- Fondazione Policlinico Gemelli Academic Hospital, Catholic University School of Medicine, Rome, Italy
| | - Joao Fonseca
- Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon.,Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Portugal
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lucía Silva-Fernández
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Diana Skingle
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ronald van Vollenhoven
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
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Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Álvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernández L, Smolen JS, Skingle D, Szekanecz Z, Kvien TK, van der Helm-van Mil A, van Vollenhoven R. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2016; 76:948-959. [PMID: 27979873 DOI: 10.1136/annrheumdis-2016-210602] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/24/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. METHODS In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. RESULTS The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. CONCLUSIONS These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.
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Affiliation(s)
- Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Claire I Daien
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Charlotte Hua
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose María Álvaro-Gracia
- Biological Therapies Unit, Servicio de Reumatología. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
| | - Margôt Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Catalin Codreanu
- Department of Rheumatology, Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Richard Conway
- Department of Rheumatology, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Maxime Dougados
- Medicine Faculty, APHP, Rheumatology B Department, Paris Descartes University, Cochin Hospital, Paris, France
| | - Paul Emery
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianfranco Ferraccioli
- Fondazione Policlinico Gemelli Academic Hospital, Catholic University School of Medicine, Rome, Italy
| | - Joao Fonseca
- Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon.,Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Portugal
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lucía Silva-Fernández
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Diana Skingle
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ronald van Vollenhoven
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
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Ferraccioli G, Tolusso B, Fedele AL, Gremese E. Do we need to apply a T2T strategy even in ACPA-negative early rheumatoid arthritis? YES. RMD Open 2016; 2:e000263. [PMID: 27099779 PMCID: PMC4823584 DOI: 10.1136/rmdopen-2016-000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Gianfranco Ferraccioli
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Barbara Tolusso
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Anna Laura Fedele
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Elisa Gremese
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
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