FRI0076 Low Disease Activity or DAS-Remission as Treatment Target in Early Rheumatoid Arthritis Patients

Objective.Clinical remission currently is the treatment target for all patients with rheumatoid arthritis (RA). At the same level of inflammation, the prognosis regarding joint damage is believed to be different for anticitrullinated protein antibody (ACPA)-negative and ACPA-positive patients. Our objective was to show the difference in prognosis at similar disease activity levels, and to illustrate how this could be translated to differentiation of treatment targets.Methods.Data were used from the Nijmegen Early RA Cohort. The relation between the time-averaged disease activity level (by Disease Activity Score; DAS) and joint damage progression over 3 years was analyzed, separately for ACPA-negative and ACPA-positive patients. Joint damage was assessed as change in Ratingen score, and dichotomized as occurrence of erosions in joints that were unaffected at baseline. Linear and logistic multivariable regression models were used.Results.The regression coefficient of DAS on change in Ratingen score was 3.9 (p < 0.001) for ACPA-negative and 4.7 (p < 0.001) for ACPA-positive patients, showing less joint damage progression at the same disease activity level in ACPA-negative patients. This difference became greater with increasing disease activity. The probability for erosions in joints unaffected at baseline was 0.35 in ACPA-negative patients when time-averaged DAS was < 2.4 versus 0.80 in ACPA-positive patients.Conclusion.At the same level of inflammation, ACPA-negative patients have less joint damage and lower probability for damage in newly affected joints than ACPA-positive patients. Low disease activity might be a sufficiently strict treatment target for ACPA-negative patients to prevent progression of joint damage.

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Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-205094 ◽

2014 ◽

Vol 73 (11) ◽

pp. 2029-2033 ◽

Cited By ~ 71

Author(s):

Maria E C Sandberg ◽

Camilla Bengtsson ◽

Henrik Källberg ◽

Annmarie Wesley ◽

Lars Klareskog ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Early Rheumatoid Arthritis ◽

Low Disease Activity

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Correction to: Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort

Clinical Rheumatology ◽

10.1007/s10067-019-04742-8 ◽

2019 ◽

Vol 38 (10) ◽

pp. 2963-2964

Author(s):

Rocio V Gamboa-Cárdenas ◽

Manuel F. Ugarte-Gil ◽

Loreto Massardo ◽

Mónica P. Sacnun ◽

Verónica Saurit ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Latin American ◽

Early Rheumatoid Arthritis ◽

Clinical Predictors ◽

Low Disease Activity ◽

Rheumatoid Arthritis Data

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Clusterin serum levels are elevated in patients with early rheumatoid arthritis and predict disease activity and treatment response

Scientific Reports ◽

10.1038/s41598-021-90973-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tereza Kropáčková ◽

Heřman Mann ◽

Olga Růžičková ◽

Olga Šléglová ◽

Lucia Vernerová ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Treatment Response ◽

Early Rheumatoid Arthritis ◽

Roc Analysis ◽

Predictive Biomarker ◽

Serum Levels ◽

Serum Concentrations ◽

Low Disease Activity ◽

Treatment Naïve

AbstractClusterin (CLU) is a molecular chaperone that participates in a variety of biological processes. Recent studies indicate its possible involvement in the development of bone erosions and autoimmunity. The aim of this study was to investigate its serum concentrations in patients with early rheumatoid arthritis (RA) and to explore their potential relationship with disease activity and treatment response. Serum levels of CLU were measured in 52 patients before and 3 months after the initiation of treatment and in 52 healthy individuals. CLU levels at baseline were significantly increased in patients with early RA compared with healthy subjects (p < 0.0001). After 3 months of treatment, the levels of CLU decreased and reached concentrations comparable to those in controls. Even though there was no relationship between CLU levels and disease activity at baseline, CLU levels positively correlated with disease activity at months 3, 6 and 12 after treatment initiation. Using ROC analysis, lower CLU baseline levels predicted achieving the therapeutic target of low disease activity and remission at months 3, 6 and 12. In summary, we found increased serum concentrations of clusterin in treatment-naïve patients with early rheumatoid arthritis, and we suggest clusterin as a predictive biomarker of disease activity and treatment response.

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Clinical, functional and radiographic consequences of achieving stable low disease activity and remission with adalimumab plus methotrexate or methotrexate alone in early rheumatoid arthritis: 26-week results from the randomised, controlled OPTIMA study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-201247 ◽

2012 ◽

Vol 72 (1) ◽

pp. 64-71 ◽

Cited By ~ 136

Author(s):

Arthur Kavanaugh ◽

Roy M Fleischmann ◽

Paul Emery ◽

Hartmut Kupper ◽

Laura Redden ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Early Rheumatoid Arthritis ◽

Low Disease Activity ◽

Randomised Controlled

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A systematic review of guidelines for managing rheumatoid arthritis

BMC Rheumatology ◽

10.1186/s41927-019-0090-7 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 11

Author(s):

Aneela Mian ◽

Fowzia Ibrahim ◽

David L. Scott

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Treatment Target ◽

Low Disease Activity ◽

Disease Modifying Drugs ◽

Early Ra ◽

Core Dataset ◽

Moderate Disease ◽

Conventional Dmards ◽

Current Guidelines

Abstract Background We systematically reviewed current guidelines for managing rheumatoid arthritis (RA) to evaluate their range and nature, assess variations in their recommendations and highlight divergence in their perspectives. Methods We searched Medline and Embase databases using the terms ‘clinical practice guidelines’ and ‘rheumatoid arthritis’ from January 2000 to January 2017 together with publications of national and international bodies. We included guidelines providing recommendations on general RA management spanning a range of treatments and published in English. We undertook narrative assessments due to the heterogeneity of the guidelines. Results We identified 529 articles; 22 met our inclusion criteria. They were primarily developed by rheumatologists with variable involvement of patient and other experts. Three dealt with early RA, one established RA and 18 all patients. Most guidelines recommend regular assessments based on the Outcome Measures in Rheumatology core dataset; 18 recommended the disease activity score for 28 joints. Twenty recommended targeting remission; 16 suggested low disease activity as alternative. All guidelines recommend treating active RA; 13 made recommendations for moderate disease. The 21 guidelines considering early RA all recommended starting disease modifying drugs (DMARDs) as soon as possible; methotrexate was recommended for most patients. Nineteen recommended combination DMARDs when patients failed to respond fully to monotherapy and biologics were not necessarily indicated. Twenty made recommendations about biologics invariably suggesting their use after failing conventional DMARDs, particularly methotrexate. Most did not make specific recommendations about using one class of biologics preferentially. Eight recommended tapering biologics when patients achieved sustained good responses. Conclusions Five general principles transcend most guidelines: DMARDs should be started as soon as possible after the diagnosis; methotrexate is the best initial treatment; disease activity should be regularly monitored; give biologics to patients with persistently active disease who have already received methotrexate; remission or low disease activity are the preferred treatment target.

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