P442 Serum vedolizumab trough levels are associated with remission rate but not with extra-intestinal manifestations in IBD patients

Abstract Background The correlation between vedolizumab trough levels and inflammatory bowel diseases (IBD) remission rates has not yet been fully defined. We aimed to evaluate the association between vedolizumab serum trough levels and disease clinical and extra-intestinal manifestations (EIMs) and biomarker activity in IBD patients. Methods Forty-six patients (31 ulcerative colitis, 15 Crohn’s disease) who started vedolizumab therapy were retrospectively followed. Clinical and laboratory data were collected before treatment, during induction and maintenance until week 52 from initiation. Documentation of EIMs included peripheral and axial arthropathy, cutaneous and ocular manifestations and perianal disease. Clinical remission was defined as a Harvey-Bradshaw Index (HBI)<5 or a Simple Clinical Colitis Activity Index (SCCAI)<3. Biomarker normalization was defined as C-reactive protein level<5 mg/L and fecal calprotectin level<250 µg/g. Two-sample t-tests were used to find correlations between drug levels and disease activity. Results Higher week-2 trough serum vedolizumab levels were associated with week 14 clinical remission compared to patients with an active disease (30.55±2.22 µg/ml vs 22.28±3.57µg/ml, p=0.05) and with weeks-14 and -30 biomarker normalization (33.77±2.98 µg/ml vs 23.6±3.19 µg/ml, p=0.05 and 30.33±1.95 µg/ml vs 19.66±6.83 µg/ml, p=0.05, respectively). Week-6 vedolizumab levels were associated with week-30 clinical remission (30.52±3.48 µg/ml vs 15.35±4.94 µg/ml, p=0.03) and biomarker normalization (28.44±2.36 µg/ml vs 15.76±4.87µg/ml, p=0.02), and week 14 vedolizumab levels were associated week 30 biomarker normalization (14.81±1.64 µg/ml vs 6.23±2.25 µg/ml, p=0.03). Throughout the follow-up period, 24% of patients presented with EIMs (n=11). No association was found between vedolizumab levels and endoscopic outcomes or EIMs activity. Conclusion Trough serum vedolizumab levels at induction is associated with remission induction and maintenance but not with EIMs improvement. Assessment of early vedolizumab trough levels may be considered for prediction of response to therapy.

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Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

ISRN Gastroenterology ◽

10.1155/2013/179024 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

Kaija-Leena Kolho ◽

Dan Turner

Keyword(s):

Ulcerative Colitis ◽

Clinical Outcome ◽

Roc Curve ◽

Clinical Remission ◽

Activity Index ◽

Fecal Calprotectin ◽

Elisa Test ◽

Clinical Activity ◽

High Level ◽

Active Disease

Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100 μg/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≥ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000 μg/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μg/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57–0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58–0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation.

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Association of Early Postinduction Adalimumab Exposure With Subsequent Clinical and Biomarker Remission in Children with Crohn’s Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa247 ◽

2020 ◽

Author(s):

Firas Rinawi ◽

Amanda Ricciuto ◽

Peter C Church ◽

Karen Frost ◽

Eileen Crowley ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Primary Outcome ◽

Activity Index ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Fecal Calprotectin ◽

Clinical Biomarker ◽

Objective Outcomes ◽

Trough Levels

Abstract Background Data on the association between early postinduction serum adalimumab (ADA) trough levels (TLs) and objective outcomes are scarce. The aim of this study was to investigate whether early ADA TLs at weeks 4 and 8 are associated with clinical and biomarker remission at week 24 in pediatric Crohn’s disease (CD). Methods Adalimumab TLs at weeks 4 and 8 were prospectively measured in anti-TNF-naïve children initiating treatment with ADA monotherapy for luminal inflammatory CD. The primary outcome was combined clinical and biomarker remission at week 24, defined as achieving steroid-free clinical remission (Pediatric CD activity index <10) and biomarker remission (fecal calprotectin <250 µg/g and CRP <5 µg/mL). Results Among 65 patients, 39 (60%) achieved combined clinical/biomarker remission at week 24 without dose escalation. Adalimumab TLs at both weeks 4 and 8 were significantly higher in remitters vs nonremitters at week 24 (P < 0.001 and P = 0.002, respectively). Adalimumab levels at weeks 4 and 8 were good predictors of combined clinical/biomarker remission at week 24 (area under the curve, 0.887, 95% CI, 0.798–0.942; and area under the curve, 0.761, 95% CI, 0.632–0.899, respectively). The best ADA TL cutoffs at weeks 4 and 8 for predicting clinical/biomarker remission at week 24 were 22.5 µg/mL (80% sensitivity, 90% specificity, positive likelihood ratio [LR+] 8.0, negative LR [LR-] 0.2) and 12.5 µg/mL (94% sensitivity, 60% specificity, LR+ 2.4, LR- 0.1), respectively. Higher induction doses per m2 correlated positively with TLs at weeks 4 and 8. Conclusion Greater early ADA exposure is associated with superior clinical/biomarker outcomes at week 24.

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A Novel UC Exclusion Diet and Antibiotics for Treatment of Mild to Moderate Pediatric Ulcerative Colitis: A Prospective Open-Label Pilot Study

Nutrients ◽

10.3390/nu13113736 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3736

Author(s):

Chen Sarbagili-Shabat ◽

Lindsey Albenberg ◽

Johan Van Limbergen ◽

Naomi Pressman ◽

Anthony Otley ◽

...

Keyword(s):

Ulcerative Colitis ◽

Pilot Study ◽

Clinical Remission ◽

Activity Index ◽

Pilot Trial ◽

Fecal Calprotectin ◽

Open Label ◽

Intention To Treat ◽

Exclusion Diet ◽

Stable Maintenance

Background: As the microbiome plays an important role in instigating inflammation in ulcerative colitis (UC), strategies targeting the microbiome may offer an alternative therapeutic approach. The goal of the pilot trial was to evaluate the potential efficacy and feasibility of a novel UC exclusion diet (UCED) for clinical remission, as well as the potential of sequential antibiotics for diet-refractory patients to achieve remission without steroids. Methods: This was a prospective, single-arm, multicenter, open-label pilot study in patients aged 8–19, with pediatric UC activity index (PUCAI) scores >10 on stable maintenance therapy. Patients failing to enter remission (PUCAI < 10) on the diet could receive a 14-day course of amoxycillin, metronidazole and doxycycline (AMD), and were re-assessed on day 21. The primary endpoint was intention-to-treat (ITT) remission at week 6, with UCED as the only intervention. Results: Twenty-four UCED treatment courses were given to 23 eligible children (mean age: 15.3 ± 2.9 years). The median PUCAI decreased from 35 (30–40) at baseline to 12.5 (5–30) at week 6 (p = 0.001). Clinical remission with UCED alone was achieved in 9/24 (37.5%). The median fecal calprotectin declined from 818 (630.0–1880.0) μg/g at baseline to 592.0 (140.7–1555.0) μg/g at week 6 (p > 0.05). Eight patients received treatment with antibiotics after failing on the diet; 4/8 (50.0%) subsequently entered remission 3 weeks later. Conclusion: The UCED appears to be effective and feasible for the induction of remission in children with mild to moderate UC. The sequential use of UCED followed by antibiotic therapy needs to be evaluated as a microbiome-targeted, steroid-sparing strategy.

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Tu1997 The Rapid Fecal Calprotectin Test in IBD Patients in Clinical Remission: Correlations With Activity Index, IBS-Like Symptoms, Anxiety, Depression and Quality of Life

Gastroenterology ◽

10.1016/s0016-5085(16)33389-3 ◽

2016 ◽

Vol 150 (4) ◽

pp. S1001

Author(s):

Daniel Cohen-Lyons ◽

Amir Nazarian ◽

Nadia Griller ◽

Gabor Kandel ◽

Samir C. Grover ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Remission ◽

Activity Index ◽

Fecal Calprotectin ◽

Anxiety Depression

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22 CHANGE IN FECAL CALPROTECTIN AND LACTOFERRIN PREDICT CLINICAL REMISSION FOLLOWING INDUCTION THERAPY WITH INFLIXIMAB IN PEDIATRIC CROHN’S DISEASE (CD)

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.175 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S68-S69

Author(s):

Ruben Colman ◽

Brendan Boyle ◽

Joshua Noe ◽

Jeffrey Hyams ◽

Phillip Minar

Keyword(s):

Treatment Response ◽

Strong Correlation ◽

Clinical Remission ◽

Trough Level ◽

Fecal Calprotectin ◽

Operating Characteristics ◽

Noninvasive Biomarkers ◽

The Relationship ◽

Trough Levels ◽

Over Time

Abstract Background The fecal biomarkers, calprotectin and lactoferrin are noninvasive biomarkers for mucosal inflammation in IBD. While prior cross-sectional studies showed a correlation between these measures, less is known about the relationship of these measurements with treatment response over time. We aimed to assess the correlation between and utility of fecal calprotectin and lactoferrin on treatment response with infliximab (IFX). Methods We analyzed fecal calprotectin (FCP) and lactoferrin (LCT) as part of a multicenter, prospective anti-TNF induction cohort. IFX induction between 5-10mg/kg occurred at 0, 2 and 6 weeks. Stool and serum were collected prior to IFX treatment (baseline) and during follow-up. We evaluated FCP, LCT and trough IFX levels prior to the first and at subsequent infusions up to infusion 4. The primary outcome was the correlations between FCP, LCT, and outcomes at maintenance. Clinical outcomes were assessed by the wPCDAI measured at each infusion. Clinical remission was defined as wPCDAI <12.5. Spearman correlation was used to assess the relationship between FCP and LCT. Predictive outcomes were calculated by receiver operating characteristics (ROC) with Youden-J statistic. Results Among 57 CD patients, 54 (95%) had FCP and LCT measured at both baseline and infusion 4. There was a strong correlation between calprotectin and lactoferrin with data at all time points (R = 0.82, P < 0.0001). The correlation was even stronger at infusion 4 (R = 0.88, P < 0.0001). A delta score for FCP and LCT was calculated by the proportional change between baseline levels to infusion-4 levels. There was a strong correlation between the FCP delta and LCT delta (R = 0.7, P < 0.0001), suggesting similarities in quantifiable change over time. At Infusion 4, an FCP < 378 μg/g predicted sustained clinical remission between week 14 and 6 months with a sensitivity (sens) of 71% and specificity (spec) of 58% (AUC 0.708; P = 0.01). LCT <20.5 μg/g predicted sustained clinical remission between week 14 and 6 months with a sens of 68% and spec of 45% (AUC 0.627; P = 0.117). FCP < 639 μg/g at infusion 4, had a sens of 75% and spec of 75% for achieving an infusion 4 trough level ≥ 5μg/ml (AUC 0.758; P = 0.005). LCT < 34.2 μg/g had a sens of 69% and spec of 54% (AUC 0.692; P = 0.036) for similar trough levels. FCP < 213.6 μg/g at infusion 4, had a sens of 56% and spec of 88% for achieving a infusion 4 trough level > 8μg/ml (AUC 0.744; P = 0.007). LCT < 6.0 μg/g had a sens of 44% and spec of 92% (AUC 0.675; P=0.05) for similar trough levels. Discussion This study demonstrates that both noninvasive biomarkers can be used to predict sustained clinical remission during IFX therapy. It also provides further evidence for the utilization of fecal calprotectin and lactoferrin as predictors to achieve IFX infusion 4 trough level targets for ≥ 5μg/ml and >8μg/ml.

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Rapid Fecal Calprotectin Level Assessment and the SIBDQ Score Can Accurately Detect Active Mucosal Inammation in IBD Patients in Clinical Remission: a Prospective Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.233.thv ◽

2014 ◽

Vol 23 (3) ◽

pp. 273-278 ◽

Cited By ~ 12

Author(s):

Theodor Voiosu ◽

Andreea Bengus ◽

Roxana Dinu ◽

Andrei M. Voiosu ◽

Paul Balanescu ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Clinical Remission ◽

Intestinal Inflammation ◽

Activity Index ◽

Fecal Calprotectin ◽

Clinical Activity ◽

Inflammatory Bowel ◽

Inflammatory Changes

Background & Aims: Mucosal healing is an important predictor of disease-related outcome in inflammatory bowel disease (IBD) patients, including those in clinical remission. However, colonoscopy is an invasive procedure and many patients decline repeated endoscopic examinations. We aimed to assess whether noninvasive biomarkers could accurately detect endoscopic mucosal inflammatory activity in IBD patients in clinical remission.Methods: We conducted a prospective observational cohort study on IBD patients in clinical remission at Colentina Hospital, Bucharest. Clinical activity was assessed using the Mayo score and Crohns Disease Activity Index (CDAI), quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Serum C-reactive protein (CRP) and fecal calprotectin (FC) levels were determined. All patients underwent ileo-colonoscopy to assess mucosal inflammatory activity.Results: 48 patients were included in this study, with 67% showing endoscopic disease activity. SIBD questionnaire and FC performed well as noninvasive markers of intestinal inflammation (AUROC 0.78 and 0.77, respectively), while CRP could not accurately predict endoscopic disease activity. Fecal calprotectin levels > 30 ľg/g showed a 93% sensitivity and a 50% specificity for detecting inflammatory changes of the mucosa while a combined test using FC > 30µg/g and a SIBDQ score < 6 achieved 81.2% sensitivity and 75% specificity, respectively, in detecting active endoscopic disease.Conclusion: Fecal calprotectin and SIBDQ have good diagnostic accuracy in detecting mucosal inflammatory changes in IBD patients in clinical remission. Combining simple, noninvasive tests such as the SIBDQ and FC levels appears to be a practical method for monitoring disease activity in these patients, possibly reducing the need for repeat endoscopic examinations.

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AB0100 EVALUATION OF PGA LEVEL FOR CLINICAL REMISSION WITH BOOLEAN CRITERIA, 10MM OR 20MM?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.288 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1078.1-1079

Author(s):

I. Yoshii

Keyword(s):

Disease Activity ◽

Patient Group ◽

Clinical Remission ◽

Global Assessment ◽

Activity Index ◽

T Test ◽

Mean Values ◽

Significant Difference ◽

Remission Criteria ◽

The Mean

Background:Patient’s global assessment (PGA) is one important component of Boolean composite criteria for remission in treat with rheumatoid arthritis (RA). However, PGA no more than 10mm is sometimes obstacle to attain clinical remission. In recent few years, one opinion that PGA no more than 20mm may be comparable as no more than 10mm.Objectives:The aim of this study is to analyze how difference of these PGA level affect disease activity and daily activities in living, and evaluate which is optimal for the remission with Boolean remission criteria from real world setting.Methods:RA patients who were followed up for more than three years in the institute were picked up in the study. Each patient was monitored with tenderness joint count (TJC), swollen joint count (SJC), PGA, evaluator’s global assessment (EGA), serum C-reactive protein level (CRP), calculated disease activity score with simplified disease activity index(SDAI), Health Assessment Questionnaire Disability Index (HAQ-DI), and pain score using visual analog scale (PS-VAS) every consulted time from the first encounter (Baseline). Patients were classified according to achievement of Boolean remission criteria. Group 1: a patient group who attained Boolean remission wih TJC≦1, SJC≦1, CRP≦1mg/dl, and PGA≦1 (G-1), Group 2: a patient group who could not attained the Boolean remission used in the G-1 evaluation, but could attained another Boolean remission with TJC≦1, SJC≦1, CRP≦1mg/dl, and PGA≦2 (G-2), and Group 3: a patient group who could not attain Boolean remission for neither criterion.Mean values of measured parameters at Baseline and after the Baseline were compared statistically with Student T-test. Mean values of the same parameters in the G-1 and G-2 at the time of attain Boolean remission for each criteria, mean values of each of these parameters thereafter, and changes of these parameters were compared statistically with Student T-test.Results:A total of 438 patients 385 in the G-1 group, 16 in the G-2 group, and 37 in the G-3 group, were recruited. In parameters at Baseline, level of TJC, SJC, PGA, EGA, SDAI, and HAQ-DI in the G-1 was significantly lower than in the G-3, whereas no significant differences in any parameters demonstrated between in the G-2 and G-3. Level of HAQ-DI, and PS-VAS after Baseline in the G-1 was lower than in the G-3, whereas no significant difference of these parameters after Baseline demonstrated between in the G-2 and G-3. TJC, SJC, PGA, and EGA demonstrated significant less level in the G-1 than in the other two groups. The mean SDAI score at the time of first achievement of Boolean remission in the G-1 and G-2 were 1.08 and 2.57, respectively. The mean value of SDAI score after remission in the G-1 and G-2 were 3.35 and 6.44, respectively. These values and PS-VAS including change of the SDAI score demonstrated significant difference between the two groups (p<0.01), whereas HAQ-DI in the two groups demonstrated no significant difference.Conclusion:These results suggested that setting PGA as no more than 10mm should be reasonable for the evaluation of clinical remission with the Boolean criteria.Disclosure of Interests:None declared

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Fecal calprotectin is a useful biomarker for predicting the clinical outcome of granulocyte and monocyte adsorptive apheresis in ulcerative colitis patients: a prospective observation study

BMC Gastroenterology ◽

10.1186/s12876-021-01889-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nobuhiro Ueno ◽

Yuya Sugiyama ◽

Yu Kobayashi ◽

Yuki Murakami ◽

Takuya Iwama ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Outcome ◽

Sensitivity And Specificity ◽

Reduction Rate ◽

Fecal Calprotectin ◽

Remission Induction ◽

Clinical Activity ◽

Observation Study ◽

Mayo Score ◽

Adsorptive Apheresis

Abstract Background Granulocyte and monocyte adsorptive apheresis (GMA) is widely used as a remission induction therapy for active ulcerative colitis (UC) patients. However, there are no available biomarkers for predicting the clinical outcome of GMA. We investigated the utility of Fecal calprotectin (FC) as a biomarker for predicting the clinical outcome during GMA therapy in active UC patients. Methods In this multicenter prospective observation study, all patients received 10 sessions of GMA, twice a week, for 5 consecutive weeks. FC was measured at entry, one week, two weeks, and at the end of GMA. Colonoscopy was performed at entry and after GMA. The clinical activity was assessed based on the partial Mayo score when FC was measured. Clinical remission (CR) was defined as a partial Mayo score of ≤ 2 and endoscopic remission (ER) was defined as Mayo endoscopic subscore of either 0 or 1. We analyzed the relationships between the clinical outcome (CR and ER) and the change in FC concentration. Result Twenty-six patients were included in this study. The overall CR and ER rates were 50.0% and 19.2%, respectively. After GMA, the median FC concentration in patients with ER was significantly lower than that in patients without ER (469 mg/kg vs. 3107 mg/kg, p = 0.03). When the cut-off value of FC concentration was set at 1150 mg/kg for assessing ER after GMA, the sensitivity and specificity were 0.8 and 0.81, respectively. The FC concentration had significantly decreased by one week. An ROC analysis demonstrated that the reduction rate of FC (ΔFC) at 1 week was the most accurate predictor of CR at the end of GMA (AUC = 0.852, P = 0.002). When the cut-off value of ΔFC was set at ≤ 40% at 1 week for predicting CR at the end of GMA, the sensitivity and specificity were 76.9% and 84.6%, respectively. Conclusion We evaluated the utility of FC as a biomarker for assessing ER after GMA and predicting CR in the early phase during GMA in patients with active UC. Our findings will benefit patients with active UC by allowing them to avoid unnecessary invasive procedures and will help establish new strategies for GMA.

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EVALUATION OF A DIET AND ANTIBIOTICS TARGETING THE MICROBIOTA FOR TREATMENT OF MILD TO MODETARE ACTIVE PEDIARTIC ULCERATIVE COLITIS: AN OPEN LABEL PILOT STUDY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.094 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S38-S38

Author(s):

Chen Sarbagili-Shabat ◽

Lindsey Albenberg ◽

Johan Van Limbergen ◽

Dror Weiner ◽

Michal Yaakov ◽

...

Keyword(s):

Ulcerative Colitis ◽

Pilot Study ◽

Dietary Intervention ◽

Activity Index ◽

Fecal Calprotectin ◽

Dietary Therapy ◽

The Novel ◽

Open Label ◽

Intention To Treat ◽

Stable Maintenance

Abstract Background Newer strategies that target the microbiome may offer an alternative therapeutic approach for Ulcerative Colitis (UC). We developed a novel diet that targets changes in the microbiome and barrier function that have been reported in UC. The goal of the current study was to evaluate the efficacy of two sequential induction of remission strategies that target the microbiota: the novel diet termed the ulcerative colitis diet (UCD) and an antibiotics cocktail combination in dietary non responders. Methods This was a prospective, single arm, open label, pilot study in patients aged 8–19, with a pediatric UC activity index (PUCAI) scores >10 and ≤45 on stable maintenance therapy (5ASA or thiopurines). PUCAI score was assessed at week 3 and 6. Patients failing to enter remission or intolerant to dietary therapy could receive an open label 14-day course of Amoxycillin, Metronidazole and Doxycycline (AMD), and had PUCAI scored at day 21. Response was defined a decline in PUCAI ≥ 10 points, remission as PUCAI< 10. The primary endpoint was intention to treat (ITT) remission at week 6 with diet as the sole intervention. Results Twenty-three children mean age of 15.1±2.9 years were enrolled. Two patients (1 responder, 1 remission) withdrew by 3 weeks, four required additional therapy by week 3, all were considered failures by ITT. Mean PUCAI decreased at week 3 and 6 from 34.5±9.8 to 21.7±14.9 and 17.6±17.2 respectively (P=0.005, P=0.001) at ITT analysis including all patients. Sixteen out of twenty-three patients (69.6%) responded by week 6. Ten of twenty-three (43.5%) achieved remission by week 6, and nine (39.1%) had clinical remission at week 6. The median fecal calprotectin (FC) level decreased in patients (n=5) who achieved remission from 630 (IQR, 332–1586) μg/g at week 0 to 230 (75–1298) μg/g at week 6. Eight patients received treatment with antibiotics after failing diet, 4/8 (50.0%) subsequently entered remission. Conclusion A dietary intervention called the UC Diet appears to be effective for induction of remission in children with mild to moderate UC. Sequential use of diet, followed by antibiotic therapy in dietary non responders, needs further evaluation as a microbiome directed steroid sparing therapy in patient’s refractory to 5ASA and thiopurines.

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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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