1
|
Conran C, Kolfenbach J, Kuhn K, Striebich C, Moreland L. A Review of Difficult-to-Treat Rheumatoid Arthritis: Definition, Clinical Presentation, and Management. Curr Rheumatol Rep 2023; 25:285-294. [PMID: 37776482 DOI: 10.1007/s11926-023-01117-6] [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] [Indexed: 10/02/2023]
Abstract
PURPOSE OF REVIEW A subset of patients with rheumatoid arthritis (RA) who fail multiple biologic therapies are deemed to have "difficult-to-treat" (D2T) RA. In 2021, a European Alliance of Associations for Rheumatology (EULAR) task force proposed a clinical definition of D2T RA. Here we review RA phenotypes and clinical assessment of RA, propose a different definition of D2T RA, discuss possible D2T RA risk factors, and summarize existing literature on the management of D2T RA. RECENT FINDINGS High disease activity at the time of diagnosis or prior to treatment with a biologic is associated with the development of D2T RA. Prolonged time from diagnosis to beginning treatment has been consistently associated with the development of D2T RA. Other clinical factors such as burden of disease, extraarticular disease, obesity, smoking, pain, fatigue, and psychological conditions have inconsistent associations with D2T RA according to current literature. D2T RA is a relatively new concept that represents an area of great need for research regarding the characterization of those with the disease as well as how best to treat the disease. With this gained knowledge, rheumatologists will be able to better identify patients at the time of diagnosis that are likely to develop D2T RA to help guide management.
Collapse
Affiliation(s)
- Carly Conran
- Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Jason Kolfenbach
- Department of Medicine, Division of Rheumatology, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Kristine Kuhn
- Department of Medicine, Division of Rheumatology, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Christopher Striebich
- Department of Medicine, Division of Rheumatology, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Larry Moreland
- Department of Medicine, Division of Rheumatology, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| |
Collapse
|
2
|
Burkard T, Vallejo-Yagüe E, Lauper K, Finckh A, Hügle T, Burden AM. Longitudinal associations between body mass index and changes in disease activity and radiographic progression in rheumatoid arthritis patients treated with infliximab. RMD Open 2023; 9:e003396. [PMID: 37802600 PMCID: PMC10565266 DOI: 10.1136/rmdopen-2023-003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Treatment response is worse in obese patients with rheumatoid arthritis (RA), including patients on weight-adjusted therapies like infliximab. We aimed to assess the association between body mass index (BMI) and changes in RA disease activity and radiographic progression over time. METHODS We included infliximab users with an RA diagnosis in the Swiss Clinical Quality Management in Rheumatic Diseases registry (1997-2020). Two cohorts were defined: (1) starting from their first BMI measurement or disease activity score (DAS28-esr), and (2) from their first BMI measurement or radiographic assessment (Rau score). We evaluated the coefficient and 95% CI of BMI with changes in mean DAS28-esr (cohort 1) and mean Rau scores (a structural joint damage score, cohort 2) using generalised estimation equations, overall and stratified by BMI categories. RESULTS Cohort 1 comprised 412 patients (74% women, mean age 53 years, mean BMI 25). We observed no change in mean DAS28-esr with increasing BMI overall (adjusted coefficient: 0.00, 95% CI -0.02 to 0.02), or in BMI categories. Cohort 2 comprised 187 patients highly alike to those in cohort 1. We observed a significant decrease of 1.05 in mean Rau scores for every increase in BMI unit (adjusted coefficient: -1.05, 95% CI -1.92 to -0.19). Results remained statistically non-significant across BMI categories. CONCLUSIONS Our longitudinal investigation suggests that BMI increase may not lead to changes in DAS28-esr in patients receiving infliximab, despite the weight-adapted dose. Yet, there may be a decrease in erosions with increasing weight non-limited to obese patients.
Collapse
Affiliation(s)
- Theresa Burkard
- Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zürich, Zurich, Switzerland
| | - Enriqueta Vallejo-Yagüe
- Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zürich, Zurich, Switzerland
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - Kim Lauper
- Department of Rheumatology, University of Geneva, Geneva, Switzerland
| | - Axel Finckh
- Department of Rheumatology, University of Geneva, Geneva, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Andrea M Burden
- Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zürich, Zurich, Switzerland
| |
Collapse
|
3
|
Tenti S, Bruyère O, Cheleschi S, Reginster JY, Veronese N, Fioravanti A. An update on the use of conventional and biological disease-modifying anti-rheumatic drugs in hand osteoarthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231158618. [PMID: 36937821 PMCID: PMC10017945 DOI: 10.1177/1759720x231158618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/02/2023] [Indexed: 03/15/2023] Open
Abstract
Osteoarthritis (OA) is a highly prevalent condition worldwide associated with pain, progressive disability, reduced participation in social activities, and impaired quality of life. Despite its growing burden, the therapeutic options are still limited and almost exclusively addressed to symptoms' management, while no disease-modifying OA drugs able to prevent or retard disease progression are actually available. For these reasons, in the last decades, relevant efforts to find new potential therapeutic targets in OA have been made and a number of existing conventional and biological disease-modifying anti-rheumatic drugs (DMARDs), including hydroxychloroquine (HCQ), methotrexate (MTX), tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 inhibitors, commonly used to treat inflammatory rheumatic diseases, have been repurposed for the treatment of OA and explored also in hand osteoarthritis (HOA). The current narrative review was aimed to provide a comprehensive and updated understanding of the possibilities and the criticisms related to the treatment of HOA with conventional and biological DMARDs. Unfortunately, therapy with conventional and biologic drugs in HOA has not achieved the expected success, despite a rationale for their use exists. Thus, our findings outline the urgent need to enhance the exploration of HOA basic molecular mechanisms to find new potential therapeutic targets, personalized for each patient, and appropriate for the different subsets of HOA and for the different phases of disease.
Collapse
Affiliation(s)
- Sara Tenti
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Sara Cheleschi
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | | |
Collapse
|
4
|
Shi H, Li S, Geng Y, Fan H, Zhang R, Zhang Y, Pan J, Song G, Ge L, Xie T, Wang L. Euphorbia factor L3 ameliorates rheumatoid arthritis by suppressing the inflammatory response by targeting Rac family small GTPase 1. Bioengineered 2022; 13:10984-10997. [PMID: 35475473 PMCID: PMC9208460 DOI: 10.1080/21655979.2022.2066761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Euphorbia factor L3 (EFL3) is extracted from Euphorbia lathyris and is known for its anti-inflammatory properties. This study focused on the potential anti-inflammatory and therapeutic effects of EFL3 on rheumatoid arthritis (RA) using fibroblast-like synoviocytes (FLSs) and arthritis animal models. Functional analysis showed that EFL3 could ameliorate the inflammatory phenotype of FLSs derived from RA patients, as evidenced by the decreases in cell viability, migration, invasion and cytokine production. Luciferase activity, Western blotting and immunofluorescence assays demonstrated that EFL3 inhibited the nuclear translocation of the p65 subunit and the subsequent activation of the nuclear factor kappa-Β (NF-κB) pathway. Furthermore, the therapeutic effects of EFL3 against arthritic progression were evidenced by decreases in joint swelling, arthritis scores, inflammatory factor production, synovial hyperplasia, and bone destruction in collagen-induced arthritis (CIA) and tumor necrosis factor-α (TNF-α) transgenic (TNF-tg) mouse models. Molecular analysis identified Rac family small GTPase 1 (Rac1) as the potential target that was required for EFL3-mediated suppression of the inflammatory RA FLS phenotype. In summary, this study uncovered the therapeutic potential of EFL3 in RA, which suggests its future clinical use.
Collapse
Affiliation(s)
- Haojun Shi
- The Second Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Shufeng Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, Guangdong, China
| | - Yun Geng
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Huancai Fan
- Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Ruojia Zhang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yuang Zhang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jihong Pan
- Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Guanhua Song
- Institute of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Luna Ge
- Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Tianhua Xie
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, Shandong, China
| | - Lin Wang
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Biomedical Sciences College & Shandong Medicinal Biotechnology Center, NHC Key Laboratory of biotechnology drugs (Shandong Academy of Medical Sciences), Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| |
Collapse
|