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Christ L, Kissling S, Finckh A, Fisher BA, Adler S, Maurer B, Möller B, Kollert F. Concomitant Sjögren's disease as a biomarker for treatment effectiveness in rheumatoid arthritis - results from the Swiss clinical quality management cohort. Arthritis Res Ther 2024; 26:68. [PMID: 38481302 PMCID: PMC10938669 DOI: 10.1186/s13075-024-03302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate the clinical phenotype and treatment response in patients with rheumatoid arthritis (RA) with and without concomitant Sjögren's disease (SjD). METHODS In this observational cohort study, patients with RA from the Swiss Clinical Quality Management in Rheumatic Diseases registry were categorised according to the presence or absence of SjD. To assess treatment effectiveness, drug retention of tumor necrosis factor-α-inhibitors (TNFi) was compared to other mode of action (OMA) biologics and Janus kinase-inhibitors (JAKi) in RA patients with and without SjD. Adjusted hazard ratios (HR) for time to drug discontinuation were compared in crude and adjusted Cox proportional regression models for potential confounders. RESULTS We identified 5974 patients without and 337 patients with concomitant SjD. Patients with SjD were more likely to be female, to have a positive rheumatoid factor, higher disease activity scores, and erosive bone damage. For treatment response, a total of 6781 treatment courses were analysed. After one year, patients with concomitant SjD were less likely to reach DAS28 remission with all three treatment modalities. Patients with concomitant SjD had a higher hazard for stopping TNFi treatment (adjusted HR 1.3 [95% CI 1.07-1.6]; OMA HR 1.12 [0.91-1.37]; JAKi HR 0.97 [0.62-1.53]). When compared to TNFi, patients with concomitant SjD had a significantly lower hazard for stopping treatment with OMA (adjusted HR 0.62 [95% CI 0.46-0.84]) and JAKi (HR 0.52 [0.28-0.96]). CONCLUSION RA patients with concomitant SjD reveal a severe RA phenotype, are less responsive to treatment, and more likely to fail TNFi.
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Affiliation(s)
- Lisa Christ
- Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland
| | - Seraphina Kissling
- Statistics and Data Management Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Benjamin A Fisher
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Biomedical Research Centre, Department of Rheumatology, National Institute for Health Research (NIHR), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sabine Adler
- Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland
- Clinic of Rheumatology and Immunology, Medical University Hospital Aarau, Aarau, Aargau, Switzerland
| | - Britta Maurer
- Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland
| | - Burkhard Möller
- Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland
| | - Florian Kollert
- Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland.
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Fakher HE, El Gazzar NM, Mabrouk MM, Nada DW. The study of serum muscarinic acetylcholine receptor subtype 3 (m3AChR)-Specific autoantibodies level in rheumatoid arthritis patients with secondary sjogren syndrome. BMC Rheumatol 2023; 7:45. [PMID: 38105265 PMCID: PMC10726573 DOI: 10.1186/s41927-023-00368-1] [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: 08/26/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Dry eyes and mouth are symptoms of Sjogren syndrome, which can occur on its own and be referred to as primary Sjogren syndrome or in conjunction with other rheumatic diseases like rheumatoid arthritis and be referred to as secondary Sjogren syndrome. Anti-muscarinic type 3 receptors have been linked to neurological issues as well as secretory dysfunction in Sjogren patients. Consequently, the purpose of this study is to determine the serum level of muscarinic acetylcholine receptor subtype 3 (m3AChR)-specific autoantibodies in rheumatoid arthritis (RA) patients and evaluate its relationship to disease activity, functional disability, and to study its role in the development of secondary Sjogren syndrome manifestations in those patients. METHODS In this cross-sectional study, 30 RA patients with secondary Sjogren syndrome signs and 30 RA patients without secondary Sjogren syndrome manifestations were included, along with 30 healthy volunteers who were aged, and sex matched as controls. All participants underwent thorough clinical examination, evaluation of disease activity using the DAS28 score, assessment of functional status using the modified health assessment questionnaire (MHAQ), and evaluation of the serum level of (m3AChR) by (ELISA). RESULTS When compared to RA patients without secondary Sjogren syndrome and healthy controls (20.09 ± 4.24, 18.36 ± 3.59 ng/ml respectively), the serum level of m3AChR antibodies among 30 RA patients with secondary Sjogren syndrome considerably increased (mean 25.98 ± 4.81 ng/ml).Analysis of the m3AChR's (ROC)-curve revealed that the three groups under study differed significantly (P < 0.001), with the AUC (0.806), cutoff (> 22.63ng/ml), sensitivity (73.33%), and specificity (86.67%) all exceeding the threshold. Additionally, there was a significant positive connection between the serum level of m3AChR and the following variables (P < 0.05): DAS scores, MHAQ score, number of tender & swollen joints, and acute phase reactants. CONCLUSION Autoantibodies against m3AChR may be one of the serum components involved in the pathophysiology of secondary Sjogren syndrome in RA patients, and because of their high sensitivity and specificity, they can be utilized as a diagnostic marker in these individuals.
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Affiliation(s)
- Hagar Elsayed Fakher
- Department of Rheumatology, Rehabilitation & Physical Medicine, Faculty of Medicine, Tanta University, El-Gharbia Governorate, Tanta City, Egypt
| | - Nagat Mohammed El Gazzar
- Department of Rheumatology, Rehabilitation & Physical Medicine, Faculty of Medicine, Tanta University, El-Gharbia Governorate, Tanta City, Egypt
| | - Maaly Mohamed Mabrouk
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta City, El- Gharbia Governorate, Egypt
| | - Doaa Waseem Nada
- Department of Rheumatology, Rehabilitation & Physical Medicine, Faculty of Medicine, Tanta University, El-Gharbia Governorate, Tanta City, Egypt.
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Park Y, Oh M, Lee YS, Kim WU. Salivary ultrasonography and histopathologic evaluation of secondary Sjögren's syndrome in rheumatoid arthritis patients. Sci Rep 2023; 13:11339. [PMID: 37443200 PMCID: PMC10344871 DOI: 10.1038/s41598-023-38469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023] Open
Abstract
Novel modalities, such as salivary ultrasonography (SGUS) and shear wave elastography (SWE), have previously been introduced to evaluate Sjögren's syndrome (SS). However, in secondary SS (sSS), the diagnostic performance of SGUS and its relationship with clinicopathological characteristics have not yet been clearly defined. In this study, we aimed to investigate sSS in RA patients using SGUS and SWE and sought to determine its pathological correlations. Thirty-one RA patients who presented with sicca symptoms were included to be evaluated on SS, and were compared with 18 primary SS (pSS) patients. All subjects were assessed through SGUS, SWE, and conventional diagnostic approaches for SS, including minor salivary gland biopsy (MSGB). In SGUS evaluation, two separate scoring systems, suggested by Hocevar and OMERACT, were used. Among 31 RA patients with sicca symptoms, 19 (61.2%) were diagnosed as sSS. Similar to pSS, SGUS showed good diagnostic performance (sensitivity 68.4% and 78.9%, and specificity 91.7% and 75.0% for Hocever and OMERACT, respectively) in differentiating sSS from RA patients with simple sicca symptoms. The sSS and pSS patients exhibited significantly higher lymphoid infiltration areas in MSGB than RA patients without SS. Focus score and lymphoid infiltration areas correlated well with sonographic severity. Severity of fibrosis in MSGB showed better positive correlation with SWE than with SGUS. Similar to pSS, SGUS shows good diagnostic performance for sSS in RA patients. SWE reflects histopathologic chronicity of MSGB well in both pSS and sSS.
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Affiliation(s)
- Youngjae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minae Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Center for Integrative Rheumatoid Transcriptomics and Dynamics, The Catholic University of Korea, Seoul, Korea.
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Xie W, Huang H, Zhang Z. Dynamic Characteristics and Predictive Profile of Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients Commencing Glucocorticoids with csDMARD: A Real-World Experience. Rheumatol Ther 2023; 10:405-419. [PMID: 36609980 PMCID: PMC10011229 DOI: 10.1007/s40744-022-00527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Glucocorticoids (GC) are currently recommended as a bridging therapy in combination with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) for the treatment of rheumatoid arthritis (RA) and should be tapered as rapidly as clinically feasible. We aimed to explore potential predictors for GC discontinuation in patients commencing GC with concomitant csDMARD. METHODS We used data from a longitudinal real-world cohort. RA patients who newly started GC concomitantly with csDMARD were included. All patients were divided into four groups, according to degree of change in disease activity at 3 months from baseline (group 1: worsening or no decrease; group 2: 0-24.9% decrease; group 3: 25.0-49.9% decrease; group 4: ≥ 50.0% decrease). Cox regression was used to estimate hazard risk (HR) with 95% confidence interval (CI). RESULTS In total, 124 out of 207 RA patients discontinued GC at the rheumatologist's discretion and 79.1% (91/115) of them successfully stopping GC without flare within 6 months after GC withdrawal. Increasing age (HR 0.99, 95% CI 0.98-1.00, p = 0.043) and concomitant nonsteroidal anti-inflammatory drugs use at GC initiation (HR 0.47, 95% CI 0.25-0.88, p = 0.018) were independently associated with GC withdrawal failure. Moreover, the degrees of disease activity improvement at 3 months significantly predicted the possibility of subsequent GC discontinuation (fully adjusted HR 1.35-1.47, p < 0.01), with 2.38-3.59 times higher in group 4 than group 1. Switching the outcome to successfully stopping GC without short-term flare yielded similar findings. CONCLUSIONS The degrees of disease activity improvement at 3 months independently predicted the subsequent GC withdrawal. These findings suggest the importance of dynamic treatment strategies with a closer look at disease activity during GC tapering and discontinuation.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034 China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034 China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034 China
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Laroche M, Degboe Y, Constantin A. Sjögren's syndrome associated with erosive rheumatoid arthritis alters its prognosis and long-term therapeutic response: a case-control study. Rheumatol Int 2023; 43:363-366. [PMID: 34999915 DOI: 10.1007/s00296-021-05074-0] [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: 10/14/2021] [Accepted: 12/18/2021] [Indexed: 02/07/2023]
Abstract
10% of rheumatoid arthritis (RA) cases are associated to so-called secondary Sjögren's syndrome (SS). These RA cases have higher DAS, fewer remissions. Is this linked to a poor response to DMARDs (disease-modifying anti-rheumatic drugs)? No study has addressed this question to date. Does the association between secondary Sjögren's syndrome (SS) and rheumatoid arthritis (RA) affect the therapeutic response to DMARDs and long-term prognosis? We conducted a retrospective case-control study: 39 RA associated with SS was (anti-SSA antibodies and/or Chisolm stage III or IV) were compared to 39 isolated cases of erosive RA matched by age, duration of progression and gender. The DAS CRP was higher in the RA + SS group in patients with disease progression of 16 years: 2.6 (1.5-4.5) compared to the RA group: 1.6 (1.3-2.8) (p = 0.0001) while fewer patients were in remission: 61 vs. 92% (p = 0.002). A higher number of B DMARDs have been prescribed: RA + SS = 3.04 (1-7); RA = 1.7 (1-5) (p = 0.004). Anti-TNFs are less effective when RA is associated with SS: 30 vs. 70%. Conversely, Rituximab is more effective when RA is associated with SS: 80 vs. 30%. Erosive RA-related SS exacerbates the clinical course of the condition: higher DAS, fewer remissions. This is linked to reduced treatment efficacy: higher number of DMARDs prescribed, reduced efficacy of anti-TNF drugs. RA-related SS could modify sensitivity to biotherapies: lower percentage of remissions and resistance to anti-TNF drugs.
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Affiliation(s)
- Michel Laroche
- Rheumatology Center, CHU Purpan (Purpan University Hospital), 1 place du Dr Baylac, 31059, Toulouse cedex, France.
| | - Yannick Degboe
- Rheumatology Center, CHU Purpan (Purpan University Hospital), 1 place du Dr Baylac, 31059, Toulouse cedex, France
| | - Arnaud Constantin
- Rheumatology Center, CHU Purpan (Purpan University Hospital), 1 place du Dr Baylac, 31059, Toulouse cedex, France
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Traditional Chinese Medicine Is Associated with Reduced Risk of Readmission in Rheumatoid Arthritis Patients with Anemia: A Retrospective Cohort Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4553985. [PMID: 35966735 PMCID: PMC9365533 DOI: 10.1155/2022/4553985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
Objective This study aimed to analyze the effect of traditional Chinese medicine (TCM) on the risk of readmission for rheumatoid arthritis (RA) patients with anemia. Methods In this study, 893 hospitalized RA patients were followed up by telephone. A retrospective cohort study was conducted using propensity score matching (PSM). The Cox proportional hazards model was used to assess the influence of various factors on the risk of readmission for RA patients with anemia. The Kaplan–Meier survival curve was utilized to analyze the effect of TCM intervention time on readmission. Results The incidence of anemia was 58.08% (471/811) in RA patients. After 1 : 1 PSM, 328 RA patients with anemia and 328 RA patients without anemia were finally included in our study. The readmission rate of anemia patients was higher than that of patients without anemia (P < 0.01). The readmission rate of RA patients with anemia was obviously lower in the TCM group than in the non-TCM group (P < 0.01). The Cox proportional hazards model showed TCM as an independent protective factor as it decreased the risk of readmission by 50% (HR = 0.50, 95% CI = 0.27–0.94, P=0.03) in RA patients with anemia. In addition, the risk of readmission was dramatically diminished in the high-exposure subgroup (TCM > 12 months) compared with the low-exposure subgroup (TCM ≤ 12 months) (log-rank P=0.016). Conclusion TCM, as a protective factor, is associated with a reduced risk of readmission in RA patients with anemia.
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Waki D, Tamai H, Yokochi R, Kido T, Yagyu Y, Yanai R, Sada KE. Effects of anti-SSA antibodies on the response to methotrexate in rheumatoid arthritis: A retrospective multicenter observational study. PLoS One 2022; 17:e0271921. [PMID: 35867726 PMCID: PMC9307181 DOI: 10.1371/journal.pone.0271921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2022] [Indexed: 12/03/2022] Open
Abstract
Comparison of clinical response to methotrexate between anti-SSA antibody-positive and -negative patients with methotrexate-naïve rheumatoid arthritis and investigate the reasons for the differences in the response. For this multicenter retrospective cohort study, a total of 210 consecutive patients with rheumatoid arthritis who newly initiated methotrexate were recruited. The effects of anti-SSA antibody positivity on achieving a low disease activity according to the 28-joint Disease Activity Score based on C-reactive protein after 6 months of methotrexate administration were investigated using a logistic regression analysis. This study involved 32 and 178 anti-SSA antibody-positive and -negative patients, respectively. The rate of achieving low disease activity according to the 28-joint Disease Activity Score based on C-reactive protein at 6 months was significantly lower in the anti-SSA antibody-positive group than in the anti-SSA antibody-negative group (56.2% vs. 75.8%, P = 0.030). After 6 months, anti-SSA antibody-positive patients had significantly higher scores on the visual analogue scale (median [interquartile range]: 22 [15–41] vs. 19 [5–30], P = 0.038) and were frequently prescribed nonsteroidal anti-inflammatory drugs (37.5% vs. 18.0%, P = 0.018). In conclusion, the presence of anti-SSA antibodies might be a predictive factor for insufficient responses to treat-to-target strategy in rheumatoid arthritis. Residual pain might contribute to the reduced clinical response to methotrexate in anti-SSA antibody-positive patients with rheumatoid arthritis.
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Affiliation(s)
- Daisuke Waki
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Okayama, Japan
- * E-mail:
| | - Hiroya Tamai
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ritsuko Yokochi
- Division of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Toshiki Kido
- The First Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yuriko Yagyu
- Department of Internal Medicine, Tokyo Kyōsai Hospital, Tokyo, Japan
| | - Ryo Yanai
- Division of Rheumatology, Showa University Hospital, Tokyo, Japan
| | - Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Kochi, Japan
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Xie W, Huang H, Li G, Hao Y, Gui Y, Wang Y, Deng X, Zhao J, Geng Y, Ji L, Zhang X, Song Z, Zhang Z. Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020. Ann Rheum Dis 2021; 80:997-1003. [PMID: 33811037 DOI: 10.1136/annrheumdis-2021-220112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To unravel the dynamical trajectory and features of glucocorticoids (GC) tapering and discontinuation in patients with rheumatoid arthritis (RA) commencing GC with concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). METHODS We used data from longitudinal real-world Treat-to-TARget in RA cohort. Patients with RA who started GC and contaminant csDMARDs therapy were included. The changes in GC dose and disease activity were evaluated. GC discontinuation rate was analysed using Kaplan-Meier analysis. The relapse profile within 6 months after GC discontinuation was also analysed. RESULTS A total of 207 patients with RA were included. During a median follow-up of 38.6 months, 124 patients discontinued GC. The median prednisolone dose of 10 (5-10) mg/day at initiation was reduced by 50% in the first 6 months and then more slowly, to zero by 48 months eventually. The cumulative probabilities of GC discontinuation were 9.7%, 26.6%, 48.0% and 58.6% at month 6, years 1, 2 and 3, with calculated median time to GC cessation of 27 months. In 110 DMARD-naïve patients, the corresponding cumulative probabilities of GC discontinuation were, respectively, 12.7%, 30.0%, 50.9% and 60.6%, with calculated median time to GC cessation of 24 months. Of the 124 patients who discontinued GC, adding other csDMARDs or concomitant csDMARDs increment was documented in 28.2% of them. Approximately half of 124 patients were in clinical remission at GC discontinuation. Within 6 months after GC withdrawal, 79.1% (91/115) of patients maintained relapse free. CONCLUSIONS In patients with RA commencing GC besides csDMARDs, GC is feasibly discontinued with favourable control of disease activity in real-life setting, mostly without short-term flare. But the withdrawal time is far from reaching the recommended time frame, indicating the gap between real-world practice and current guidelines.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Guangtao Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yanjie Hao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yanni Gui
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - LanLan Ji
- 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
| | - Zhibo Song
- 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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Xie W, Li G, Huang H, Zhang Z. How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort. Rheumatol Ther 2020; 8:289-301. [PMID: 33355913 PMCID: PMC7991037 DOI: 10.1007/s40744-020-00270-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction The aim of this work is to propose Boolean-defined low disease activity (LDA) and to test its utility in rheumatoid arthritis (RA). Methods We used data from a longitudinal academic clinical database of RA in Peking University First Hospital over a decade. The initial proposal of Boolean-defined LDA was proposed with ascending thresholds from 2 to 5 in steps of 1 (referred to as Boolean-LDA2/3/4/5). Agreement and residual swollen joint count (SJC) pattern with the index-based [Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)] LDA was analyzed. To confirm discovery, we randomly classified RA patients in a 3:2 ratio into either analysis cohort or validation cohort. Results In total, 4881 visits of 672 patients were included in the analysis cohort. Of these visits, the frequencies of achieving LDA were 71.9% (SDAI), 73.6% (CDAI), 52.8% (Boolean-LDA2), 65.2% (Boolean-LDA3), 73.5% (Boolean-LDA4), and 80.7% (Boolean-LDA5). High consistency and similar SJC pattern with SDAI-LDA or CDAI-LDA were observed in Boolean-LDA3 (kappa = 0.796, 0.771). Further analysis found meeting SDAI-LDA but not Boolean-LDA3 was largely attributable to higher patient’s global assessment (PGA) scores (62.9%). In further modification of Boolean-LDA3, better agreement with SDAI-LDA or CDAI-LDA was reached when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by evaluator’s global assessment (EGA) with cutoff to 3.0. These findings were further replicated in randomly generated validation cohort of 449 patients with 3306 clinic visits. Conclusions Using cutoff of 3 to Boolean-LDA provides great clinical utility with index-based LDA, especially when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by EGA with cutoffs to 3.0. This may deserve being considered in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00270-z.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Guangtao Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China.
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