Immunosuppressants

Combination Therapies ◽

Beneficial Effects ◽

A variety of immunosuppressants and disease-modifying anti-rheumatic drugs (DMARDs) with beneficial effects on inflammatory rheumatic diseases have been identified over the last 50 years. Their use for these conditions is now well established and has led to considerable improvements in disease management. Their use earlier in the inflammatory disease process and the use of combination therapies have also led to significantly improved patient outcomes. This chapter provides an overview of the immunosuppressants and DMARDs used to treat rheumatic disease, focusing particularly on those in common use and with the best evidence for efficacy. The mechanism of action, toxicity, and clinical indications are outlined. Tips for practical prescribing and for monitoring for potential complications are also included.

Immunosuppressants

10.1093/med/9780199642489.003.0080 ◽

2013 ◽

Author(s):

Joanna Ledingham ◽

Sarah Westlake

Keyword(s):

Disease Management ◽

Rheumatic Disease ◽

Patient Outcomes ◽

Mechanism Of Action ◽

Inflammatory Disease ◽

Disease Process ◽

Combination Therapies ◽

Beneficial Effects ◽

A variety of immunosuppressants and disease-modifying anti-rheumatic drugs (DMARDs) with beneficial effects on inflammatory rheumatic diseases have been identified over the last 50 years. Their use for these conditions is now well established and has led to considerable improvements in disease management. Their use earlier in the inflammatory disease process and the use of combination therapies have also led to significantly improved patient outcomes. This chapter provides an overview of the immunosuppressants and DMARDs used to treat rheumatic disease, focusing particularly on those in common use and with the best evidence for efficacy. The mechanism of action, toxicity, and clinical indications are outlined. Tips for practical prescribing and for monitoring for potential complications are also included.

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 ◽

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.

Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe?

RMD Open ◽

10.1136/rmdopen-2020-001439 ◽

2021 ◽

Vol 7 (1) ◽

pp. e001439

Author(s):

Cristiana Sieiro Santos ◽

Xenia Cásas Férnandez ◽

Clara Moriano Morales ◽

Elvira Díez Álvarez ◽

Carolina Álvarez Castro ◽

...

Keyword(s):

General Population ◽

Rheumatic Disease ◽

Infection Rate ◽

Rheumatic Diseases ◽

Hospital Care ◽

Biological Agents ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

BackgroundThe recent outbreak of COVID-19 has raised concerns in the rheumatology community about the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It is not clear whether the use of biological agents may suppose a risk or protection against SARS-CoV-2 infection; however, it has been suggested that severe respiratory forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. This prompted the use of interleukin 6 (IL-6) (tocilizumab and sarilumab) and IL-1 inhibitors (anakinra) in severe COVID-19 disease and more recently JAK1/2 inhibitor (baricitinib). Therefore, patients with rheumatic diseases provide a great opportunity to learn about the use of biological agents as protective drugs against SARS-CoV-2.ObjectivesTo estimate COVID-19 infection rate in patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) for inflammatory rheumatic diseases (RMD), determine the influence of biological agents treatment as risk or protective factors and study the prognosis of patients with rheumatic diseases receiving biological agents compared to the general population in a third-level hospital setting in León, Spain.MethodsWe performed a retrospective observational study including patients seen at our rheumatology department who received bDMARDs for rheumatic diseases between December 1st 2019 and December 1st 2020, and analysed COVID-19 infection rate. All patients who attended our rheumatology outpatient clinic with diagnosis of inflammatory rheumatic disease receiving treatment with biological agents were included. Main variable was the hospital admission related to COVID-19. The covariates were age, sex, comorbidities, biological agent, duration of treatment, mean dose of glucocorticoids and need for intensive care unit . We performed an univariate and multivariate logistic regression models to assess risk factors of COVID-19 infection.ResultsThere were a total of 4464 patients with COVID-19 requiring hospitalisation. 40 patients out of a total of 820 patients with rheumatic diseases (4.8%) receiving bDMARDs contracted COVID-19 and 4 required hospital care. Crude incidence rate of COVID-19 requiring hospital care among the general population was 3.6%, and it was 0.89% among the group with underlying rheumatic diseases. 90% of patients receiving bDMARDS with COVID-19 did not require hospitalisation. Out of the 4464 patients, 869 patients died, 2 of which received treatment with biological agents. Patients with rheumatic diseases who tested positive for COVID-19 were older (female: median age 60.8 IQR 46-74; male: median age 61.9 IQR 52-70.3) than those who were negative for COVID-19 (female: median age 58.3 IQR 48-69; male: median age 56.2 IQR 47-66), more likely to have hypertension (45% vs 26%, OR 2.25 (CI 1.18-4.27),p 0.02), cardiovascular disease (23 % vs 9.6%, OR 2.73 (1.25-5.95), p 0.02), be smokers (13% vs 4.6%, OR 2.95 (CI 1.09-7.98), p 0.04), receiving treatment with rituximab (20% vs 8%, 2.28 (CI 1.24-6.32), p 0.02) and a higher dose of glucocorticoids (OR 2.5 (1.3-10.33, p 0.02) and were less likely to be receiving treatment with IL-6 inhibitors (2.5% vs 14%, OR 0.16, (CI 0.10-0.97, p 0.03). When exploring the effect of the rest of the therapies between groups (affected patients vs unaffected), we found no significant differences in bDMARD proportions. IL-1 inhibitors, IL-6 inhibitors, JAK inhibitors and belimumab-treated patients showed the lowest incidence of COVID-19 among adult patients with rheumatic diseases. We found no differences in sex or rheumatological disease between patients who tested positive for COVID-19 and patients who tested negative.ConclusionsOverall, the use of biological disease-modifying antirheumatic drugs (bDMARDs) does not associate with severe manifestations of COVID-19. Patients with rheumatic disease diagnosed with COVID-19 were more likely to be receiving a higher dose of glucocorticoids and treatment with rituximab. IL-6 inhibitors may have a protective effect.

Disease Modifying Antirheumatic Drug

Patterns of the rheumatic disease course in the setting of a new coronavirus infection

Russian Medical Inquiry ◽

10.32364/2587-6821-2021-5-2-84-88 ◽

2021 ◽

Vol 5 (2) ◽

pp. 84-88

Author(s):

V.V. Vakhlevskiy ◽

◽

V.V. Tyrenko ◽

I.S. Svintsitskaya ◽

E.V. Kryukov ◽

...

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Disease Process ◽

Antirheumatic Drug ◽

Disease Course ◽

Antirheumatic Drugs ◽

Antirheumatic Therapy ◽

Coronavirus Infection ◽

Disease Modifying ◽

The article describes the main pathophysiological mechanisms underlying the potential use of antirheumatic therapy in the new COVID-19 in patients with rheumatic diseases. Also, it summarizes current data on the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. To date, there are no large randomized studies on the use of antirheumatic drugs in patients with rheumatic diseases in the setting of COVID-19. Besides, there is no convincing evidence that any disease-modifying antirheumatic drug (conventional synthetic, biological, or targeted synthetic) can prevent the development of a severe COVID-19 course. At the same time, the importance of concomitant pathology (hypertension, obesity, cardiovascular diseases, diabetes mellitus) and risk factors (smoking) in the development of a severe COVID-19 course in patients with rheumatic diseases is shown. The article presents possible options for initiating and continuing treatment with antirheumatic drugs in patients with rheumatic diseases, depending on the stage of the infectious disease process. KEYWORDS: COVID-19, rheumatic diseases, disease-modifying antirheumatic drug, interleukin, tumor necrosis factor, glucocorticosteroids. FOR CITATION: Vakhlevskiy V.V., Tyrenko V.V., Svintsitskaya I.S., Kryukov E.V. Patterns of the rheumatic disease course in the setting of a new coronavirus infection. Russian Medical Inquiry. 2021;5(2):84–88. DOI: 10.32364/2587-6821-2021-5-2-84-88.

THU0658 Recommendations for the assessment and optimisation of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: a process based on literature reviews and consensus

10.1136/annrheumdis-2018-eular.2340 ◽

2018 ◽

Cited By ~ 2

Author(s):

L. Gossec ◽

A. Molto ◽

X. Romand ◽

D. Puyraimond-Zemmour ◽

M. Lavielle ◽

...

Keyword(s):

Rheumatic Diseases ◽

Disease Modifying Drugs ◽

Literature Reviews ◽

Chronic Inflammatory Rheumatic Diseases ◽

Comorbidities of rheumatic disease

10.1093/med/9780199642489.003.0032 ◽

2013 ◽

Cited By ~ 1

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Physical Inactivity ◽

Organ Damage ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

Comorbidities of rheumatic disease

10.1093/med/9780199642489.003.0032_update_001 ◽

2015 ◽

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Physical Inactivity ◽

Organ Damage ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217984 ◽

2020 ◽

Vol 79 (11) ◽

pp. 1393-1399 ◽

Cited By ~ 5

Author(s):

Dalifer D Freites Nuñez ◽

Leticia Leon ◽

Arkaitz Mucientes ◽

Luis Rodriguez-Rodriguez ◽

Judit Font Urgelles ◽

...

Keyword(s):

Risk Factors ◽

Hospital Admission ◽

Rheumatic Diseases ◽

Hospital Admissions ◽

Tertiary Hospital ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Multivariable Logistic Regression Model ◽

ObjectivesTo describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.MethodsAn observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.ResultsThe study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.ConclusionOur results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

Comorbidities of rheumatic disease

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0032_update_002 ◽

2013 ◽

pp. 243-250

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Organ Damage ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact ◽

Index Disease

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. The concept of ‘multimorbidity’ is being used increasingly, shifting the focus from the index disease to two or more chronic diseases that exist in the same individual. In this chapter, we discuss the impact of multi/comorbidities. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.