1
|
Abstract
"Disease modification" in axial spondyloarthritis (axSpA) seeks to not only alleviate clinical symptoms but also alter the disease's natural course by impeding new bone formation. Recent years have witnessed the effectiveness of treatments, including biologics and nonsteroidal anti-inflammatory drugs, in managing axSpA symptoms. Emerging evidence points toward their potential impact on slowing structural disease progression. This comprehensive review centers on the pivotal role of inhibiting new bone formation in axSpA disease modification. It delves into the significance of imaging techniques for assessing disease progression and explores the disease-modifying properties of available axSpA treatments, encompassing NSAIDs, TNF inhibitors, IL-17 inhibitors, and JAK inhibitors. This article offers valuable insights into the evolving landscape of disease modification strategies in axial spondyloarthritis, highlighting the multifaceted approaches used to attain these objectives.
Collapse
Affiliation(s)
- Brona Dinneen
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.
| | - Finbar O'Shea
- Department of Rheumatology, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lianne Gensler
- Department of Rheumatology, University of California, San. Francisco (UCSF) Medical Centre, California, United States
| |
Collapse
|
2
|
Chivulescu M, Lie ØH, Popescu BA, Skulstad H, Edvardsen T, Jurcut RO, Haugaa KH. High penetrance and similar disease progression in probands and in family members with arrhythmogenic cardiomyopathy. Eur Heart J 2021; 41:1401-1410. [PMID: 31504415 PMCID: PMC7138527 DOI: 10.1093/eurheartj/ehz570] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/24/2019] [Accepted: 07/26/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed to assess structural progression in arrhythmogenic cardiomyopathy (AC) patients and mutation-positive family members and its impact on arrhythmic outcome in a longitudinal cohort study. METHODS AND RESULTS Structural progression was defined as the development of new Task Force imaging criteria from inclusion to follow-up and progression rates as annual changes in imaging parameters. We included 144 AC patients and family members (48% female, 47% probands, 40 ± 16 years old). At genetic diagnosis and inclusion, 58% of family members had penetrant AC disease. During 7.0 [inter-quartile range (IQR) 4.5-9.4] years of follow-up, 47% of family members without AC at inclusion developed AC criteria, resulting in a yearly new AC penetrance of 8%. Probands and family members had a similar progression rate of right ventricular outflow tract diameter (0.5 mm/year vs. 0.6 mm/year, P = 0.28) by mixed model analysis of 598 echocardiographic examinations. Right ventricular fractional area change progression rate was even higher in family members (-0.6%/year vs. -0.8%/year, P < 0.01). Among 86 patients without overt structural disease or arrhythmic history at inclusion, a first severe ventricular arrhythmic event occurred in 8 (9%), of which 7 (88%) had concomitant structural progression. Structural progression was associated with higher incidence of severe ventricular arrhythmic events adjusted for age, sex, and proband status (HR 21.24, 95% CI 2.47-182.81, P < 0.01). CONCLUSION More than half of family members had AC criteria at genetic diagnosis and yearly AC penetrance was 8%. Structural progression was similar in probands and family members and was associated with higher incidence of severe ventricular arrhythmic events.
Collapse
Affiliation(s)
- Monica Chivulescu
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Øyvind H Lie
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Bogdan A Popescu
- Institute for Cardiovascular Diseases C.C. Iliescu, 258, Fundeni street, District 2, 022322 Bucharest Romania.,Carol Davila University of Medicine and Pharmacy, 37, Dionisie Lupu street, District 2, 020021 Bucharest, Romania
| | - Helge Skulstad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Ruxandra O Jurcut
- Institute for Cardiovascular Diseases C.C. Iliescu, 258, Fundeni street, District 2, 022322 Bucharest Romania.,Carol Davila University of Medicine and Pharmacy, 37, Dionisie Lupu street, District 2, 020021 Bucharest, Romania
| | - Kristina H Haugaa
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.,Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| |
Collapse
|
3
|
Legrand J, Kirchgesner T, Sokolova T, Vande Berg B, Durez P. Early clinical response and long-term radiographic progression in recent-onset rheumatoid arthritis: Clinical remission within six months remains the treatment target. Joint Bone Spine 2019; 86:594-599. [PMID: 30928534 DOI: 10.1016/j.jbspin.2019.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The primary objective was to evaluate the correlation between 5-year radiographic structural disease progression and early clinical remission in recent-onset rheumatoid arthritis (RA). The secondary objective was to assess the correlation between erosion development in joints free of damage at baseline and early clinical remission. METHODS A single-center retrospective study was performed in 133 patients meeting ACR criteria for RA of recent onset. Two radiologists independently quantified radiographic structural lesions at the hands and forefeet using the Sharp van der Heijde (SVdH) Score at the diagnosis then 5 years later. The patients were divided into two groups based on whether the lesions were stable (SVdH Score increase ≤ 10 points, Xray-STAB group) or had worsened (SVdH Score increase > 10 points, Xray-PROG group). The clinical response was assessed after 3, 6, and 12 months. Clinical remission was defined based on the DAS28-CRP, SDAI, CDAI, and ACR/EULAR Boolean remission criteria. RESULTS Of the 133 patients, 90 were in the Xray-STAB group (mean SVdH score increase, 2.4 ± 2.9) and 43 in the Xray-PROG group (22.9 ± 13.4). The 6-month disease activity indices were higher in the Xray-PROG group (P < 0.05). Achieving a 6-month clinical remission had 58.6%, 39.1%, 40.0%, and 32.2% sensitivity for predicting 5-year radiographic stability when the DAS28-CRP, SDAI, CDAI, and Boolean definition were used, respectively; corresponding values for specificity were 73.8%, 85.7%, 83.7%, and 90.5%. CONCLUSION Achieving a clinical remission within 6 months is key to preventing radiographic structural progression in patients with recent-onset RA.
Collapse
Affiliation(s)
- Julie Legrand
- Service de radiologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium
| | - Thomas Kirchgesner
- Service de radiologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium
| | - Tatiana Sokolova
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium; Service de rhumatologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium
| | - Bruno Vande Berg
- Service de radiologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium
| | - Patrick Durez
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Bruxelles, Belgium; Service de rhumatologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium.
| |
Collapse
|
4
|
van der Heijde D, Durez P, Schett G, Naredo E, Østergaard M, Meszaros G, De Leonardis F, de la Torre I, López-Romero P, Schlichting D, Nantz E, Fleischmann R. Structural damage progression in patients with early rheumatoid arthritis treated with methotrexate, baricitinib, or baricitinib plus methotrexate based on clinical response in the phase 3 RA-BEGIN study. Clin Rheumatol 2018; 37:2381-2390. [PMID: 30078086 PMCID: PMC6097080 DOI: 10.1007/s10067-018-4221-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 05/01/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022]
Abstract
The objective of this study was to evaluate structural damage progression based on clinical response in rheumatoid arthritis patients with no or limited prior disease-modifying anti-rheumatic drug treatment receiving the Janus kinase (JAK)1/JAK2 inhibitor baricitinib 4 mg, methotrexate (MTX), or the combination. Data from the phase 3 RA-BEGIN study were analysed post hoc. Proportions of patients with structural damage progression (change from baseline greater than the smallest detectable change in modified total Sharp score) at week 52 were evaluated based on sustained Disease Activity Score for 28-joint count with serum high-sensitivity C-reactive protein (DAS28-hsCRP) ≤ 3.2 or Simplified Disease Activity Index (SDAI) score ≤ 11; no formal statistical comparisons between treatments were performed to test these proportions. Baseline factors associated with risk of structural damage progression, including Clinical Disease Activity Index (CDAI) score, were identified using multivariate analysis. Patients achieving versus not achieving sustained DAS28-hsCRP ≤ 3.2 or SDAI score ≤ 11 were less likely to experience structural damage progression at week 52. In patients achieving these responses, structural damage progression was less likely with baricitinib monotherapy or plus MTX than with MTX monotherapy. In patients not achieving these sustained clinical thresholds, structural damage progression was less likely with baricitinib plus MTX than with either monotherapy. Independent of treatment, baseline factors significantly associated with increased risk of structural damage progression included higher hsCRP and CDAI score, smoking, female sex, and lower body mass index. In conclusion, patients achieving versus not achieving sustained DAS28-hsCRP ≤ 3.2 or SDAI score ≤ 11 were less likely to show structural damage progression, irrespective of treatment.
Collapse
Affiliation(s)
| | - Patrick Durez
- Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Eric Nantz
- Eli Lilly & Company, Indianapolis, IN, USA
| | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Zhang P, Luo D, Li P, Sharpsten L, Medeiros FA. Log-gamma linear-mixed effects models for multiple outcomes with application to a longitudinal glaucoma study. Biom J 2015; 57:766-76. [PMID: 26075565 DOI: 10.1002/bimj.201300001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/03/2013] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/09/2022]
Abstract
Glaucoma is a progressive disease due to damage in the optic nerve with associated functional losses. Although the relationship between structural and functional progression in glaucoma is well established, there is disagreement on how this association evolves over time. In addressing this issue, we propose a new class of non-Gaussian linear-mixed models to estimate the correlations among subject-specific effects in multivariate longitudinal studies with a skewed distribution of random effects, to be used in a study of glaucoma. This class provides an efficient estimation of subject-specific effects by modeling the skewed random effects through the log-gamma distribution. It also provides more reliable estimates of the correlations between the random effects. To validate the log-gamma assumption against the usual normality assumption of the random effects, we propose a lack-of-fit test using the profile likelihood function of the shape parameter. We apply this method to data from a prospective observation study, the Diagnostic Innovations in Glaucoma Study, to present a statistically significant association between structural and functional change rates that leads to a better understanding of the progression of glaucoma over time.
Collapse
Affiliation(s)
- Peng Zhang
- Department of Mathematics, Zhejiang University, 86 Zheda Road, Hangzhou, Zhejiang, 310012, China
| | - Dandan Luo
- Bank of Montreal, Toronto M5X 1A1, Canada
| | - Pengfei Li
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Lucie Sharpsten
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, 92093, USA
| |
Collapse
|