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Frade-Sosa B, Ponce A, Ruiz-Ortiz E, De Moner N, Gómara MJ, Azuaga AB, Sarmiento-Monroy JC, Morlà R, Ruiz-Esquide V, Macías L, Sapena N, Tobalina L, Ramirez J, Cañete JD, Yague J, Auge JM, Gomez-Puerta JA, Viñas O, Haro I, Sanmarti R. Neutrophilic Activity Biomarkers (Plasma Neutrophil Extracellular Traps and Calprotectin) in Established Patients with Rheumatoid Arthritis Receiving Biological or JAK Inhibitors: A Clinical and Ultrasonographic Study. Rheumatol Ther 2024:10.1007/s40744-024-00650-9. [PMID: 38430455 DOI: 10.1007/s40744-024-00650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION This study assesses the accuracy of neutrophil activation markers, including neutrophil extracellular traps (NETs) and calprotectin, as biomarkers of disease activity in patients with established rheumatoid arthritis (RA). We also analyse the relationship between NETs and various types of therapies as well as their association with autoimmunity. METHODS Observational cross-sectional study of patients with RA receiving treatment with biological disease-modifying antirheumatic drugs or Janus kinase inhibitors (JAK-inhibitors) for at least 3 months. Plasma calprotectin levels were measured using an enzyme-linked immunosorbent assay test kit and NETs by measuring their remnants in plasma (neutrophil elastase-DNA and histone-DNA complexes). We also assessed clinical disease activity, joint ultrasound findings and autoantibody status [reumatoid factor (RF), anti-citrullinated peptide/protein antibodies (ACPAs) and anti-carbamylated protein (anti-CarP)]. Associations between neutrophilic biomarkers and clinical or ultrasound scores were sought using correlation analysis. The discriminatory capacity of both neutrophilic biomarkers to detect ultrasound synovitis was analysed through receiver-operating characteristic (ROC) curves. RESULTS One hundred fourteen patients were included. Two control groups were included to compare NET levels. The active control group consisted of 15 patients. The second control group consisted of 30 healthy subjects. Plasma NET levels did not correlate with clinical disease status, regardless of the clinic index analysed or the biological therapy administered. No significant correlation was observed between NET remnants and ultrasound synovitis. There was no correlation between plasma NET and autoantibodies. In contrast, plasma calprotectin positively correlated with clinical parameters (swollen joint count [SJC] rho = 0.49; P < 0.001, Clinical Disease Activity Index [CDAI] rho = 0.30; P < 0.001) and ultrasound parameters (rho > 0.50; P < 0.001). Notably, this correlation was stronger than that observed with acute phase reactants. CONCLUSION While NET formation induced by neutrophils may play a role in RA pathogenesis, our study raises questions about the utility of NET remnants in peripheral circulation as a biomarker for inflammatory activity. In contrast, this study strongly supports the usefulness of calprotectin as a biomarker of inflammatory activity in patients with RA.
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Affiliation(s)
- Beatriz Frade-Sosa
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Andrés Ponce
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Estíbaliz Ruiz-Ortiz
- Department of Immunology-CDB, Hospital Clinic of Barcelona, Barcelona, Barcelona, Spain
| | - Noemí De Moner
- Department of Immunology-CDB, Hospital Clinic of Barcelona, Barcelona, Barcelona, Spain
| | - María J Gómara
- Unit of Synthesis and Biomedical Applications of Peptides, Institute for Advanced Chemistry of Catalonia. Consejo Superior de Investigaciones Científicas (IQAC-CSIC), Barcelona, Spain
| | - Ana Belén Azuaga
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Juan C Sarmiento-Monroy
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Rosa Morlà
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Laura Macías
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nuria Sapena
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Lola Tobalina
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Juan D Cañete
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Jordi Yague
- Department of Immunology-CDB, Hospital Clinic of Barcelona, Barcelona, Barcelona, Spain
| | - Josep M Auge
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José A Gomez-Puerta
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain
| | - Odette Viñas
- Department of Immunology-CDB, Hospital Clinic of Barcelona, Barcelona, Barcelona, Spain
| | - Isabel Haro
- Unit of Synthesis and Biomedical Applications of Peptides, Institute for Advanced Chemistry of Catalonia. Consejo Superior de Investigaciones Científicas (IQAC-CSIC), Barcelona, Spain
| | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, IDIBAPS, Carrer Villarroel 170, 08170, Barcelona, Spain.
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Mascaro JM, Rodriguez-Pinto I, Poza G, Mensa-Vilaro A, Fernandez-Martin J, Caminal-Montero L, Espinosa G, Hernández-Rodríguez J, Diaz M, Rita-Marques J, Sanmarti R, Castañeda S, Colunga D, Coto-Hernández R, Fanlo P, Elejalde JI, Bujan S, Figueras I, Marco FM, Andrés M, Suárez S, Gonzalez-Garcia A, Fustà-Novell X, Garcia-Belando C, Granados A, Fernandez-Figueras MT, Quilis N, Orriols-Caba M, Gómez de la Torre R, Cid MC, Espígol-Frigolé G, Alvarez-Abella A, Labrador E, Rozman M, Lopez-Guerra M, Castillo P, Alamo-Moreno JR, Gonzalez-Roca E, Plaza S, Fabregat V, Lara R, Vicente-Rabaneda EF, Tejedor-Vaquero S, Magri G, Bonet N, Solis-Moruno M, Cerutti A, Fornas O, Casals F, Yagüe J, Aróstegui JI. Spanish cohort of VEXAS syndrome: clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism. Ann Rheum Dis 2023; 82:1594-1605. [PMID: 37666646 PMCID: PMC10646843 DOI: 10.1136/ard-2023-224460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants. OBJECTIVES To investigate the presence of VEXAS syndrome among patients with adult-onset undiagnosed AID. Additional studies evaluated the mosaicism distribution and the circulating cytokines. METHODS Gene analyses were performed by both Sanger and amplicon-based deep sequencing. Patients' data were collected from their medical charts. Cytokines were quantified by Luminex. RESULTS Genetic analyses of enrolled patients (n=42) identified 30 patients carrying UBA1 pathogenic variants, with frequencies compatible for postzygotic variants. All patients were male individuals who presented with a late-onset disease (mean 67.5 years; median 67.0 years) characterised by cutaneous lesions (90%), fever (66.7%), pulmonary manifestations (66.7%) and arthritis (53.3%). Macrocytic anaemia and increased erythrocyte sedimentation rate and ferritin were the most relevant analytical abnormalities. Glucocorticoids ameliorated the inflammatory manifestations, but most patients became glucocorticoid-dependent. Positive responses were obtained when targeting the haematopoietic component of the disease with either decitabine or allogeneic haematopoietic stem cell transplantation. Additional analyses detected the UBA1 variants in both haematopoietic and non-haematopoietic tissues. Finally, analysis of circulating cytokines did not identify inflammatory mediators of the disease. CONCLUSION Thirty patients with adult-onset AID were definitively diagnosed with VEXAS syndrome through genetic analyses. Despite minor interindividual differences, their main characteristics were in concordance with previous reports. We detected for the first time the UBA1 mosaicism in non-haematopoietic tissue, which questions the previous concept of myeloid-restricted mosaicism and may have conceptual consequences for the disease mechanisms.
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Affiliation(s)
- Jose Manuel Mascaro
- Department of Dermatology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | | | - Gabriela Poza
- Department of Internal Medicine, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Anna Mensa-Vilaro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | - Luis Caminal-Montero
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Gerard Espinosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jose Hernández-Rodríguez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marina Diaz
- Department of Haematology, Hospital Clínic, Barcelona, Spain
| | - Joana Rita-Marques
- Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Raimon Sanmarti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigaciones Sanitarias Princesa (IIS-Princesa), Madrid, Spain
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Dolores Colunga
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Coto-Hernández
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Patricia Fanlo
- Department of Internal Medicine, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Segundo Bujan
- Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignasi Figueras
- Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain
| | - Francisco Manuel Marco
- Department of Immunology, Hospital General Universitario de Alicante Dr Balmis, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Mariano Andrés
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
- Seccion de Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain
- Department of Clinic Medicine, Universidad Miguel Hernandez de Elche, Elche, Spain
| | - Silvia Suárez
- Department of Internal Medicine, Hospital Valle del Nalón, Langreo, Spain
| | - Andres Gonzalez-Garcia
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal | IRYCIS, Madrid, Spain
| | | | - Clara Garcia-Belando
- Department of Rheumatology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana Granados
- Department of Internal Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Neus Quilis
- Department of Rheumatology, Hospital Universitari de Vinalopo, Elche, Spain
| | - Maria Orriols-Caba
- Department of Internal Medicine, Hospital comarcal Alt Penedès, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | | | - Maria Cinta Cid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Maria Rozman
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Haematology, Hospital Clínic, Barcelona, Spain
| | - Monica Lopez-Guerra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | | | - Eva Gonzalez-Roca
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Susana Plaza
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | - Rocio Lara
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Esther F Vicente-Rabaneda
- Department of Rheumatology, Hospital Universitario La Princesa, Madrid, Spain
- Instituto de Investigaciones Sanitarias Princesa (IIS-Princesa), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Giuliana Magri
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Immunology Unit, Department of Biomedical Sciences, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Nuria Bonet
- Genomics Core Facility, Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manuel Solis-Moruno
- Genomics Core Facility, Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Andrea Cerutti
- Hospital del Mar Medical Research Institute, PRBB, Barcelona, Spain
- Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Oscar Fornas
- Flow Cytometry Unit, Universitat Pompeu Fabra - Center of Genomic Regulation, Barcelona, Spain
| | - Ferran Casals
- Departament de Genètica, Microbiologia i Estadística, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Juan I Aróstegui
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
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Sanmarti R, Frade-Sosa B, Morlà R, Cañete JD. Seronegative palindromic rheumatism: what are we talking about? Comment on the article by Yang et al. Arthritis Rheumatol 2023; 75:485. [PMID: 36245287 DOI: 10.1002/art.42387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Raimon Sanmarti
- Rheumatology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Rosa Morlà
- Rheumatology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan D Cañete
- Rheumatology Service, Hospital Clinic of Barcelona, Barcelona, Spain
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Frade-Sosa B, Azuaga AB, Ruiz-Esquide V, Gómez-Puerta JA, Sanmarti R. Complete disappearance of pulmonary rheumatoid nodules after long term rituximab treatment: case report. Rheumatol Int 2023; 43:533-536. [PMID: 36318308 DOI: 10.1007/s00296-022-05220-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
The natural history of pulmonary rheumatoid nodules in rheumatoid arthritis remains uncertain. We present a case of a patient with rheumatoid arthritis with pulmonary rheumatoid nodules diagnosed while receiving etanercept in whom pulmonary nodules resolved completely after 5 years of rituximab treatment. Rituximab has been evaluated in case series of patients with pulmonary rheumatoid nodules, resulting in most cases in no progression or a reduction in the size of the nodules, although the complete resolution is uncommon probably due to the short follow-up period. Complete disappearance of pulmonary rheumatoid nodules may be expected after long-term treatment with rituximab.
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Affiliation(s)
- Beatriz Frade-Sosa
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ana Belen Azuaga
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | | | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clinic of Barcelona, Barcelona, Spain.
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Frade-Sosa B, Ponce A, Inciarte-Mundo J, Morlà R, Ruiz-Esquide V, Macías L, Azuaga AB, Ramirez J, Cañete JD, Yague J, Auge JM, Gomez-Puerta JA, Sanmarti R. Plasma calprotectin as a biomarker of ultrasound synovitis in rheumatoid arthritis patients receiving IL-6 antagonists or JAK inhibitors. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114105. [PMID: 36148395 PMCID: PMC9486267 DOI: 10.1177/1759720x221114105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To analyse the accuracy of plasma calprotectin in patients with rheumatoid arthritis (RA) receiving monoclonal antibodies against IL-6 receptors (anti-rIL-6) or JAK inhibitors (JAKis) in detecting ultrasound (US) synovitis and compare it with acute phase reactants [high-sensitivity C-reactive protein (hs-CRP) and ESR]. Methods An observational cross-sectional study of RA patients receiving anti-rIL-6 (tocilizumab or sarilumab) or JAKi, (baricitinib or tofacitinib) was made. Plasma calprotectin for the diagnosis of US synovitis [synovial hypertrophy grade (SH) ⩾ 2 plus power Doppler signal (PD) ⩾ 1] was analysed using receiver operating characteristic curves (ROCs). The performance of ESR and hs-CRP was also studied. The three ROC curves were compared to determine which had the highest discriminatory power. Associations between plasma calprotectin and US scores were made using correlation analysis. Results Sixty-three RA patients were included. Mean plasma calprotectin levels were significantly higher in patients with US synovitis than in those without (0.89 ± 0.85 vs 0.30 ± 0.12 μg/ml; p = 0.0003). A moderate correlation between calprotectin and all US scores (HS score Rho = 0.479; PD score Rho = 0.492; and global score Rho = 0.495) was found. The discriminatory capacity of plasma calprotectin showed an AUC of 0.795 (95% CI: 0.687-0.904). The AUC of hs-CRP and ESR was 0.721 and 0.564, respectively. hs-CRP serum levels showed a low positive correlation with the three US scores (Rho < 0.40). After analysis according to the drugs administered, the correlation disappeared in patients receiving anti-rIL-6. Conclusion Plasma calprotectin may be a sensitive biomarker of synovial inflammation in RA patients treated with anti-rIL-6 or JAKi.
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Affiliation(s)
| | | | | | - Rosa Morlà
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | | | - Laura Macías
- Biochemistry and Molecular Genetics Department,
Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Belen Azuaga
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Juan D. Cañete
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Jordi Yague
- Department of Immunology, Hospital Clinic –
CDB, Barcelona, Spain
| | - Josep M. Auge
- Biochemistry and Molecular Genetics
Department, Hospital Clínic of Barcelona, Barcelona, Spain
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Castellanos-Moreira R, Rodríguez-García SC, Haro I, Sanmarti R. Response to: ‘Autoantibodies and interstitial lung disease in rheumatoid arthritis: towards a ‘mix-and-match’ approach’ by Alunno et al. Ann Rheum Dis 2022; 81:e54. [DOI: 10.1136/annrheumdis-2020-217432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
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Macias-Muñoz L, Frade-Sosa B, Iniciarte-Mundo J, Hidalgo S, Morla RM, Gallegos Y, Sanmarti R, Auge JM. Analytical and clinical evaluation of DiaSorin Liaison® Calprotectin fecal assay adapted for serum samples. J Clin Lab Anal 2022; 36:e24258. [PMID: 35122317 PMCID: PMC8906016 DOI: 10.1002/jcla.24258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Calprotectin is a calcium‐binding protein that can be measured in serum, plasma, and feces. Increased serum and plasma calprotectin concentrations have been found in chronic inflammatory rheumatic disorders. An analytical and clinical evaluation of the DiaSorin Liaison® fecal Calprotectin assay using LIAISON® XL was performed. Methods The protocol included an analytical and clinical evaluation in which imprecision, the linearity of dilution, differences between serum and plasma samples and method comparison with CalproLab™ ELISA kit were assessed. Serum calprotectin concentrations in active (n = 26) and remission (n = 23) rheumatoid arthritis (RA) patients were compared. Results The intra‐day and inter‐day analytical imprecision CVs ranged from 2.9% to 4.0% and 2.7% to 10.4%, respectively. Correlation between measured and expected values was high (R > 0.99), indicating good linearity. The Wilcoxon signed‐rank test showed that serum and plasma matched samples presented statistically significant differences (p < 0.001) being the highest concentrations of calprotectin observed in serum samples. Deming regression equation was as follows: Diasorin calprotectin (μg/ml) = −0.32 (95% CI: −0.65 ‐ −0.05) +1.58 (95% CI: 1.42–1.79).* Calprolab calprotectin (μg/ml). Significantly higher serum calprotectin levels were found in RA patients with active disease when compared to patients with low disease activity or in clinical remission (mean ± SD) [(3.35 μg/ml ± 1.55) vs. (1.63 μg/ml ± 0.52), p < 0.001] and these levels correlated well with all disease activity indices. Conclusions The DiaSorin Liaison® fecal Calprotectin assay adapted for serum samples showed adequate technical performances and the clinical performances were similar to other assays.
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Affiliation(s)
- Laura Macias-Muñoz
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Beatriz Frade-Sosa
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jose Iniciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Susana Hidalgo
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Rosa Maria Morla
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Yadira Gallegos
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Raimon Sanmarti
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Maria Auge
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Frade-Sosa B, Ponce A, Ruiz-Esquide V, García-Yébenes MJ, Morlá R, Sapena N, Ramirez J, Azuaga AB, Sarmiento JC, Cañete JD, Gomez-Puerta JA, Sanmarti R. High Sensitivity C Reactive Protein in Patients with Rheumatoid Arthritis Treated with Antibodies against IL-6 or Jak Inhibitors: A Clinical and Ultrasonographic Study. Diagnostics (Basel) 2022; 12:diagnostics12010182. [PMID: 35054349 PMCID: PMC8774492 DOI: 10.3390/diagnostics12010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: We examined whether high-sensitivity CRP (hsCRP) reflected the inflammatory disease status evaluated by clinical and ultrasound (US) parameters in RA patients receiving IL-6 receptor antibodies (anti-IL-6R) or JAK inhibitors (JAKi). Methods: We conducted a cross-sectional study of patients with established RA receiving anti-IL-6R (tocilizumab, sarilumab) or JAKi (tofacitinib, baricitinib). Serum hsCRP and US synovitis in both hands were measured. Associations between hsCRP and clinical inflammatory activity were evaluated using composite activity indices. The association between hsCRP and US synovitis was analyzed. Results: 63 (92% female) patients (42 anti- IL-6R and 21 JAKi) were included, and the median disease duration was 14.4 (0.2–37.5) years. Most patients were in remission or had low levels of disease. Overall hsCRP values were very low, and significantly lower in anti-IL-6R patients (median 0.04 mg/dL vs. 0.16 mg/dL). Anti-IL-6R (82.4%) patients and 48% of JAKi patients had very low hsCRP levels (≤0.1 mg/dL) (p = 0.002). In the anti-IL-6R group, hsCRP did not correlate with the composite activity index or US synovitis. In the JAKi group, hsCRP moderately correlated with US parameters (r = 0.5) but not clinical disease activity, and hsCRP levels were higher in patients with US synovitis (0.02 vs. 0.42 mg/dL) (p = 0.001). Conclusion: In anti-IL-6R RA-treated patients, hsCRP does not reflect the inflammatory disease state, but in those treated with JAKi, hsCRP was associated with US synovitis.
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Affiliation(s)
- Beatriz Frade-Sosa
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Andrés Ponce
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Virginia Ruiz-Esquide
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | | | - Rosa Morlá
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Nuria Sapena
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Ana Belen Azuaga
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Juan Camilo Sarmiento
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Juan D. Cañete
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Jose A. Gomez-Puerta
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
| | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (B.F.-S.); (A.P.); (V.R.-E.); (R.M.); (N.S.); (J.R.); (A.B.A.); (J.C.S.); (J.D.C.); (J.A.G.-P.)
- Correspondence:
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Picado C, de Landazuri IO, Vlagea A, Bobolea I, Arismendi E, Amaro R, Sellarés J, Bartra J, Sanmarti R, Hernandez-Rodriguez J, Mascaró JM, Colmenero J, Vaquero EC, Pascal M. Spectrum of Disease Manifestations in Patients with Selective Immunoglobulin E Deficiency. J Clin Med 2021; 10:jcm10184160. [PMID: 34575269 PMCID: PMC8466644 DOI: 10.3390/jcm10184160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Selective IgE deficiency (SIgED) has been previously evaluated in selected patients from allergy units. This study investigates the effects of SIgED on the entire population in a hospital setting and sought to delineate in detail the clinical aspects of SIgED. METHODS A retrospective study of the data obtained from electronic medical records of 52 adult patients (56% female) with a mean age of 43 years and IgE levels of <2.0 kU/L with normal immunoglobulin (Ig) IgG, IgA, and IgM levels, seen at our hospital, without selection bias, from 2010 to 2019. RESULTS Recurrent upper respiratory infections were recorded in 18 (34.6%) patients, pneumonia was recorded in 16 (30.7%) patients, bronchiectasis was recorded in 16 (30.7%) patients, and asthma was recorded in 10 (19.2%) patients. Eighteen patients (34.6%) suffered autoimmune clinical manifestations either isolated (19%) or combining two or more diseases (15%), Hashimoto's thyroiditis being the most frequent (19%), which was followed by arthritis (10%) and thrombocytopenia and/or neutropenia (5.7%). Other less frequent associations were Graves' disease, primary sclerosing cholangitis, Sjögren's syndrome, and autoimmune hepatitis. Eczematous dermatitis (15.3%), chronic spontaneous urticaria (17.3%), and symptoms of enteropathy (21%) were also highly prevalent. Thirty percent of patients developed malignancies, with non-Hodgkin lymphomas (13.4%) being the most prevalent. CONCLUSIONS The clinical manifestations of SIgED encompass a variety of infectious, non-infectious complications, and malignancy. Since it cannot be ruled out that some type of selection bias occurred in the routine assessment of IgE serum Ievels, prospective studies are required to better characterize SIgED and to determine whether it should be added to the list of antibody deficiencies.
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Affiliation(s)
- César Picado
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence:
| | - Iñaki Ortiz de Landazuri
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Alexandru Vlagea
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
| | - Irina Bobolea
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Ebymar Arismendi
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Rosanel Amaro
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Jacobo Sellarés
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Joan Bartra
- Institut Clinic Respiratory, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.B.); (E.A.); (R.A.); (J.S.); (J.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
| | - Raimon Sanmarti
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Rheumatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José Hernandez-Rodriguez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - José-Manuel Mascaró
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Department of Dermatology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Jordi Colmenero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Liver Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Eva C. Vaquero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Centro de Investigaciones en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Gastroenterology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mariona Pascal
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.S.); (J.H.-R.); (J.-M.M.); (J.C.); (E.C.V.); (M.P.)
- Immunology Department, CDB. Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (I.O.d.L.); (A.V.)
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10
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Castellanos-Moreira R, Gomez A, Haro I, Ruiz-Esquide V, Marsal S, Sanmarti R. Anti-carbamylated protein antibodies are associated with early abatacept response in rheumatoid arthritis. Comment on: Anti-carbamylated protein antibodies as a clinical response predictor in rheumatoid arthritis patients treated with abatacept. Clin Exp Rheumatol 2021; 39:1142-1143. [DOI: 10.55563/clinexprheumatol/gh5eq7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022]
Affiliation(s)
| | - Antonio Gomez
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Isabel Haro
- Unit of Synthesis and Biomedical Applications of Peptides, Institute of Advanced Chemistry of Catalonia (IQAC-CSIC), Consejo Superior de Investigaciones Científicas, Barcelona, Spain
| | | | - Sara Marsal
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Raimon Sanmarti
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Spain.
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11
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Castellanos-Moreira R, Rodriguez-Garcia SC, Cabrera-Villalba S, Gomara MJ, Salvador G, Ruiz-Esquide V, Ramirez J, Inciarte-Mundo J, Morla R, Garcia-Moreno C, Cuervo A, Gómez-Puerta JA, Cañete JD, Haro I, Sanmarti R. Anti-carbamylated protein antibody isotype pattern differs between palindromic rheumatism and rheumatoid arthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20978139. [PMID: 33354232 PMCID: PMC7734508 DOI: 10.1177/1759720x20978139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background A restricted response against citrullinated peptides/proteins, with less isotype usage, has been found in palindromic rheumatism (PR) in comparison with rheumatoid arthritis (RA). We hypothesized that this different antibody response may be observed for other post-translational modified proteins. We compared the prevalence and isotype usage of two specificities of anti-carbamylated peptide/protein antibodies (Anti-CarP) in patients with PR and RA. Methods Cross-sectional study including 54 patients with pure PR and 53 patients with RA, matched by sex, age, disease duration and ACPA. Anti-CarP specificities were determined by home-made enzyme-linked immunosorbent assay tests using a synthetic chimeric fibrin/filaggrin homocitrullinated peptide (CFFHP) and fetal calf serum (FCS) homocitrullinated protein as antigens. IgG, IgA and IgM isotypes were measured. Results Anti-CarP were positive (CFFHP or FCS) in 24% and 64% of patients with PR and RA, respectively (p < 0.005). All Anti-CarP isotype proportions were significantly lower in PR than in RA: Anti-CarP-IgG (24% versus 51%), Anti-CarP-IgA (7% versus 34%) and Anti-CarP-IgM (7% versus 36%). Mean titers of Anti-CarP isotypes were also lower in PR. In Anti-CarP positive patients, the isotype distribution differed between PR and RA: IgG Anti-CarP was used in all PR patients and in 79% of RA patients. By contrast, a significantly lower isotype usage of both IgA (31% versus 53%) and IgM (31% versus 56%) was observed in PR patients. No significant differences in clinical or demographic characteristics were observed according to Anti-CarP status in PR patients, except for a higher prevalence of ACPA and higher mean titers of ACPA and rheumatoid factor in Anti-CarP positive patients. Conclusion Anti-CarP are found in patients with PR but in a lower proportion and with a different isotype usage from in RA, suggesting a distinct B cell response to homocitrullinated antigens in PR.
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Affiliation(s)
| | | | | | - María José Gomara
- Unit of Synthesis and Biomedical Applications of Peptides, Institute of Advanced Chemistry of Catalonia, Consejo Superior de Investigaciones Científicas (IQAC-CSIC), Barcelona, Spain
| | - Georgina Salvador
- Rheumatology Department, University Hospital Mutua Tarrasa, Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Julio Ramirez
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jose Inciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Rosa Morla
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Garcia-Moreno
- Unit of Synthesis and Biomedical Applications of Peptides, Institute of Advanced Chemistry of Catalonia, Consejo Superior de Investigaciones Científicas (IQAC-CSIC), Barcelona, Spain
| | - Andrea Cuervo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jose A. Gómez-Puerta
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan D. Cañete
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Isabel Haro
- Unit of Synthesis and Biomedical Applications of Peptides, Institute of Advanced Chemistry of Catalonia, Consejo Superior de Investigaciones Científicas (IQAC-CSIC), Barcelona, Spain
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Castellanos-Moreira R, Rodriguez-Garcia SC, Hernandez-Gonzalez F, Sellares J, Haro I, Sanmarti R. Is Auto-Antibody Expansion the Turning Point Between Idiopathic Pulmonary Fibrosis and Rheumatoid Arthritis? Chest 2020; 158:1777-1778. [DOI: 10.1016/j.chest.2020.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
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Martin-Martinez MA, Castañeda S, Sánchez-Alonso F, García Gomez C, Gonzalez Juanatey C, Belmonte MA, Tornero J, Santos Rey J, Sanchez Gonzalez CO, Quesada-Masachs E, Moreno Gil MD, Cobo-Ibáñez T, Pinto Tasende JA, Babío J, Bonilla G, Mas AJ, Manero J, Romera M, Bachiller-Corral J, Chamizo Carmona E, Calvo J, Sanmarti R, Erausquin MC, Garcia de Vicuna R, Barbadillo C, Ros Exposito S, Del Pino J, Gonzalez MJ, Pina Salvador JM, Llorca J, González-Gay MA. OP0002 INCIDENCE OF FIRST CARDIOVASCULAR EVENT IN SPANISH PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: PROSPECTIVE DATA FROM THE CARMA PROJECT AFTER 5 YEARS OF FOLLOW-UP. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:To determine the incidence and risk factors implicated in the development of first cardiovascular (CV) event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending Spanish rheumatology clinics after 5 years of follow-upMethods:Analysis of data of patients included in an observational prospective study [CARdiovascular in rheuMAtology (CARMA) project] after 5 years of follow-up. The study includes a cohort of 2234 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA), and another cohort of matched individuals (n=677) without CIRD from 67 hospitals in Spain. Cumulative incidence per 1000 patients of CVE was estimated in both cohorts at 5 years from the start. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence intervals (CI) of the risk factors involved in the development of CV events. Losses to follow-up and their causes were also analyzed.Results:The total number patient who completed the follow-up visit at 5 years was 2.382 (81.9%). Fifteen patients died due to CVE and sixty due to non-CVE. The patients with CIRD showed higher cardiovascular cumulative incidence (40.5; 95% CI: 36.2-44.8) than controls (28.3; 95% CI: 21.8-34.8). The higher risk of developing a first CVE during the 5 years of follow-up was seen in patients with AS (HR: 4.60; 95% CI: 1.32-15.99; p=0.02), those with older age (HR:1.09; 95% CI: 1.05-1.13; p<0.001), higher systolic blood pressure (HR: 2.64; 95% CI: 1.32-5.25; p=0.006), and those with longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12; p=0.002). In contrast, woman gender was a protective factor (HR: 0.45; 95% CI: 0.21-0.99; p=0.047).Conclusion:Patients with AS prospectively followed-up at rheumatology outpatient clinics showed higher risk of developing a first CVE than those without CIRD. Besides traditional CV disease risk factors, a longer time course of the disease is a risk factor for the development of CV disease in patients with CIRD.Acknowledgments:This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie.Disclosure of Interests:Maria Auxiliadora Martin-Martinez: None declared, Santos Castañeda: None declared, Fernando Sánchez-Alonso: None declared, Carmen García Gomez: None declared, Carlos Gonzalez Juanatey: None declared, Maria Angeles Belmonte: None declared, Jesús Tornero: None declared, José Santos Rey: None declared, CARMEN OLGA SANCHEZ GONZALEZ: None declared, Estefanía Quesada-Masachs: None declared, MARIA DELPUERTO MORENO GIL: None declared, Tatiana Cobo-Ibáñez: None declared, Jose Antonio Pinto Tasende: None declared, Jesús Babío: None declared, Gemma Bonilla: None declared, Antonio Juan Mas: None declared, Javier Manero: None declared, Montserrat Romera: None declared, Javier Bachiller-Corral: None declared, Eugenio Chamizo Carmona: None declared, Javier Calvo: None declared, Raimon Sanmarti: None declared, Maria Celia Erausquin: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Carmen Barbadillo: None declared, Sergio Ros Exposito: None declared, Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, MARIA JOSE GONZALEZ: None declared, José Manuel Pina Salvador: None declared, Javier Llorca: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD
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Julià A, Lopez Lasanta M, Blanco F, Gómez A, Haro I, Mas AJ, Erra A, García Vivar ML, Monfort J, Sánchez Fernandez S, González-Álvaro I, Alperi-López M, Castellanos R, Fernandez-Nebro A, Diaz Torne C, Palau N, Lastra RM, Lladós J, Sanmarti R, Marsal S. SAT0006 SIMULTANEOUS ANALYSIS OF ANTI-CCP, RHEUMATOID FACTOR, ANTI-PAD4 AND ANTI-CARBAMYLATED PROTEIN ANTIBODIES REVEALS INTERACTION EFFECTS WITH RESPONSE TO ANTI-TNF THERAPY IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Blocking of the Tumor Necrosis Factor (TNF) activity is a successful therapeutic approach for 2 out of 3 Rheumatoid Arthritis patients. Identifying the patients that will not respond to this therapeutic approach is a major translational goal in RA. Association of seropositivity to rheumatoid factor (RF) or anti-cyclic-citrullinated antibodies (anti-CCP) with anti-TNF response has proven inconclusive, suggesting that other yet unexplored biomarkers could be more informative for this goal.Objectives:We tested the association of two recently introduced biomarkers in RA: anti-carbamylated protein antibodies (anti-CarP) and anti-peptidylarginine deiminase type 4 (anti-PAD4).Methods:A prospective cohort of n=80 RA patients starting anti-TNF therapy was recruited and levels for all four autoantibodies -RF, anti-CCP, anti-CarP and anti-PAD4- were measured at baseline. The change in DAS28 score between baseline and week 12 of therapy was used as the clinical endpoint.Results:Single marker-analysis showed no significant association with drug response. However, when testing for interactions between autoantibodies, we found highly significant associations with drug response. Anti-CCP and RF showed a positive interaction with the response to anti-TNF therapy (P=0.00068), and anti-PAD4 and antiCarP titers showed a negative interaction with the clinical response at week 12 (P=0.0062). Using an independent retrospective sample (n=199 patients), we validated the interaction between anti-CCP and RF with the clinical response to anti-TNF agents. (P=0.044).Conclusion:The results of this study show that interactions between antibodies are important in the response to anti-TNF therapy and suggest potential pathogenic relationships.Acknowledgments :We would like to thank the clinical researchers and patients participating in the IMID Consortium for their collaborationDisclosure of Interests:Antonio Julià: None declared, Maria Lopez Lasanta: None declared, Francisco Blanco: None declared, Antonio Gómez: None declared, Isabel Haro: None declared, Antonio Juan Mas: None declared, Alba Erra: None declared, Mª Luz García Vivar: None declared, Jordi Monfort: None declared, Simon Sánchez Fernandez: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Mercedes Alperi-López: None declared, Raúl Castellanos: None declared, Antonio Fernandez-Nebro: None declared, Cesar Diaz Torne: None declared, Núria Palau: None declared, Raquel M Lastra: None declared, Jordi Lladós: None declared, Raimon Sanmarti: None declared, Sara Marsal: None declared
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Castellanos-Moreira R, Rodríguez-García SC, Gomara MJ, Ruiz-Esquide V, Cuervo A, Casafont-Solé I, Ramírez J, Holgado S, Gómez-Puerta JA, Cañete JD, Haro I, Sanmarti R. Anti-carbamylated proteins antibody repertoire in rheumatoid arthritis: evidence of a new autoantibody linked to interstitial lung disease. Ann Rheum Dis 2020; 79:587-594. [PMID: 32156708 DOI: 10.1136/annrheumdis-2019-216709] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyse the association between anti-carbamylated protein antibodies (Anti-CarP) and interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. METHODS Cross-sectional study including RA patients fulfilling the 2010 ACR/EULAR criteria. The main population comprised two groups: (1) RA patients diagnosed with RA-ILD (RA-ILD group); (2) RA patients without ILD (non-ILD RA group). Non-ILD RA patients in whom ILD was suspected underwent a diagnostic work-up and, if ILD was diagnosed, were switched to the RA-ILD group. ILD was diagnosed by high-resolution computed tomography and confirmed by a multidisciplinary committee. An independent replication sample was also obtained. Three Anti-CarP IgG autoantibodies against fetal calf serum (Anti-FCS), fibrinogen (Anti-Fib) and chimeric fibrine/filagrine homocitrullinated peptide (Anti-CFFHP) and one Anti-CarP IgA against FCS (Anti-FCS-IgA) were determined by home-made ELISA. Associations between Anti-CarP and ILD were analysed using multivariable logistic regression adjusted by smoking, sex, age, RA disease duration, rheumatoid factor and anticitrullinated protein antibodies. RESULTS We enrolled 179 patients: 37 (21%) were finally diagnosed with RA-ILD. Anti-CarP specificities were more frequent in RA-ILD patients (Anti-FCS 70% vs 43%; Anti-Fib 73% vs 51%; Anti-CFFHP 38% vs 19%; Anti-CarP-IgA 51% vs 20%, p<0.05 for all comparisons). Serum titers of Anti-CarP were significantly higher in RA-ILD patients. Anti-CarP specificities showed a robust effect towards increasing the odds of ILD in the multivariate analysis (Anti-FCS (OR: 3.42; 95% CI: 1.13 to 10.40), Anti-Fib (OR: 2.85; 95% CI: 0.83 to 9.70), Anti-CFFHP (OR: 3.11; 95% CI: 1.06 to 9.14) and Anti-FCS-IgA (OR: 4.30; 95% CI: 1.41 to 13.04)). Similar findings were observed in the replication sample. CONCLUSIONS Anti-CarP were strongly associated with ILD. The role of homocitrullination in RA-ILD merits further investigation.
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Affiliation(s)
| | | | - Maria Jose Gomara
- Consejo Superior de Investigaciones Científicas, Unit of Synthesis and Biomedical Applications of Peptides, CSIC-IQAC, Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Andrea Cuervo
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Julio Ramírez
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Susana Holgado
- Rheumatology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jose A Gómez-Puerta
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan D Cañete
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Isabel Haro
- Consejo Superior de Investigaciones Científicas, Unit of Synthesis and Biomedical Applications of Peptides, CSIC-IQAC, Barcelona, Spain
| | - Raimon Sanmarti
- Rheumatology Department, Arthritis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
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Sanmarti R, Veale DJ, Martin‐Mola E, Escudero‐Contreras A, González C, Ercole L, Alonso R, Fonseca JE, Alcañiz C, Álvaro‐Gracia JM, Balsa A, Pablos JL, Miguel CD, Rodríguez JM, Alves J, Aurrecoechea E, Calvo J, Belzunegui J, Blanco F, Caliz R, Calvo J, Ivorra JR, Canhão H, Santos H, Chamizo E, Pino J, Delgado C, Díaz C, Nebro AF, Fraser A, Gomez A, Hernández B, Navarro F, Povedano J, Mas AJ, Kane D, Whelan B, Marras C, Moreno J, Venegas JP, Pombo M, Riera E, Rosas A, Ryan J, Santos J, Santos M, Tornero J, Tovar JV, Ucar E, Vasconcelos C, Veiga R, Vela P. Reducing or Maintaining the Dose of Subcutaneous Tocilizumab in Patients With Rheumatoid Arthritis in Clinical Remission: A Randomized, Open‐Label Trial. Arthritis Rheumatol 2019; 71:1616-1625. [DOI: 10.1002/art.40905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - Douglas J. Veale
- St. Vincent's University Hospital and University College Dublin Belfield Dublin Ireland
| | | | - Alejandro Escudero‐Contreras
- Rheumatology Service Reina Sofia Hospital Maimonides Institute for Research in Biomedicine of Cordoba University of Cordoba Cordoba Spain
| | | | | | | | - João E. Fonseca
- Universidade de Lisboa and Hospital de Santa Maria CHLN Lisbon Portugal
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Castellanos-Moreira R, Rodriguez-Garcia SC, Gómez-Puerta JA, Ruiz-Esquide V, Camacho O, Ramírez J, Cuervo A, Morlà R, Cañete JD, Haro I, Sanmarti R. Rheumatoid Arthritis Initiating as Palindromic Rheumatism: A Distinct Clinical Phenotype? J Rheumatol 2019; 47:652-657. [DOI: 10.3899/jrheum.190061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
Objective.To analyze the prevalence of preexisting palindromic rheumatism (PR) in patients with established rheumatoid arthritis (RA) and to evaluate whether these patients have a distinctive clinical and serological phenotype.Methods.Cross-sectional study in patients with established RA. Preexisting PR was determined using a structured protocol and confirmed by retrospective review of medical records. Demographic, clinical, radiological, immunological, and therapeutic features were compared in patients with and without PR.Results.Included were 158 patients with established RA (78% female) with a mean disease duration since RA onset of 5.1 ± 2.7 years. Preexisting PR was recorded in 29 patients (18%). The median time from the onset of PR to progression to RA was 1.2 years. No between-group differences in demographic features, current disease activity, radiographic erosive disease, or disability were observed. Patients with PR had a higher prevalence of smoking (72% vs 40%). Positive rheumatoid factor, anticitrullinated peptide antibodies, and anticarbamylated protein antibodies were numerically higher in patients with PR. No differences in treatment were observed except for greater hydroxychloroquine (HCQ) use in patients with PR (38% vs 6%). Palindromic flares persisted in a significant proportion of patients during the RA course, including patients in clinical remission or receiving biological disease-modifying antirheumatic drugs.Conclusion.Eighteen percent of patients with RA had a history compatible with PR previous to RA onset. No specific clinical or serological phenotype was identified in these patients, although higher HCQ use and smoking prevalence were identified. Palindromic flares may persist during the RA disease course despite treatment.
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Choy E, Caporali R, Xavier R, Fautrel B, Sanmarti R, Bao M, Devenport J, Pethö-Schramm A. Effects of concomitant glucocorticoids in TOZURA, a common-framework study programme of subcutaneous tocilizumab in rheumatoid arthritis. Rheumatology (Oxford) 2019; 58:1056-1064. [PMID: 30649524 PMCID: PMC6532446 DOI: 10.1093/rheumatology/key393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This post hoc analysis of the TOZURA study programme evaluated the efficacy and safety of subcutaneous tocilizumab (TCZ-SC) as monotherapy or with concomitant conventional synthetic DMARDs (csDMARDs) in patients with RA categorized by baseline glucocorticoid (GC) use. METHODS TOZURA was a multinational, open-label, single-arm, common-framework study programme (11 protocols, 22 countries) in patients with moderate to severe RA in whom csDMARDs or biologic therapies had failed or who were MTX naïve. Patients received once-weekly TCZ-SC 162 mg for ⩾24 weeks as monotherapy or in combination with csDMARDs and/or oral GC use (⩽10 mg/day prednisone or equivalent), which was to be continued unchanged for 24 weeks. Treatment subgroups were defined by baseline GC use and analysed for efficacy and safety. RESULTS Of 1804 patients who received TCZ-SC, 145 received monotherapy + GC, 208 received monotherapy without GC, 730 received combination therapy + GC and 721 received combination therapy without GC. The median GC dose in both GC subgroups was 5 mg/day. The proportion of patients who achieved clinical remission, defined as DAS in 28 joints using ESR <2.6, increased similarly from baseline to week 24 in all subgroups. Improvements in patient-reported outcomes were similar in all subgroups. Overall adverse event profiles were generally similar between subgroups, with some slight numerical differences between GC and non-GC subgroups. CONCLUSION The incremental efficacy benefits of TCZ-SC as monotherapy and in combination with csDMARDs were similar between patients with and without previous and continued oral GC treatment, with generally similar safety profiles. TRIAL REGISTRATION ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01941940, NCT01941095, NCT01951170, NCT01987479, NCT01988012, NCT01995201, NCT02001987, NCT02011334, NCT02031471, NCT02046603, NCT02046616.
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Affiliation(s)
- Ernest Choy
- Division of Infection and Immunity, CREATE Centre, Cardiff University, Cardiff, UK
| | - Roberto Caporali
- Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Ricardo Xavier
- Department of Medicine, Universidade Federal do Rio Grande do Sul Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruno Fautrel
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Min Bao
- Genentech, Inc., South San Francisco, CA, USA
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Moreno M, Gratacós J, Torrente-Segarra V, Sanmarti R, Morlà R, Pontes C, Llop M, Juanola X. Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study. Arthritis Res Ther 2019; 21:88. [PMID: 30953541 PMCID: PMC6451276 DOI: 10.1186/s13075-019-1873-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6–8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient’s global assessment. Results Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
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Affiliation(s)
- Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain.
| | | | - Raimon Sanmarti
- Rheumatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rosa Morlà
- Rheumatology Department, Hospital del Vendrell, Tarragona, Spain
| | - Caridad Pontes
- Clinical Pharmacology Department, ParcTaulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Sanmarti R, Ramírez J, Castellanos-Moreira R, Cabrera-Villalba SR, Ruiz-Esquide V, Salvador G. Ultrasound findings in palindromic rheumatism. Ann Rheum Dis 2018; 79:e30. [PMID: 30552178 DOI: 10.1136/annrheumdis-2018-214832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Raimon Sanmarti
- Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Julio Ramírez
- Rheumatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | | | | | - Georgina Salvador
- Rheumatology Department, Hospital Mútua de Terrassa, Barcelona, Spain
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21
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Inciarte-Mundo J, Ramirez J, Hernández MV, Ruiz-Esquide V, Cuervo A, Cabrera-Villalba SR, Pascal M, Yagüe J, Cañete JD, Sanmarti R. Calprotectin strongly and independently predicts relapse in rheumatoid arthritis and polyarticular psoriatic arthritis patients treated with tumor necrosis factor inhibitors: a 1-year prospective cohort study. Arthritis Res Ther 2018; 20:275. [PMID: 30545393 PMCID: PMC6292085 DOI: 10.1186/s13075-018-1764-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/08/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Calprotectin is a biomarker of disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and predicts relapse in juvenile idiopathic arthritis. Higher drug trough serum levels are associated with a good response in patients treated with tumor necrosis factor inhibitors (TNFi). Power Doppler ultrasound synovitis is predictive of relapse and structural damage progression in patients in clinical remission. The purpose of this study was to analyze the accuracy of serum calprotectin levels, drug trough serum levels (TSL), and power Doppler (PD) activity as predictors of relapse in RA and PsA patients in remission or with low disease activity receiving TNFi. METHODS This was a longitudinal, prospective, 1-year single-center study of 103 patients (47 RA, 56 PsA) receiving TNFi in remission or with low disease activity (28-joint Disease Activity Score (DAS28) ≤ 3.2). The predictive value of serum calprotectin, TNFi TSL, and PD were assessed using receiver operating characteristic (ROC) analyses. To illustrate the predictive performance of calprotectin, TNFi TSL, and PD score, Kaplan-Meier curves were constructed from baseline to relapse. Associations between baseline factors and relapse were determined using Cox regression models. Multivariate models were constructed to analyze the effect of covariates and to fully adjust the association between calprotectin, TNFi TSL, and PD score with relapse. A generalized estimating equation model with an identity link for longitudinal continuous outcomes was used to assess the effect of covariates on TNFi TSL. RESULTS Ninety-five patients completed 1 year of follow-up, of whom 12 experienced a relapse. At baseline, relapsers had higher calprotectin levels, lower TNFi TSL, and higher PD activity than nonrelapsers. ROC analysis showed calprotectin fully predicted relapse (area under the curve (AUC) = 1.00). TNFi TSL and PD had an AUC of 0.790 (95% confidence interval (CI) 0.691-0.889) and 0.877 (95% CI 0.772-0.981), respectively. Survival analyses and log rank tests showed significant differences between groups according to calprotectin serum levels (p < 0.001), TNFi TSL (p = 0.004), and PD score (p < 0.001). Univariate Cox regression models showed that time-to-remission/low disease activity (hazard ratio (HR) = 1.17, p < 0.001), calprotectin levels (HR = 2.38, p < 0.001), TNFi TSL (HR = 0.47, p = 0.018), and PD score (HR = 1.31, p < 0.001) were significantly associated with disease relapse. In the multivariate analysis, only baseline calprotectin levels independently predicted disease relapse (HR = 2.41, p = 0.002). The generalized estimating equation analysis showed that only disease activity by DAS28-erythrocyte sedimentation rate (ESR) was significantly associated with longitudinal changes in TNFi TSL (regression coefficient 0.26 (0.0676 to 0.0036), p = 0.001). CONCLUSION Time-to-remission/low disease activity, calprotectin serum levels, TNFi TSL, and PD score were significantly associated with disease relapse. However, only baseline calprotectin serum levels independently predicted disease relapse in RA and PsA patients under TNFi therapy.
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Affiliation(s)
- José Inciarte-Mundo
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Maria Victoria Hernández
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Andrea Cuervo
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | | | - Mariona Pascal
- Department of Immunology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Department of Immunology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan D. Cañete
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
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Balsa A, Sanmarti R, Rosas J, Martin V, Cabez A, Gómez S, Montoro M. Drug immunogenicity in patients with inflammatory arthritis and secondary failure to tumour necrosis factor inhibitor therapies: the REASON study. Rheumatology (Oxford) 2018; 57:688-693. [PMID: 29365183 DOI: 10.1093/rheumatology/kex474] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives The aims were to evaluate the prevalence of anti-drug antibodies (ADA) in patients with RA or SpA experiencing secondary failure to anti-TNF therapy and to correlate ADA presence with anti-TNF concentration and clinical response. Methods This was a cross-sectional, observational study of patients with active RA or SpA experiencing secondary failure to etanercept (ETN), infliximab (INF) or adalimumab (ADL). Concomitant non-biologic DMARDs were permitted. Serum anti-TNF and ADA levels were measured with two-site ELISA. Results Among 570 evaluable patients, those with RA (n = 276) were mostly female (80 vs 39%), older (56 vs 48 years), received concomitant DMARDs (83 vs 47%) and had maintained good clinical disease control for longer (202 vs 170 weeks) compared with patients with SpA (n = 294). ADA were found in 114/570 (20.0%) patients; 51/188 (27.1%) against INF and 63/217 (29.0%) against ADL; none against ETN. Of these 114 patients, 92 (81%) had no detectable serum drug concentrations. Proportionately more patients with SpA (31.3%) had anti-INF antibodies than those with RA (21.1%; P = 0.014). A significantly lower proportion of patients receiving concomitant DMARDs (16.5%) developed ADA than those on monotherapy (26.4%; P < 0.05). Conclusion In patients with RA or SpA and secondary failure, the development of ADA against ADL or INF, but not ETN, appears to be one of the main reasons for secondary treatment failure, but not the only one. Further investigations are needed to determine other causes of anti-TNF failure.
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Affiliation(s)
- Alejandro Balsa
- Department of Rheumatology, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Raimon Sanmarti
- Arthritis Unit, Department of Rheumatology, Hospital Clinic de Barcelona and IDIBAPS, Barcelona, Spain
| | - José Rosas
- Department of Rheumatology, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | | | - Ana Cabez
- Medical Affairs, Pfizer España, Madrid, Spain
| | - Susana Gómez
- Inflammation Rheumatology, Medical Department, Pfizer SLU, Madrid, Spain
| | - María Montoro
- Inflammation Rheumatology, Medical Department, Pfizer SLU, Madrid, Spain
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Diaz-Torne C, Ortiz MDA, Moya P, Hernandez MV, Reina D, Castellvi I, De Agustin JJ, Fuente DDL, Corominas H, Sanmarti R, Zamora C, Cantó E, Vidal S. The combination of IL-6 and its soluble receptor is associated with the response of rheumatoid arthritis patients to tocilizumab. Semin Arthritis Rheum 2017; 47:757-764. [PMID: 29157669 DOI: 10.1016/j.semarthrit.2017.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND IL-6 contributes significantly to the chronic inflammatory process of rheumatoid arthritis (RA). Tocilizumab, a humanized anti-human IL-6 receptor antibody that blocks the signaling originated by the IL-6/IL-6R complex, is an effective treatment. However, predictors of the response to tocilizumab are still required. We aimed to combine IL-6 and soluble IL-6R (sIL-6R) levels to identify groups of responses. METHODS Heparinized blood and clinical data from 63 RA patients were collected before treatment and after 3 and 6 months. Two-step clustering (SPSS v.18) was used to establish the relationship between IL-6 and sIL-6R. Then, we compared European League Against Rheumatism (EULAR) response criteria with remission achievement in the groups of patients. RESULTS Three statistical significant clusters of RA patients (i.e., g1, g2, and g3) were defined by serum concentrations of IL-6 and sIL-6R at baseline. All groups of RA patients had higher IL-6 and sIL-6R levels than healthy donors. The levels of IL-6 expressed as median (IQR) in g1 patients were 124(90-183)pg/ml, in g2 12.3(4.4-24)pg/ml, and in g3 60.1(30-146)pg/ml (p < 0.001). The levels of sIL-6R expressed as mean ± sd in g1 patients were 250.5 ± 72ng/ml, in g2 269.1 ± 125ng/ml, and in g3 732.7 ± 243ng/ml (p < 0.001). Disease activity score (DAS)28, C-reactive protein, and erythrocyte sedimentation rate were comparable in the three groups at baseline. Disease duration in g3 was the longest (median(IQR) years: g1 = 11(5-15), g2 = 12(8-20), and g3 23(16-26); p = 0.006), with years of disease evolution being correlated with sIL-6R levels (R = 0.417, p < 0.001). Simple and Clinical Disease Activity Index (SDAI and CDAI) decreased significantly in the three groups. However, EULAR response criteria and remission achievement at 6m was different in the three groups (p = 0.03 and 0.04, respectively). In all. 17 out of the 18 patients in g1 had a good or moderate response to tocilizumab. Conversely, the percentage of patients with no response to tocilizumab was higher in g3 than in g1 and g2. We also observed different changing patterns of IL-6 and sIL-6R levels among the three groups. CONCLUSIONS RA patients could be easily stratified prior to therapeutic intervention with two molecules related to the pathway blocked by tocilizumab. G1 patients, who had the best response to tocilizumab, had the highest level of IL-6 and the lowest level of sIL-6R.
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Affiliation(s)
- Cesar Diaz-Torne
- Department of Rheumatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
| | - Maria Dels Angels Ortiz
- Department of Immunology, Institut de Recerca, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Patricia Moya
- Department of Rheumatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Delia Reina
- Department of Rheumatology, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Ivan Castellvi
- Department of Rheumatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | | | - Hector Corominas
- Department of Rheumatology, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Raimon Sanmarti
- Unit of Rheumatology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Carlos Zamora
- Department of Immunology, Institut de Recerca, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Elisabet Cantó
- Department of Immunology, Institut de Recerca, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Silvia Vidal
- Department of Immunology, Institut de Recerca, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
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Inciarte-Mundo J, Victoria Hernández M, Ruiz-Esquide V, Raquel Cabrera-Villalba S, Ramirez J, Cuervo A, Pascal M, Yagüe J, Cañete JD, Sanmarti R. Serum Calprotectin Versus Acute-Phase Reactants in the Discrimination of Inflammatory Disease Activity in Rheumatoid Arthritis Patients Receiving Tumor Necrosis Factor Inhibitors. Arthritis Care Res (Hoboken) 2017; 68:899-906. [PMID: 26841119 DOI: 10.1002/acr.22795] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/26/2015] [Accepted: 11/17/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the accuracy of serum calprotectin and acute-phase reactants (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) in stratifying disease activity in rheumatoid arthritis (RA) patients receiving tumor necrosis factor inhibitors (TNFi), and to correlate calprotectin levels with TNFi trough serum levels. METHODS We conducted a cross-sectional study of 87 RA patients receiving adalimumab, etanercept (ETN), or infliximab (IFX); 56 psoriatic arthritis (PsA) patients and 40 healthy blood donors were included as controls. Associations between calprotectin, CRP, and ESR and composite articular indices (Disease Activity Score in 28 joints [DAS28], Simplified Disease Activity Index [SDAI], and Clinical Disease Activity Index) were analyzed by correlation and linear regression and the accuracy and discriminatory capacity of calprotectin by receiver operator characteristic curves (area under the curve [AUC]). RESULTS Calprotectin levels correlated better with all composite activity indices than CRP and ESR (all r coefficients >0.70). Calprotectin levels were significantly lower in RA and PsA patients in clinical remission compared with those with low disease activity for all articular indices. In RA, ESR discriminated between remission and low disease activity only when using DAS28, and CRP only with SDAI. In RA patients in remission/low disease activity, calprotectin but not CRP or ESR distinguished between patients with no swollen joints and those with ≥1 swollen joint (1.74 μg/ml versus 3.04 μg/ml; P = 0.010). Using DAS28 ≥2.6 as the reference variable, calprotectin showed an AUC of 0.92; the best cutoff was ≥2.47 μg/ml with a likelihood ratio of 6.3 (95% confidence interval 2.5-15.8). Calprotectin serum levels inversely correlated with trough serum drug levels of ETN (ρ = -0.671, P < 0.001) and IFX (ρ = -0.729, P = 0.017). CONCLUSION Calprotectin may more accurately discriminate disease activity in RA patients receiving TNFi than acute-phase reactants, even in patients with low inflammatory activity.
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Affiliation(s)
| | | | | | | | - Julio Ramirez
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrea Cuervo
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan D Cañete
- Hospital Clinic, University of Barcelona, Barcelona, Spain
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Inciarte‐Mundo J, Sanmarti R. Reply. Arthritis Care Res (Hoboken) 2017; 69:606-607. [DOI: 10.1002/acr.23125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | - Raimon Sanmarti
- Hospital Clinic de Barcelona and University of BarcelonaBarcelona Spain
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Tornero Molina J, Calvo Alen J, Ballina J, Belmonte MÁ, Blanco FJ, Caracuel MÁ, Carbonell J, Corominas H, Chamizo E, Hidalgo C, Ivorra JR, Marenco JL, Moreno Muelas JV, Muñoz-Fernández S, Nolla JM, Pérez T, Sanmarti R, Trenor P, Urrego C, Vidal J, Rosas Gomez de Salazar J. Recommendations for the use of parenteral methotrexate in rheumatic diseases. ACTA ACUST UNITED AC 2017; 14:142-149. [PMID: 28082032 DOI: 10.1016/j.reuma.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience. METHODS A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). RESULTS Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text. CONCLUSIONS The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
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Affiliation(s)
| | | | - Javier Ballina
- Hospital Universitario Central de Asturias, Oviedo, España
| | | | | | | | | | | | | | - Cristina Hidalgo
- Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | | | | | | | - Joan M Nolla
- Hospital Universitari de Bellvitge, Barcelona, España
| | | | | | | | | | - Javier Vidal
- Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España
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Inciarte-Mundo J, Ramirez J, Hernández MV, Ruiz-Esquide V, Cuervo A, Cabrera-Villalba SR, Pascal M, Yagüe J, Cañete JD, Sanmarti R. Calprotectin and TNF trough serum levels identify power Doppler ultrasound synovitis in rheumatoid arthritis and psoriatic arthritis patients in remission or with low disease activity. Arthritis Res Ther 2016; 18:160. [PMID: 27391315 PMCID: PMC4938924 DOI: 10.1186/s13075-016-1032-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Serum levels of calprotectin, a major S100 leucocyte protein, are associated with disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. Higher drug trough serum levels are associated with good response in patients treated with tumour necrosis factor inhibitors (TNFi). Power Doppler ultrasound (PDUS) synovitis is predictive of flare and progression of structural damage in patients in clinical remission. The purpose of this study was to analyse the accuracy of calprotectin and TNFi trough serum levels in detecting PDUS synovitis in RA and PsA patients in clinical remission or with low disease activity who were receiving TNFi. Methods We conducted a cross-sectional study of 92 patients (42 with RA, 50 with PsA) receiving adalimumab (ADA), etanercept (ETN) or infliximab who were in remission or had low disease activity (28-joint Disease Activity Score based on erythrocyte sedimentation rate <3.2). Associations of calprotectin, TNFi trough serum levels and acute phase reactants with PDUS synovitis were assessed using correlation and linear regression analyses. The accuracy and discriminatory capacity in detecting PDUS synovitis was assessed using ROC curves. Results PDUS synovitis was found in 62.4 % of RA patients and 32 % of PsA patients. Both RA and PsA patients with PDUS synovitis had higher calprotectin levels and lower TNFi trough serum levels. Calprotectin positively correlated with ultrasound scores (all r coefficients >0.50 in RA). Calprotectin correlated with the PDUS synovitis score in patients treated with ADA and ETN. Using PDUS synovitis (yes or no) as the reference variable, calprotectin had an AUC of 0.826. The best cut-off was ≥1.66 μg/ml, with a likelihood ratio of 2.77. C-reactive protein (AUC 0.673) and erythrocyte sedimentation rate (AUC 0.731) had a lower discriminatory capacity. TNFi trough serum levels were significantly associated with PDUS synovitis (OR 0.67, 95 % CI 0.52–0.85, p < 0.001) but their accuracy (AUC <0.5) was less than that of calprotectin. TNFi trough serum levels were inversely correlated with calprotectin and PDUS synovitis in RA and PsA patients receiving ADA and ETN. Conclusions Calprotectin and TNFi trough serum levels may help identify PDUS synovitis in RA and PsA patients in clinical remission or with low disease activity.
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Affiliation(s)
- José Inciarte-Mundo
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Maria Victoria Hernández
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Virginia Ruiz-Esquide
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Andrea Cuervo
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Sonia Raquel Cabrera-Villalba
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Mariona Pascal
- Department of Immunology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Department of Immunology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan D Cañete
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - Raimon Sanmarti
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain.
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Hernández M, Sánchez-Piedra C, Cañete J, Sánchez-Alonso F, Manero-Ruiz J, Ortiz-García A, Rosello Pardo R, Pérez-Pampín E, Rodriguez-Lozano C, Sanmarti R, Gomez-Reino J. AB0361 Evaluation of Baseline Characteristics of Rheumatoid Arthritis Patients Treated with Abatacept or Tumor Necrosis Factor Inhibitors in Clinical Practice in Spain:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Choy E, Caporali R, Xavier R, Fautrel B, Sanmarti R, Bernasconi C, Pethö-Schramm A. FRI0215 Subcutaneous Tocilizumab as Monotherapy or in Combination with A csDMARDs in Patients with Rheumatoid Arthritis – Interim Analysis of A Large Phase IV International Umbrella Study, “Tozura”. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Inciarte-Mundo J, Hernández M, Ruiz-Esquide V, Ramírez J, Cuervo A, Cabrera-Villalba S, Pascal M, Yagüe J, Cañete J, Sanmarti R. AB0208 Prediction of Flare in Rheumatoid Arthritis and Psoriatic Arthritis Patients with Low Disease Activity Receiving Tnf Inhibitors: Role of Calprotectin and Drug Trough Serum Levels. A One-Year Prospective Cohort Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arévalo Salaet M, Aparicio M, Pontes C, Torres F, Salman T, Blanco F, Sellas A, Sanmarti R, Gratacos J. SAT0404 Evaluation of The Clinical Usefulness of A Standardized Dose Reduction Protocol for Maintenance of Remission in Patients with As under anti-TNF Treatment: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sanmarti R, Inciarte-Mundo J, Estrada-Alarcόn P, García-Manrique M, Narvaez J, Gόmez-Centeno A, Rodríguez-Moreno J, Pascal M, Yagüe J. FRI0093 Immunogenicity of TNF Inhibitors in Patients with Rheumatoid Arthritis or Polyarticular Psoriatic Arthritis in Clinical Remission or Low Disease Activity: A One-Year Multicentre Prospective Study (The Inmunoremar Study). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Inciarte-Mundo J, Ruiz-Esquide V, Hernández MV, Cañete JD, Cabrera-Villalba SR, Ramirez J, Yagüe J, Sanmarti R. Calprotectin more accurately discriminates the disease status of rheumatoid arthritis patients receiving tocilizumab than acute phase reactants. Rheumatology (Oxford) 2015; 54:2239-43. [PMID: 26242859 DOI: 10.1093/rheumatology/kev251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the accuracy of serum calprotectin levels, CRP and ESR in stratifying disease activity in RA patients receiving tocilizumab (TCZ). METHODS Cross-sectional study of 33 RA patients receiving TCZ. DAS28, Simplified Disease Activity Index, Clinical Disease Activity Index, joint counts and serum levels of CRP, ESR, calprotectin and TCZ were measured. Associations between calprotectin, ESR and CRP and articular indices were analysed by correlation and linear regression. The accuracy and discriminatory capacity of calprotectin was assessed by receiver operating characteristic curves (area under the curve). RESULTS Calprotectin levels, but not CRP or ESR, were strongly correlated with all composite indices (all r coefficients over 0.50). Calprotectin, but not CRP or ESR, was significantly lower in patients in remission compared with those with low disease activity [1.57 μg/ml (s.d. 1) vs 3.35 μg/ml (s.d. 1), P = 0.001]. In a fully adjusted model (R(2) = 0.82), DAS28-ESR increased 0.48 units per μg/ml calprotectin increase (P < 0.001). Using a DAS28 >3.2 as the reference variable, calprotectin showed an area under the curve of 0.922, and the best cut-off was 5.19 μg/ml (odds ratio 11.5). CRP levels, but not calprotectin, were dependent on detectable TCZ trough serum levels. CONCLUSION Calprotectin serum levels seem to be an accurate biomarker for assessing disease activity in RA patients receiving TCZ.
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Affiliation(s)
| | | | | | | | | | | | - Jordi Yagüe
- Department of Immunology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Inciarte-Mundo J, Hernández M, Ruiz-Esquide V, Ramírez J, Cuervo A, Amaya J, Pascal M, Yagüe J, Cañete J, Sanmarti R. SAT0118 Calprotectin Stratifies Disease Activity Better than Acute Phase Reactants in Rheumatoid Arthritis Patients Receiving TNF Inhibitors: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tornero J, Fernández-Nebro A, Blanco F, Gonzalez-Alvaro I, Sanmarti R, Maymo J, Ballina J, Fernández-Gutierrez B, Olive A, Corominas H, Erra A, Pluma A, Alonso A, Tortosa R, Lόpez Lasanta M, Marsal S. AB1128 Epidemiological Comparative Analysis in a Large Cohort of Rheumatoid Arthritis Patients: Results of the Spanish IMID Consortium. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Inciarte-Mundo J, Hernández M, Cabrera-Villalba S, Ruiz-Esquide V, Ramírez J, Cuervo A, Cañete J, Sanmarti R. FRI0044 Dose Reduction of Biological Therapy in Rheumatic Diseases: A Two-Year Prospective Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sanmarti R, Inciarte-Mundo J, Estrada Alarcόn P, García Manrique M, Narvaez J, Rodríguez J, Gόmez Centeno T, Pascal M, Yagüe J. FRI0133 Serum Levels of TNF Antagonists in Rheumatoid Arthritis: Can we Establish an Optimal Cut-Off to Identify Patients in Remission or Low Disease Activity? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ruiz-Esquide V, Zufferey P, Yagüe J, Berner J, Inciarte-Mundo J, González-Navarro A, Hernández V, Ramírez J, Cuervo A, Cañete J, Sanmarti R. OP0032 Relationship Between Clinical Remission and Serum Levels of Tocilizumab in the Treatment of Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cabrera Villalba S, Gomara M, Ramirez J, Salvador G, Ruiz-Esquide V, Hernandez M, Inciarte-Mundo J, Cuervo A, Cañete J, Sanmarti R. THU0113 Differing Isotypes of the Anti-Citrullinated Peptide/Protein Antibodies in Palindromic Rheumatism and Rheumatoid Arthritis: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sanmarti R, Inciarte-Mundo J, Estrada-Alarcon P, Garcia-Manrique M, Narvaez J, Rodriguez-Moreno J, Gomez-Centeno A, Pascal M, Yagüe J. Towards optimal cut-off trough levels of adalimumab and etanercept for a good therapeutic response in rheumatoid arthritis. Results of the INMUNOREMAR study. Ann Rheum Dis 2015; 74:e42. [DOI: 10.1136/annrheumdis-2015-207530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 11/03/2022]
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Cabrera-Villalba S, Ramirez J, Salvador G, Ruiz-Esquide V, Hernández MV, Inciarte-Mundo J, Gómez-Puerta JA, Cañete JD, Sanmarti R. Is There Subclinical Synovitis in Patients with Palindromic Rheumatism in the Intercritical Period? A Clinical and Ultrasonographic Study According to Anticitrullinated Protein Antibody Status. J Rheumatol 2014; 41:1650-5. [DOI: 10.3899/jrheum.131545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective.To investigate the presence of subclinical synovitis by ultrasound (US) and the clinical phenotype in patients with palindromic rheumatism (PR) according to anticitrullinated protein antibody (ACPA) status.Methods.Fifty-four patients with PR were studied. Clinical, demographic, serological, and therapeutic characteristics were compared in ACPA-positive and ACPA-negative patients. US searching for synovial hypertrophy (SH) and power Doppler signal (PDUS) in 22 joints of the hands was performed in the intercritical period. The results were compared according to ACPA status and with a healthy control group (n = 30). In 10 patients, US was performed during the joint attack.Results.Most patients were female (63%) with a mean disease duration of 11.6 ± 10.7 years. Thirty-six patients (66.7%) were ACPA-positive. ACPA-positive patients had a shorter duration of attacks, a younger age, and less knee involvement at disease onset. US examination showed SH grade ≥ 1 in 79.6% of patients with PR and 50% of controls. Significant US results (SH ≥ 2 or PDUS) were observed in 2.7% and 1.4% of joints assessed and in 33% and 25.9% of patients with PR, respectively. Only 4 patients (7.4%) had US active synovitis (SH ≥ 2 plus PDUS) in at least 1 joint. US assessment showed no significant differences between ACPA-positive and ACPA-negative patients. PDUS was observed in 7 out of 10 patients during attacks.Conclusion.Some differences emerged in the clinical phenotype of PR according to ACPA status. Most patients with PR do not have US subclinical synovitis in the intercritical period, even those who are ACPA-positive.
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Sanmarti R, Inciarte J, Estrada Alarcόn P, Garcia Manrique M, Gonzalez Navarro A, Narvaez J, Rodríguez-Moreno J, Gomez-Centeno A, Yagüe J. FRI0265 Immunogenicity of Anti-TNF Antagonists in Patients with Rheumatoid Arthritis or Polyarticular Psoriatic Arthritis in Clinical Remission or Low Disease Activity: The Inmunoremar Study: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Inciarte-Mundo J, Ramirez Garcia J, Estrada Alarcόn P, Garcia Manrique M, Gonzalez Navarro A, Saura C, Narvaez J, Rodríguez-Moreno J, Gόmez-Centeno A, Yagüe J, Cañete J, Sanmarti R. AB0388 Drug Serum Levels of TNF Antagonists do not Correlate with Subclinical Synovitis by Ultrasound in Patients with Rheumatoid Arthritis and Psoriatic Arthritis in Clinical Remission or Low Disease Activity:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ruiz-Esquide V, González-Navarro A, Yagüe J, Ramírez J, Hernández M, Cabrera-Villalba S, Inciarte-Mundo J, Cañete J, Sanmarti R. SAT0259 Serum Levels of TOCILIZUMAB and Its Relationship with Disease Activity and Drug Dosage in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yeremenko N, Celis R, van Duivenvoorde L, Ramírez J, Marsal S, Pablos J, Sanmarti R, Cañete J, Baeten D. OP0107 Ectopic Lymphoid Neogenesis is Specifically Associated with Activation of the IL-23/IL-17 Pathway in Rheumatoid Synovitis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cabrera-Villalba S, Ruiz-Esquide V, Gomez-Puerta J, Hernandez M, Salvador G, Cañete J, Sanmarti R. AB0336 Clinical significance of serial measurement of anti-citrullinated protein antibodies (ACPA) in patients with palindromic rheumatism. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cabrera-Villaba S, Ramirez Garcia J, Salvador G, Ruiz-Esquide V, Hernández MV, Saura C, Cañete J, Sanmarti R. SAT0015 Searching for Subclinical Synovitis in Palindromic Rheumatism: An Ultrasound Study in 40 Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ruiz-Esquide V, Cabrera-Villalba S, Gόmez-Puerta J, Hernández M, Gόmez-Caballero M, Graell E, Cañete J, Ercilla G, Viñas O, Sanmarti R. AB0340 Association between tobacco and anti-CCP in an early rheumatoid arthritis cohort. A dose-dependent effect:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Magallares B, Quesada E, Lisbona M, Calvet J, Sanmarti R, Reina D, Narvaez J, Diaz-Torne C, Marsal S, Maymo J, Garcia-Manrique M, Moreno M, Hernández V, Corominas H, Nolla J. AB0517 Tocilizumab monotherapy in the clinical practice: Retrospective analysis of a cohort of patients with active rheumatoid arthritis in catalonia, spain. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cañete J, Celis R, Ramírez J, Marsal S, Epis O, Ruiz-Esquide V, Avila G, Sanmarti R, Pablos J. FRI0041 Synovial lymphoid neogenesis in rheumatoid arthritis is associated with higher expression of TH17/23 cytokine axis and higher disease activity. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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