Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus

Background:The Coronavirus pandemic caused many consequences on well being, access to care and therapeutic maintenance in patients with chronic diseases.Objectives:To assess the impact of COVID-19 on therapeutic maintenance of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) and to identify related factors to difficulties in access to rheumatologist care during the COVID-19 pandemic.Methods:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics, impact of COVID-19 on access to rheumatologist care and therapeutic maintenance during the confinement. Reasons of therapeutic interruption and of diificulties in access to healthcare were precised.Results:We received answers from 350 patients (female sex of 68%, mean age of 46,1 ± 14,4 years) suffering from Chronic Inflammatory Rheumatic Diseases (CIRD):rheumatic arthritis (RA) (62.3%), spondyloarthropathies (34.3%), and undifferentiated CIRD (3.4%). The global average disease evolution was 12,1 ± 9,7 years.The patients were treated with conventional Disease-modifying anti-rheumatic drugs (cDMARDs) and biologic Disease-modifying anti-rheumatic drugs (bDMARDs) in respectively 67.4% and 30.6% of cases. Corticosteroids and Nonsteroidal Anti-Inflammatories (NSAIDs) intake was noted in 39.1 and 33.7% of patients.Difficulties to access to rheumatologist care appointments were reported in 82.9% of the participants. Reasons of thoses difficulties are summurized in Figure 1.Figure 1.Causes of difficulties of access to Rheumatologist care during COVID-19 pandemic.Half of patients declared that the pandemic had affected their therapeutic compliance. Discontinued drugs were in decreasing order: Synthetic antimalarials (68.4%), NSAIDs (45.8%), Methotrexate (43.8%), bDMARDs (25.2%), Sulfasalazine (18.2%) and Corticosteroids (10,2%).Causes of treatments interruption are summarized in Table I.Table 1.Causes of treatments interuption in patients with CIRDDrugsNot found in pharmaciesThe pharmacy refuses to give me the treatment without a recent prescriptionTo avoid the decrease in immunity and therefore to avoid catching Covid-19I stopped the follow-up, and so I stopped the treatment...Other reasonsNSAIDS027.874.144.427.8Corticosteroids014.392.957.150Methotrexate70.1310.416.422.4Sulfasalazine012.52575100Synthetic antimalarial69.20023.161.5Leflunomide00000bDMARDs07.440.744.451.9Conclusion:The COVID-19 pandemic impacted heavly on therapeutic maintenance in CIRD patients in our country. Patients expressed many difficulties in access to appropiate management. Facing to all thoses consequences, we need to devolopp as soon as possible adequate solutions adapted in such health crisis, especially therapeutic education and telemedecine.Disclosure of Interests:None declared

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Perygravid management of rheumatic disease

HEALTH OF WOMAN ◽

10.15574/hw.2020.148.42 ◽

2020 ◽

pp. 42-51

Author(s):

I.Yu. Golovach ◽

◽

Ye.D. Yehudina ◽

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases ◽

Key Words Pregnancy ◽

Disease Modifying Drugs ◽

The Past ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Targeted Approach ◽

Necrosis Factor

Management of inflammatory rheumatic diseases in preconception period, pregnancy and breastfeeding has undergone significant changes over the past few years. Modern therapy, including biological and targeted synthetic disease modifying drugs, has significantly improved the control of rheumatic diseases, which has led to an increase in the patients’ number planning a pregnancy with serious diseases. When consulting such patients, it is necessary to discuss the possible time of conception (regarding the activity of the disease), the effect of the disease on pregnancy and pregnancy on the disease, as well as the potential need to change the regimen of medications during pregnancy and breastfeeding. This review summarizes information on the effects of pregnancy on various rheumatic diseases and vice versa, changes in therapy and monitoring of patients with rheumatic diseases before, during and after pregnancy. Women with inflammatory rheumatic diseases need advice on drug therapy before planning pregnancy, during pregnancy, and breastfeeding. Safe disease-modifying drugs that can be taken during pregnancy are hydroxychloroquine, sulfosalazine, azathioprine, and cyclosporine. Glucocorticoids and non-steroidal anti-inflammatory drugs can also be taken up to 32 weeks of gestation. Most inhibitors of tumor necrosis factor (anti-TNF) are also safe during pregnancy. During pregnancy, a clear monitoring of the activity of the disease is necessary, control of the level of autoantibodies, especially anti-SSA / Ro and anti-SSB / La and antiphospholipid antibodies, an assessment of the degree of organ dysfunction, especially kidney damage. Presented are modern approaches to optimizing the management of inflammatory rheumatic disease during pregnancy. For patients with inflammatory rheumatic diseases, a successful pregnancy outcome is optimized by creating an individual plan to suppress disease activity using a targeted approach. Key words: pregnancy, rheumatic diseases, treatment, lactation, management tactics, drugs.

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Human Papilloma Virus Vaccination and Chronic Inflammatory Rheumatic Diseases.

Case Medical Research ◽

10.31525/ct1-nct04180228 ◽

2019 ◽

Author(s):

Keyword(s):

Human Papilloma Virus ◽

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases ◽

Papilloma Virus ◽

Virus Vaccination ◽

Chronic Inflammatory Rheumatic Diseases ◽

Human Papilloma Virus Vaccination

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Body Mass Index and Disease Activity in Chronic Inflammatory Rheumatic Diseases: Results of the Cardiovascular in Rheumatology (Carma) Project

Journal of Clinical Medicine ◽

10.3390/jcm10030382 ◽

2021 ◽

Vol 10 (3) ◽

pp. 382

Author(s):

Jesús A. Valero-Jaimes ◽

Ruth López-González ◽

María A. Martín-Martínez ◽

Carmen García-Gómez ◽

Fernando Sánchez-Alonso ◽

...

Keyword(s):

Body Mass Index ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Body Mass ◽

Rheumatic Diseases ◽

Activity Index ◽

Response To Therapy ◽

Inflammatory Rheumatic Diseases ◽

Psoriasis Area Severity Index ◽

Chronic Inflammatory Rheumatic Diseases

Objective: Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. Methods: Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. Results: Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01–0.05); p = 0.007) and PsA (β = 0.036; 95%CI (0.015–0.058); p = 0.001) but not in those with AS (β = 0.001; 95%CI (−0.03–0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. Conclusions: BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients.

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SAT0450 GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A MULTIVARIATE LINEAR REGRESSION ANALYSIS IDENTIFYING PREDICTIVE FACTORS FOR LOW BONE MASS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4427 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1182.2-1182

Author(s):

E. Wiebe ◽

D. Freier ◽

D. Huscher ◽

R. Biesen ◽

S. Hermann ◽

...

Keyword(s):

Bone Mass ◽

Rheumatic Diseases ◽

Positive Association ◽

Fragility Fractures ◽

Life Time ◽

Inflammatory Rheumatic Diseases ◽

Low Bone Mass ◽

Cross Sectional ◽

Chronic Inflammatory Rheumatic Diseases ◽

Prevalence Of Osteoporosis

Background:Rheumatic diseases are associated with increased systemic bone loss and fracture risk related to chronic inflammation, disease-specific, general and demographic risk factors as well as treatment with glucocorticoids (GC). Yet, there is evidence that GCs may, by adequately suppressing systemic inflammation, also have a positive effect on bone mineral density (BMD) and fracture risk1.Objectives:The purpose of this study was to investigate the prevalence of osteoporosis and fragility fractures in patients with inflammatory rheumatic diseases and to analyze the impact that treatment with GCs, other known risk factors and preventive measures have on bone health in these patients.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic inflammatory rheumatic diseases and psoriasis treated with GCs. In this cross-sectional analysis, we evaluated the initial visit of 1091 patients. A multivariate linear regression model with known or potentially influential factors adjusted for age and sex was used to identify predictors of BMD as measured by dual-energy X-ray absorptiometry (DXA). Multiple imputation was applied for missing baseline covariate data.Results:In the total cohort of 1091 patients (75% female of which 87.5% were postmenopausal) with a mean age of 62.1 (±13.2) years, the prevalence of osteoporosis by DXA was 21.7%, while fragility fractures have occurred in 31.2% of the study population (6.7% vertebral, 27.7% non-vertebral). Current GC therapy was common (64.9%), with a median daily dose of 5.0mg [0.0;7.5], a mean life-time total GC dose of 17.7g (±24.6), and a mean GC therapy duration of 7.8 years (±8.5). Bisphosphonates were the most commonly used anti-osteoporotic drug (12.6%).Multivariate analysis showed that BMD as expressed by the minimum T-Score at all measured sites was negatively associated with higher age, female sex and menopause as well as Denosumab and Bisphosphonate treatment. A positive association with BMD was found for body mass index as well as current and life-time (cumulative) GC dose. While comedication with proton-pump-inhibitors significantly predicted low bone mass, concomitant use of non-steroidal anti-inflammatory drugs showed a positive association with BMD. Of the measured bone-specific laboratory parameters, higher alkaline phosphatase levels were determinants of low DXA-values, while the association was positive for gamma-glutamyltransferase.BMD was neither predicted by duration of GC treatment nor by treatment with disease modifying anti-rheumatic drugs.Predictive variables for BMD differed at the respective anatomical site. While treatment with Denosumab predicted low bone mass at the lumbar spine and not at the femoral neck, the opposite was true for health assessment questionnaire (HAQ) score. Current and life-time GC-dose as well as direct sun-exposure of more than 30 minutes daily were positively associated with bone mass at the femoral sites only.Conclusion:This cross-sectional analysis of a prospective cohort study quantified the prevalence of osteoporosis and identified predictive variables of BMD in patients with rheumatic diseases.Multivariate analyses corroborated low BMD to be predicted by traditional factors like age, female sex and menopause but showed current and well as life-time GC dose to be positively associated with BMD in our cohort of patients with chronic inflammatory rheumatic diseases. This suggests that optimal management of disease activity with GCs might be beneficial in order to avoid bone loss due to inflammation.References:[1]Güler-Yüksel et al. “Glucocorticoids, Inflammation and Bone.” Calcified Tissue International (January 08 2018).Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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