Endothelial dysfunction in young patients with long-term rheumatoid arthritis and low disease activity

Background:Several recent studies have reported that MTX could be discontinued in patients with low disease activity who are taking biologic DMARDs or tofacitinib. However, there are limited studies on whether MTX could be discontinued in patients with low disease activity who have taken MTX for a long term.Objectives:We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.Methods:This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in DAS28 of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.Results:In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the mean time to flare was 98 ± 37.7 days. According to univariable logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic DMARDs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (OR, 1.014; 95% CI, 1.014–1.342; p = 0.031) was significantly associated with flare risk.Conclusion:Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half of the patients remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.Disclosure of Interests:None declared

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Cytogenetic alterations in rheumatoid arthritis patients treated with methotrexate and dry olive leaf extract

Genetika ◽

10.2298/gensr2001067p ◽

2020 ◽

Vol 52 (1) ◽

pp. 67-80

Author(s):

Andrea Pirkovic-Cabarkapa ◽

Lada Zivkovic ◽

Mirjana Zlatkovic-Svenda ◽

Suncica Borozan ◽

Dijana Topalovic ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Chromosome Aberrations ◽

Leaf Extract ◽

Olive Leaf ◽

Low Disease Activity ◽

Cytogenetic Damage ◽

Olive Leaf Extract ◽

Active Disease

Oxidative stress and inflammation are DNA instability factors for rheumatoid arthritis (RA) patients. The aims of this study were to evaluate cytogenetic alterations in Peripheral Blood Lymphocytes (PBL) in two groups of RA patients: the early and the long-term RA group; and to examine potential of concomitant treatment with Methotrexate (MTX) and Dry olive leaf extract (DOLE) against cytogenetic damage in RA patients after a 3-weeks treatment. A total of 32 RA patients and 10healthy individuals were included. RA patients were equally divided into four groups: two groups with early phase RA (one treated with MTX alone, the other in combination with DOLE); and two long-term phase RA groups (group with active disease and group with low disease activity)-both treated with MTX and DOLE combination. PBL cultures were screened for chromosome aberrations and micronuclei frequencies. Significantly increased frequencies of micronuclei were shown in active phase RA disease (both early and long-term) but not in the group with low disease activity, as compared to controls. Chromosome aberrations were detected for all 4 RA groups. The highest frequencies of micronuclei and chromosome aberrations were found in the long-termactive RA group. After 3 weeks-treatment, there were no significant decrease of the micronuclei frequencies compared to baseline, although they were reduced in all RA groups, except for the group with the long-term active disease. High level of cytogenetic damage in RA patients was concordant with duration and activity of the RA disease. At 3 weeks of therapy, neither the combined treatment (MTX+DOLE), nor MTX alone did not affect the frequency of micronuclei formation.

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AB0224 SUSTAINABLE LOW DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: REAL-WORLD EXPERIENCE WITH TOCILIZUMAB

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2335 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1138.1-1138

Author(s):

T. Shivacheva ◽

T. Georgiev ◽

S. Hristova ◽

S. Dimitrov ◽

S. Bogdanova-Petrova ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

Real World ◽

Long Term Results ◽

Sustained Remission ◽

Low Disease Activity ◽

The Mean ◽

Concomitant Hypertension

Background:Sustainability, the ability of drugs to maintain remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA), plays a crucial role for the prevention of structural damage to joints and thus, preserving patients’ functional capacity, health-related quality of life and general sense of well-being. Therefore, studying the sustainable effectiveness of tocilizumab (TCZ) as a monotherapy or combined with methotrexate (MTX) is important (1).Objectives:We aimed to examine to what extend TCZ, alone or combined with MTX, could achieve and further sustain LDA in patients with long-standing RA in the light of current, strictly index-based definitions of LDA and to compare the two versions of DAS28 in patients in real clinical practiceMethods:85 RA patients treated with TCZ for at least eighteen months were consecutively enrolled in the present single-center, retrospective cohort study. All participants met the 1987 ACR classification criteria and attended the rheumatology department of University Hospital “St. Marina” Varna in an outpatient setting. Patients receiving pre-filled syringe contained 162 mg TCZ once weekly subcutaneously. Real-world data were extracted and analyzed from patient’s full medical file. For each visit, disease activity score 28 with ESR and CRP (DAS28-ESR and DAS28-CRP) and simple disease activity index (SDAI) were calculated simultaneously according to generally adopted formulas. A twelve-month result was determined for sustained LDA at each of the patient’s three visits (at 6-month intervals), according to DAS28 and SDAI. Descriptive statistics, Chi square test, Cochran´s Q test, kappa statistic were used, a binary logistics model was compiled to study the impact. Significance level of p <0.05.Results:Two hundred fifty-five patient visits were analyzed. The mean durations of RA and treatment with TCZ were 12.6 (±9.6) years and 3.64 (±1.8) years, respectively. The mean age of patients was 60.3 years (37-87 years), 80% were women, 24.7% were obese, 65.9% have concomitant hypertension. 61.2% of patients are treated with combination therapy TCZ with MTX.Of all patients, these with a sustained 12-month LDA were 41.2%, 28.2% or 23.5% depending on the studied index (DAS28-CRP, SDAI, or DAS28-ESR, respectively).A 12-month SDAI LDA was found in a significantly small proportion of patients (28.2%, p = 0.001). The DAS28 ESR determined a proportion similar to SDAI (23.5%, p> 0.05), while according to the DAS28 CRP, patients with a sustained 12-month LDA were significantly more (41.2% p = 0.005). A moderate level of agreement was found between the assessments of SDAI and the two variants of DAC28 when determining 12-month results of Tocilizumab treatment (DAS28-ESR k = 0.511, p <0.001 and DAC28-CRP k = 0.618, p <0.001). No relationship was found between the combination of TCZ with MTX and the patients’ chance of a sustained 12-month LDA, regardless of which index the result was measured.Patients with hypertension were significantly less likely to have sustained 12-month LDA according to SDAI and DAS 28 ESR (OR 0.135, 95% CI 0.048-0.386; OR 0.313, 95% CI 0.111-0.882, respectively), but not according to DAS28 CRP.Conclusion:Sustained 12- month LDA with TCZ in patients with long-term RA remains uncommon in daily clinical practice. Co-administration of MTX is not associated with an increased likelihood of achieving a sustained LDA in the analysis of long-term responses. Patients with concomitant hypertension are less likely to be in a sustained 12-month LDA, according to SDAI and DAS28-ESR. The results according to DAS28 ESR, but not according to DAS28CRP are comparable to those of SDAI when measuring long-term results of treatment with TCZ.References:[1]Hamann PDH, Pauling JD, McHugh N, Shaddick G, Hyrich K; BSRBR-RA Contributors Group. Predictors, demographics and frequency of sustained remission and low disease activity in anti-tumour necrosis factor-treated rheumatoid arthritis patients. Rheumatology (Oxford). 2019 Dec 1;58(12):2162-2169.Disclosure of Interests:None declared

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4P-1093 Endothelial dysfunction in young rheumatoid arthritis patients with low disease activity

Atherosclerosis Supplements ◽

10.1016/s1567-5688(03)91349-3 ◽

2003 ◽

Vol 4 (2) ◽

pp. 314

Author(s):

S. Marchesi ◽

G. Vaudo ◽

R. Gerli ◽

D. Siepi ◽

M. Pirro ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Endothelial Dysfunction ◽

Disease Activity ◽

Low Disease Activity

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The prediction and long-term maintenance of low disease activity during therapy with disease modifying anti-inflammatory drugs for rheumatoid arthritis

Modern Rheumatology Journal ◽

10.14412/1996-7012-2014-2-66-70 ◽

2014 ◽

Vol 0 (2) ◽

pp. 66 ◽

Cited By ~ 1

Author(s):

E.L. Luchikhina

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Low Disease Activity ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Anti Inflammatory ◽

Term Maintenance

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SAT0028 Strict Acr-Remission within 6 Months Predicts Sustained Long-Term Very Low Disease Activity in Actively Treated Rheumatoid Arthritis Patients, 5-Year Results of the Neo-Raco Trial

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.1754 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A589.1-A589

Author(s):

V. Rantalaiho ◽

H. Kautiainen ◽

M. Korpela ◽

M. Leirisalo-Repo

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Low Disease Activity

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AB0216 LONG-TERM RESULTS OF T2T THERAPY INITIATED AT THE ONSET OF RHEUMATOID ARTHRITIS (DATA FROM OREL REGISTRY)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1552 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1134.2-1134

Author(s):

V. Rybakova ◽

A. Avdeeva ◽

Y. Olyunin ◽

E. Nasonov

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Long Term Results ◽

Treatment Target ◽

Low Disease Activity ◽

Synthetic Dmards ◽

Real Clinical Practice

Background:Current guidelines for the treatment of rheumatoid arthritis (RA) recommend early administration of methotrexate (MTX) and addition of a biologic if MTX monotherapy does not provide remission or low activity of the disease. Efficacy of this strategy in real clinical practice was assessed using data from the Russian RA registry OREL.Objectives:To analyze long-term results of intensive treatment initiated at RA onset in real clinical practice.Methods:141 RA patients with disease duration less than 3 years (29 men, 112 women) were included. 112 were positive for rheumatoid factor and 119 – for anti-cyclic citrullinated peptide antibody. Subcutaneous MTX was initiated at 10-15 mg per week with further dose escalation up to 20-30 mg per week. Therapy was adjusted every 3 months. If MTX monotherapy did not allow to achieve treatment target of remission or low disease activity, biologics were added.Results:Median DAS 28 at baseline was 5,31 [4,79; 6,14]. Initiation of treatment resulted in steady decrease of disease activity (p<0.05, table1). After 1 year of follow-up 33.8% of patients received MTX monotherapy, 33.8% – MTX in combination with tumor necrosis factor alpha inhibitors, 22.0% – MTX +abatacept, 0.55% – MTX+ tocilizumab, 0.47% – MTX + rituximab. Low disease activity was achieved in 16.3% patients, and remission - in 45.8%. After 6 years median age of patients was 58 [49; 66] years, disease duration – 84 [79; 89] months, low disease activity was documented in 21.3%, and remission – in 7.8% of cases (fig. 1). 7% of patients were able to maintain remission without any treatment. Biologics were discontinued in 15 patients after achieving remission or low disease activity, and synthetic DMARDs – in 5 patients having remission.Conclusion:Intensive therapy initiated at RA onset demonstrates high effectiveness, allowing 61.5% of patients to achieve low disease activity or remission within 12 months, and to maintain these results after 6 years of treatment in 29.2%. Adherence to this strategy allowed to discontinue biologics in 15 patients and synthetic DMARDs in 5 patients after achieving treatment target.Figure 1.Changes of the disease activity during follow-upTable 1.Changes of the main inflammatory activity measures, Me [25th; 75th percentile]Parametres012 months6 yearsDAS285,31 [4,79; 6,14]2,85 [2; 3,90] *4,008 [3,4; 4,59] *SDAI28,27 [18,79; 40,73]5,67 [2; 11,98] *15,06 [9,32; 21] *CDAI25 [17; 36]5 [1,7; 11] *15 [9; 21] *ESR (mm/hr)32 [19; 50]16 [8; 30] *16 [10; 25] *CRP (mg/l)26,55 [6,4; 45,30]3,85 [1,5; 11,3]*2,2 [0,9; 4,9] ** p<0.05 in all cases.Disclosure of Interests:None declared

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