Time spent in inactive disease before MTX withdrawal is relevant with regard to the flare risk in patients with JIA

2018 ◽  
Vol 77 (7) ◽  
pp. 996-1002 ◽  
Author(s):  
Jens Klotsche ◽  
Kirsten Minden ◽  
Martina Niewerth ◽  
Gerd Horneff
Keyword(s):  
Disease Activity ◽  
Disease Activity Score ◽  
Juvenile Arthritis ◽  
Inactive Disease ◽  
Moderate Disease ◽  
Risk Of Disease ◽  
Long Term Observation ◽  
Moderate Disease Activity

ObjectivesTo determine the reasons of methotrexate (MTX) discontinuation, frequency of adverse events (AE) and whether the time in inactive disease before MTX withdrawal disease is associated with the risk of disease flare.MethodsPatients with juvenile idiopathic arthritis (JIA) beginning treatment with MTX were prospectively observed in the national JIA biologic register Biologika in der Kinderrheumatologie/Biologics in Paediatric Rheumatology and its follow-up register Juvenile arthritis Methotrexate/Biologics long-term Observation. Inactive disease was defined by a clinical Juvenile Arthritis Disease Activity Score ≤1, flare after MTX discontinuation by reoccurrence of at least moderate disease activity or restart of treatment with a disease-modifying antirheumatic drug .ResultsMTX treatment was initiated in 1514 patients after a mean disease duration of 2.1 years (SD=2.8). 40% of the patients experienced oligoarticular onset of JIA. MTX was discontinued in 982 (64.9%) patients. Ineffectiveness (36.9%) and achieving inactive disease (32.1%) were the most common reasons. Among the latter (n=316), 184 (58.2%) patients experienced a flare on follow-up. The likelihood of a flare was a function of time in inactive disease prior to MTX discontinuation (HR 0.95; 95% CI 0.92 to 0.97). Patients with inactive disease for longer than 12 months had a significantly lower flare rate (58 of 119, 48.7%; HR 0.48; 95% CI 0.34 to 0.69). The most frequently reported AE was MTX intolerance, including nausea, aversion and vomiting, accounting for 441 events (13.0 events/100 exposure years) in 307 (20.3%) patients.ConclusionsPatients who spent at least 12 months in inactive disease before MTX discontinuation had a significantly lower flare rate.

scholarly journals AB0272 CAN NONSTEROIDAL ANTI-INFLAMMATORY DRUGS CONTROL THE SYMPTOMS OF MODERATE RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1162.2-1162
Author(s):  
E. Pogozheva ◽  
A. Karateev ◽  
V. Amirdzhanova ◽  
E. Filatova
Keyword(s):  
Rheumatoid Arthritis ◽  
Global Health ◽  
Disease Activity ◽  
Biological Agents ◽  
Das 28 ◽  
Moderate Disease ◽  
Inflammatory Drugs ◽  
Moderate Disease Activity

Objectives:to evaluate the efficacy of long-term pain therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA) with an initially moderate disease activity (DAS 28 <5,1).Methods:the study included 404 RA patients, disease duration was more than 1 year, mean DAS 28 3.7±1.6, mean age 58.6±10.0 years, 69% women, 76,7% RF “+”, 81,5% ACPA “+”. 91,2% of the patients received conventional DMARDs (methotrexate), 8,8% - biological agents. All patients received NSAIDs (aceclofenac) to control their symptoms. Тhe follow-up period was 6 months. We evaluated the dynamics of the DAS 28 index, the level of pain and patient global health on a 100- mm visual analog scale (VAS).Results:the level of pain (VAS) decreased from 63,1 ± 15,4 to 46,3± 8,3 (p=0,001) by 3 months of follow-up and up to 39,5± 11,2 (p= 0,001) by 6 months of follow-up. The patient global health (VAS) also improved from 58,2 ± 13,4 at baseline to 40,3 ± 11,2 (p=0,001) at 3 months and to 35,5 ± 9,7 (p=0,001) at 6 months of follow up. The mean DAS 28 remained within the moderate disease activity and decreased from 3,7±1,5 to 3,4 ±1,1 (p=0,01) after 3 months, and to 3,1± 0,9 (p=0,01) after 6 months.Conclusion:long-term NSAID therapy allows to control the disease activity in patients with moderate RA. This should be taken into account when planning therapy, including deciding whether to “switch” DMARDs and prescribing biological agents.Disclosure of Interests:None declared

scholarly journals CORRELATION STUDY OF DISEASE ACTIVITY SCORE AND SERUM CARTILAGE OLIGOMERIC MATRIX PROTEINLEVELS OF RHEUMATOID ARTHRITIS PATIENTS IN BANDUNG, INDONESIA

2016 ◽  
Vol 10 (1) ◽  
pp. 290
Author(s):  
Nyi Mekar Saptarini ◽  
Dainar Eka Pratiwi ◽  
Ellin Febrina ◽  
Marlia Singgih Wibowo ◽  
Tutus Gusdinar
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Matrix Protein ◽  
Disease Activity Score ◽  
Correlation Study ◽  
Activity Score ◽  
Rheumatology Clinic ◽  
Das 28 ◽  
Moderate Disease ◽  
Moderate Disease Activity

ABSTRACTObjective: This study was designed to determine the correlation between Disease Activity Score (DAS 28) and the serum Cartilage Oligomeric MatrixProtein (COMP) levels in Indonesian Rheumatoid Arthritis (RA) patients. Methods: The subjects were patients who visit the rheumatology clinic at one governmental hospital in Bandung, Indonesia. DAS was determinedby the QxMD Software based on erythrocyte sedimentation rate, and serum COMP levels were determined by enzyme-linked immunosorbent assay.Statistical analysis was conducted with IBM SPSS Statistics 23. Results: DAS 28 value was 3.36 ± 0.16 which indicates the moderate disease activity. Serum COMP levels were 843.80 ± 35.79 ng/ml in RA patientsand 830.00 ± 48.92 ng/ml in normal controls. Conclusion: There is no correlation between DAS 28 and serum COMP levels in RA patients (p = 0.496 and rho = 0.129). Keywords: Autoimmune disease, Rheumatoid arthritis monitoring, Cartilage oligomeric matrix protein, Disease activity score 28

scholarly journals Rheumatoid arthritis patients on persistent moderate disease activity on biologics have adverse 5-year outcome compared to persistent low-remission status and represent a heterogeneous group

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Irini Genitsaridi ◽  
Irini Flouri ◽  
Dimitris Plexousakis ◽  
Konstantinos Marias ◽  
Kyriaki Boki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Disease Activity ◽  
Serious Adverse Events ◽  
Term Outcome ◽  
Mixed Effect ◽  
Long Term Outcome ◽  
Moderate Disease ◽  
Moderate Disease Activity

Abstract Background The long-term outcome of rheumatoid arthritis (RA) patients who in clinical practice exhibit persistent moderate disease activity (pMDA) despite treatment with biologics has not been adequately studied. Herein, we analyzed the 5-year outcome of the pMDA group and assessed for within-group heterogeneity. Methods We included longitudinally monitored RA patients from the Hellenic Registry of Biologic Therapies with persistent (cumulative time ≥ 50% of a 5-year period) moderate (pMDA, 3.2 < DAS28 ≤ 5.1) or remission/low (pRLDA, DAS28 ≤ 3.2) disease activity. The former was further classified into persistent lower-moderate (plMDA, DAS28 < 4.2) and higher-moderate (phMDA, DAS28 ≥ 4.2) subgroups. Five-year trajectories of functionality (HAQ) were the primary outcome in comparing pRLDA versus pMDA and assessing heterogeneity within the pMDA subgroups through multivariable mixed-effect regression. We further compared serious adverse events (SAEs) occurrence between the two groups. Results We identified 295 patients with pMDA and 90 patients with pRLDA, the former group comprising of plMDA (n = 133, 45%) and phMDA (n = 162, 55%). pMDA was associated with worse 5-year functionality trajectory than pRLDA (+ 0.27 HAQ units, CI 95% + 0.22 to + 0.33; p < 0.0001), while the phMDA subgroup had worse 5-year functionality than plMDA (+ 0.26 HAQ units, CI 95% 0.18 to 0.36; p < 0.0001). Importantly, higher persistent disease activity was associated with more SAEs [pRLDA: 0.2 ± 0.48 vs pMDA: 0.5 ± 0.96, p = 0.006; plMDA: 0.32 ± 0.6 vs phMDA: 0.64 ± 1.16, p = 0.038]. Male gender (p = 0.017), lower baseline DAS28 (p < 0.001), HAQ improvement > 0.22 (p = 0.029), and lower average DAS28 during the first trimester since treatment initiation (p = 0.001) independently predicted grouping into pRLDA. Conclusions In clinical practice, RA patients with pMDA while on bDMARDs have adverse long-term outcomes compared to lower disease activity status, while heterogeneity exists within the pMDA group in terms of 5-year functionality and SAEs. Targeted studies to better characterize pMDA subgroups are needed, in order to assist clinicians in tailoring treatments.

scholarly journals Ultrasound Findings in Hand Joints Involvement in Patients with Psoriatic Arthritis and Its Correlation with Clinical DAS28 Score

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Priyanka Naranje ◽  
Mahesh Prakash ◽  
Aman Sharma ◽  
Sunil Dogra ◽  
Niranjan Khandelwal
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Power Doppler ◽  
Periosteal Reaction ◽  
Activity Score ◽  
Hand Joints ◽  
Moderate Disease ◽  
Ultrasound Findings ◽  
Moderate Disease Activity

Objective. To determine the frequency of the various ultrasound findings in hand joints in patients with psoriatic arthritis and correlate grayscale and Power Doppler ultrasonography findings with Disease Activity Score 28.Methods. This prospective study was performed in 30 patients. Ultrasound evaluation of 28 joints of both hands was undertaken and various findings were recorded including synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. Spearman correlation was used to see relationship between the ultrasound and DAS28 scores.Results. Ultrasound detected more abnormalities in the hand joints than did clinical examination. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 100%, Power Doppler abnormality suggesting hypervascularity was seen in 36.7%, soft tissue thickening was seen in 66.7%, periosteal reaction was seen in 33.3%, erosions were seen in 30% (mostly in DIP and PIP joints), and flexor tendonitis was seen in 6.7% of patients. Significant correlation was found between Disease Activity Score 28 and grayscale joint score (GSJS) (Spearman’sρ: 0.499;P: 0.005), grayscale joint count (GSJC) (ρ: 0.398;P: 0.029), and Power Doppler joint score (PDJS) (ρ: 0.367;P: 0.046). There was a statistically significant difference between remission and low disease activity group and moderate disease activity group in terms of GSJC, GSJS, PDJC, and PDJS (P<0.05). These ultrasound measures were higher in moderate disease activity zone patients.Conclusion. Ultrasound is a useful modality for the objective assessment of psoriatic arthritis. Ultrasound including Power Doppler can be used as a modality for assessment of severity of psoriatic arthritis as it correlates with the clinical scoring.

scholarly journals Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

RMD Open ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e000888 ◽  
Author(s):  
Maria Backström ◽  
Pirjo Tynjälä ◽  
Kristiina Aalto ◽  
Minna-Maija Grönlund ◽  
Heikki Ylijoki ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Characteristic Curve ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Juvenile Arthritis ◽  
Activity Score ◽  
Inactive Disease ◽  
International Consensus ◽  
Polyarticular Disease

ObjectivesTo validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts.MethodsIn a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated.ResultsOur earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0–0.5/0.0–0.7, LDA: 0.6–3.8/0.8–5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0–0.7 for CID, 0.8–5.0 for LDA and >5.0 for MDA.ConclusionInternational consensus on JADAS cut-off values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.

scholarly journals AB0683 IS THE NEW ASDAS NOMENCLATURE IN LINE WITH THERAPEUTIC DECISION MAKING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1637.1-1637
Author(s):  
B. Garcia-Magallon ◽  
M. D. C. Castro Villegas ◽  
R. Rosselló ◽  
V. Navarro-Compán
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Axial Spondyloarthritis ◽  
Therapeutic Decision ◽  
Low Disease Activity ◽  
Moderate Disease ◽  
Therapeutic Attitude ◽  
Very High ◽  
Moderate Disease Activity

Background:The Assessment of SpondyloArthritis international Society (ASAS) proposed in 2018 a change in the nomenclature of the Ankylosing Spondylitis Disease Activity Score (ASDAS) for monitoring disease activity in axial spondyloarthritis (axSpA), renaming the previously status of moderate disease activity as low disease activity status, with the presumption that this better reflects the perception that the doctor and the patient have about the disease situation. However, this decision was not data-driven.Objectives:To evaluate the association between the state of low disease activity according to the new ASDAS nomenclature and the therapeutic decision in patients with axSpA.Methods:Longitudinal retrospective study in which patients with axSpA recruited in a secondary hospital were included. All patients with clinical diagnosis of axSpA who started treatment with a first inhibitor of tumor necrosis factor between January 2014 and June 2019 were included. At each follow-up visit, disease activity assessments (including BASDAI and CRP) and the therapeutic decision of the doctor were collected. Later, the ASDAS was calculated and disease status at each visit was classified according to the new nomenclature (inactive, low, high and very high activity). Using descriptive statistics, the association between the disease activity status and the therapeutic decision was evaluated.Results:A total of 304 visits were analyzed in 104 patients with axSpA. Out of these, 57% were women, 47% had a subtype of non-radiographic axSpA and 42% were HLA-B27 positive. The mean (standard deviation) age at diagnosis was 46.9 (12.5) years. In the visits with an ASDAS showing a status of low activity, the therapeutic attitude was not to intensify the treatment in 98.2% of the cases. However, in visits with an ASDAS status of high or very high disease activity, treatment was intensified in 33.7% and 82.8% of cases, respectively.Conclusion:In clinical practice, the status of disease activity initially classified by the ASDAS as moderate disease activity is currently considered to represent low disease activity status based on the therapeutic attitude of following a non-intensification strategy in this situation. These data support the recent change in the nomenclature of disease activity states according to the ASDAS.References:[1]Machado PM, Landewé R, van der Heijde D. Assessment of Spondyloarthritis international Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis 2018; 77:1539-1540.Figure 1.Association between the state of disease activity according to the new ASDAS nomenclature and the therapeutic decision.Disclosure of Interests:Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, María del Carmen Castro Villegas: None declared, Rosa Rosselló: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

scholarly journals AB0972 DEVELOPMENT OF THE PARENT VERSION OF THE JUVENILE ARTHRITIS DISEASE ACTIVITY SCORE CUT-OFFS FOR MODERATE AND HIGH DISEASE ACTIVITY STATES IN JUVENILE IDIOPATHIC ARTHRITIS IN A LARGE MULTINATIONAL PATIENT SAMPLE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1781.2-1781
Author(s):  
I. Avrusin ◽  
R. Naddei ◽  
F. Ridella ◽  
G. Januskeviciute ◽  
M. Kostik ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Juvenile Arthritis ◽  
High Disease Activity ◽  
Activity Score ◽  
Inactive Disease ◽  
Youden Index ◽  
Research Support ◽  
Attending Physician

Background:Measurement of disease activity level is of pivotal importance in the care of patients with juvenile idiopathic arthritis (JIA). According to the most recent requirements, both, parent’s and children’s perception should be taken into account while evaluating the disease course and assessing effectiveness of therapy. Therefore, a new disease activity evaluation tool, based only on parent assessment of the outcome, is under development and named Parent Juvenile Arthritis Disease Activity Score (parJADAS) [1].Objectives:The aim of this study is to develop the parJADAS cut-off values of moderate disease activity (MDA) and high disease activity (HDA) in JIA patients.Methods:The parJADAS (score range 0-40) is the sum of 4 values: 1) parent’s assessment of disease activity on a 21-numbered circle 0-10 VAS; 2) assessment of pain intensity on a 21-numbered circle 0-10 VAS; 3) proxy assessment of joint disease up to a maximum of 10 joints; 4) assessment of morning stiffness (MS) on a Likert scale, ranging from no MS (0 points) to > 2 hours of MS (10 points). The study dataset is composed of 2,412 patients with JIA, seen in 3389 visits with parJADAS available, enrolled in the the multinational registry PharmaChild, assessing the long-term safety of treatment of children with JIA. At each visit, subjects were subjectively rated as being in inactive disease, low disease activity, MDA, or HDA by the attending physician. For each patient, only one visit per disease state was retained.To identify the cut-offs the following methods were implemented: 1) Mapping: the 25thpercentile value of the parJADAS in patients having MDA or HDA, respectively, was calculated; 2) Youden Index: Youden Index (J) identifies the maximum potential effectiveness of the biomarker through the receiver operating characteristic (ROC) curve analysis; 3) Max agreement: The analysis of agreement was based on kappa statistics, which assesses the agreement beyond chance between 2 dichotomous ratings. The first rating was obtained using all possible parJADAS values as hypothetical test criteria; to obtain the second rating, the categorical ratings of each attending physician were dichotomized and were coded as 0 or 1.Results:Preliminary cut-off values for parJADAS with sensitivity and specificity are presented in the table.25th centileYouden IndexKappaMeanSensitivitySpecificityAUCMDA659773.482.00.853HDA14.81118.51571.287.60.892Conclusion:Tentative cut-off values for classifying the states of MDA and HAD using parJADAS were calculated. The obtained values will be tested in the validation analysis. Once validated the cut-offs are ideally suited to identify subjects at risk of disease flare when remotely monitored with the parJADAS.References:[1]Ridella F., et al. Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1434.Acknowledgments:We wish to thank all researchers and patients participating in the PharmaChild registryDisclosure of Interests:Ilia Avrusin: None declared, Roberta Naddei: None declared, Francesca Ridella: None declared, Giedre Januskeviciute: None declared, Mikhail Kostik: None declared, Ben Whitehead: None declared, Romina Gallizzi: None declared, Elzbieta Smolewska: None declared, Serena Pastore: None declared, Philip Hashkes: None declared, Joost F. Swart: None declared, Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Angelo Ravelli: None declared, Alessandro Consolaro Grant/research support from: Pfizer Inc., AlfaSigma, Speakers bureau: AbbVie

scholarly journals Serum progranulin level is associated with disease activity following orthopedic surgery in rheumatoid arthritis patients

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097145
Author(s):  
Chunyu Kong ◽  
Yuquan Shi ◽  
Junhua Xu ◽  
Zijuan Xiu ◽  
Wufang Qi
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Orthopedic Surgery ◽  
Disease Activity Score ◽  
C Reactive Protein ◽  
Independent Predictive Factor ◽  
Reactive Protein ◽  
Moderate Disease ◽  
The Mean ◽  
Moderate Disease Activity

Background Few studies have focused on the ability of progranulin to predict postoperative disease activity in rheumatoid arthritis (RA) patients who have undergone surgery. This study evaluated serum progranulin levels in active RA patients and analyzed its relationship with postoperative disease activity. Methods One hundred thirty-two patients with active RA and 72 healthy subjects were included in this study. Serum progranulin was measured, and clinical data were collected. The postoperative 1-year Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) scores was evaluated as an indicator of disease activity. The predictive value of progranulin in postoperative 1-year disease activity in RA patients was also analyzed. Results Serum progranulin was significantly associated with the postoperative 1-year RA disease activity. The mean serum progranulin level in patients with a high disease activity was significantly higher than that of RA patients with low-to-moderate disease activity (54.2 ± 10.6 ng/mL vs. 46.7 ± 8.8 ng/mL). Serum progranulin was also evaluated as an independent predictive factor for postoperative 1-year RA disease activity in multivariate analysis (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.02–8.85). Conclusions Serum progranulin levels may be a promising indicator of postoperative disease activity in RA patients who underwent orthopedic surgery.

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