scholarly journals The challenges of antirheumatic therapy and travel-associated infections

Rheumatology ◽  
2021 ◽  
Author(s):  
Ryan M Hum ◽  
Hector Chinoy ◽  
Giorgio Calisti ◽  
Shuayb Elkhalifa
Keyword(s):  
Antirheumatic Therapy

scholarly journals Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042246
Author(s):  
Sanjoy K Paul ◽  
Olga Montvida ◽  
Jennie H Best ◽  
Sara Gale ◽  
Attila Pethö-Schramm ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Type 2 Diabetes ◽  
T Cell ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

ObjectiveTo explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participantsFive treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.ResultsIn the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.ConclusionsTreatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.

scholarly journals COVID-19 vaccination and antirheumatic therapy

Rheumatology ◽  
2021 ◽  
Author(s):  
Jack Arnold ◽  
Kevin Winthrop ◽  
Paul Emery
Keyword(s):  
Immunosuppressive Therapy ◽  
Management Strategy ◽  
Humoral Response ◽  
Vaccine Response ◽  
Antirheumatic Therapy ◽  
Post Vaccination ◽  
Vaccine Responses ◽  
History Of ◽  
Humoral Responses ◽  
Existing Data

Abstract The coronavirus disease 2019 (COVID-19) vaccination will be the largest vaccination programme in the history of the NHS. Patients on immunosuppressive therapy will be among the earliest to be vaccinated. Some evidence indicates immunosuppressive therapy inhibits humoral response to the influenza, pneumococcal and hepatitis B vaccines. The degree to which this will translate to impaired COVID-19 vaccine responses is unclear. Other evidence suggests withholding MTX for 2 weeks post-vaccination may improve responses. Rituximab has been shown to impair humoral responses for 6 months or longer post-administration. Decisions on withholding or interrupting immunosuppressive therapy around COVID-19 vaccination will need to be made prior to the availability of data on specific COVID-19 vaccine response in these patients. With this in mind, this article outlines the existing data on the effect of antirheumatic therapy on vaccine responses in patients with inflammatory arthritis and formulates a possible pragmatic management strategy for COVID-19 vaccination.

scholarly journals AB0798 EFFECT OF ANTIRHEUMATIC THERAPY ADMINISTERED IN ACCORDANCE WITH “TREAT TO TARGET” PRINCIPLES ON DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLES IN PATIENTS WITH ACTIVE EARLY PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1699.2-1699
Author(s):  
E. Markelova
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Inflammatory Diseases ◽  
Statistical Significance ◽  
Certolizumab Pegol ◽  
Cardiovascular Death ◽  
Treat To Target ◽  
Antirheumatic Therapy ◽  
Time Curve ◽  
Low Prevalence

Background:Рsoriatic arthritis (PsA) are chronic inflammatory diseases, with massive increase of cardiovascular events (CVE) and cardiovascular death. Diastolic dysfunction of the left ventricles (LVDD) is a risk factor for the development of the heart failure.Objectives:to study the effect of antirheumatic therapy administered in accordance with “Treat to target” principles on LVDD in early PsA (EPsA) patients (pts).Methods:48 (F.-23) DMARD-naive PsA pts, according to the CASPAR criteria, age 36[27; 45] years (yrs.), PsA duration – 6[4; 8] months. All pts were assessed for transthoracic echocardiography. Diastolic function was determined by early and atrial peak filling rates derived from differential volume-time-curve analysis. Methotrexate therapy was started in all pts with an escalation of the dose up to 25 mg/week subcutaneously. In case of no remission 3 months later, MT was added with biologic therapy: Adalimumab, Certolizumab pegol, Ustekinumab. Antihypertensive therapy received all pts with arterial hypertension (AH). All p less then 0.05 considered to statistical significance.Results:At baseline LVDD was identified in 5(10.4%). The LVDD pts were older, in more cases they had AH, abdominal obesity (p<0.05). Significant negative correlations were found between LVDD and body mass index (BMI) (r=-0.41), age (r=-0.71), total cholesterol (r=-0.44), triglycerides (r=-0.48), low density lipoproteins (r=-0.44), systolic (r=-0.59) and diastolic blood pressure (r=-0.4), for all p<0,01. By 18 months of therapy significantly decreased DAS from 4.06[3.48; 4.91] to 0,97[0,65;1,48]; C-RP from 19.4 [8.8;37.5] to 2.2 [0.9; 4.6]mg/l, for all p<0,001. DAS remission was achieved in 69% of pts. We didn’t find significant differences between baseline and after treatment the frequency of LVDD – 5(10,4%) to 4(8.3%).Conclusion:in pts with EPsA frequently (10.4%) were detected LVDD, which are associated with a АН, age, higher BMI. Low prevalence LVDD in patients with EPsA is possibly caused by short duration of disease and early start of antirheumatic therapy. This has implications for development of preventive strategies for heart failure in EPsA patients.Disclosure of Interests:None declared

ANTIRHEUMATIC THERAPY

1979 ◽  
Vol 1 (S2) ◽  
pp. 19-21
Author(s):  
Stephen Potter
Keyword(s):  
Antirheumatic Therapy

scholarly journals AB0249 POSITIVE EFFECT OF ANTIRHEUMATIC THERAPY ON THE COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1424.3-1425
Author(s):  
I. Kirillova ◽  
D. Novikova ◽  
T. Popkova ◽  
Y. Gorbunova ◽  
E. Markelova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Disease Activity ◽  
Diastolic Function ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Antirheumatic Therapy ◽  
Early Ra ◽  
Lv Diastolic Function

Background:Objectives:to evaluate the effect of antirheumatic therapy according to the “treat to target” strategy on the course of chronic heart failure (CHF) in patients with early RA.Methods:The study included 22 patients CHF with valid diagnosis of RA (criteria ACR / EULAR, 2010), 17 (77%) of women, median (Me) age - 60 years, Me disease duration - 7 months; IgM seropositive for rheumatoid factor 10 (45%) and / or antibodies to the cyclic citrulline peptide 22 (100%), DAS28-5.6 [4,8;6,5]. CHF verified in accordance the recommendations for the diagnosis and treatment of CHF Society of Specialists in Heart Failure (2013). The concentration of NT-proBNP was determined by electrochemiluminescence. For all patients was started methotrexate (MT) therapy with a rapid increase in the dose to 30 mg per week subcutaneously. If the MT was not effective enough, after 3 months a biological Disease-Modifying Anti-Rheumatic Drug (bDMARDs) was added to the therapy, predominantly TNF-alpha inhibitors. After 18 months, 10 (45%) patients were in remission and low disease activity, 6 (60%) of patients underwent MT therapy in combination with bDMARDs.Results:In baseline CHF with preserved EF was revealed in 21 (95%) patients, in 1 patient - CHF with reduced EF. After 18 months there was a positive dynamics of improvement of clinical symptoms, echocardiographic indicators (decrease the size of the left atrium (LА) and the index of end-systolic volume of LА, IVRT, E’ LV), diastolic function of the left ventricle (LV). There was no decompensation of CHF. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n = 5) and low (n = 2) disease activity, mainly in the treatment of MT and bDMARDs. In patients with RA and CHF, the level of NT-proBNP decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg / ml (p <0.001), normalized in 16 of 22 (73%) patients (p <0.001) with remission or low RA activity. In 5 (22%) patients, the clinical manifestations of CHF regressed, LV diastolic function and NT-proBNP level normalized.Conclusion:In patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF. There were an improvement in the clinical course of CHF, diastolic function of the left ventricle and a decrease in NT-proBNP.Disclosure of Interests:None declared

Combination of Methotrexate and Leflunomide Is Safe and Has Good Drug Retention Among Patients With Psoriatic Arthritis

2021 ◽  
pp. jrheum.201408
Author(s):  
Muhammad Haroon ◽  
Shabnam Batool ◽  
Sadia Asif ◽  
Farzana Hashmi ◽  
Saadat Ullah
Keyword(s):  
Cervical Spine ◽  
Psoriatic Arthritis ◽  
Musculoskeletal Disease ◽  
Sacroiliac Joints ◽  
Antirheumatic Therapy ◽  
Short Delay ◽  
Drug Retention ◽  
Immune Mediated

Psoriatic arthritis (PsA) is a potentially progressive immune-mediated musculoskeletal disease with the involvement of synovium, enthesis, and axial structures (especially the cervical spine and sacroiliac joints), along with the involvement of skin and nails. Even a short delay in the diagnosis and commencement of antirheumatic therapy can cause long-term damage and disabilities.1

Inflammation and Microvascular and Macrovascular Endothelial Dysfunction in Rheumatoid Arthritis: Effect of Treatment

2010 ◽  
Vol 37 (4) ◽  
pp. 711-716 ◽  
Author(s):  
WILL FOSTER ◽  
DAVID CARRUTHERS ◽  
GREGORY Y.H. LIP ◽  
ANDREW D. BLANN
Keyword(s):  
Rheumatoid Arthritis ◽  
Endothelial Dysfunction ◽  
Vascular Function ◽  
Venous Blood ◽  
Microvascular Function ◽  
Control Group ◽  
Antirheumatic Therapy ◽  
Antiinflammatory Therapy ◽  
Patients With Diabetes ◽  
Plasma Markers

Objective.To determine whether abnormalities in microvascular and macrovascular function in rheumatoid arthritis (RA) are associated with plasma markers [von Willebrand factor (VWF)] of endothelial dysfunction and inflammation [C-reactive protein (CRP)] and whether the abnormalities would be altered by treatment. Endothelial dysfunction and inflammation in RA may contribute to adverse cardiovascular events. Although endothelial dysfunction in RA has been demonstrated by altered plasma markers, the relationships with macrovascular and microvascular function are relatively unexplored.Methods.We recruited 66 patients with chronic RA, 48 community controls (CC), and 25 patients with diabetes and hypertension as a disease control group (DC). Subjects had venous blood sampled for plasma markers, and underwent laser Doppler perfusion imaging of forearm skin (to assess microvascular circulation) following acetylcholine and sodium nitroprusside iontophoresis, to assess endothelium-dependent and endothelium-independent responses, respectively. Brachial artery flow-mediated dilatation assessed endothelial dysfunction in a macrovascular bed. A subgroup of 29 patients with RA were assessed pretherapy and after 2–4 weeks of antirheumatic therapy.Results.As expected, patients with RA had higher CRP, erythrocyte sedimentation rate (ESR), and VWF. Endothelium-independent vasoreactivity was abnormal in RA, and this correlated negatively with CRP. All aspects of microvascular function were abnormal in the DC compared to the CC. Macrovascular function was preserved in RA but was abnormal in the DC group. Four weeks of antiinflammatory therapy reduced CRP and ESR but had no effect on any vascular function index in the patients with RA.Conclusion.Patients with RA have abnormal endothelium-independent microvascular function that correlates with inflammation but is not altered by short-term antiinflammatory therapy.

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