scholarly journals AB0324 REASONS FOR DISCONTINUATION OF BIOLOGICS IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS: RESULTS OF A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1461.1-1461
Author(s):  
V. Sygyrta ◽  
S. Glukhova ◽  
E. Aronova ◽  
A. Satybaldyev ◽  
A. Lila
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Adverse Events ◽  
Certolizumab Pegol ◽  
Refractory Rheumatoid Arthritis ◽  
Tnf Α ◽  
Sequential Administration ◽  
The Mean ◽  
Third Line ◽  
Line Of Therapy

Background:Refractory rheumatoid arthritis (RRA) is a subtype of rheumatoid arthritis (RA), in which the sequential administration of optimal methotrexate (MT) doses in combination with glucocorticoids (GCs), and at least - two biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action during 18-24 months does not lead to a significant decrease in the inflammatory activity of RA.Objectives:Analysis of the selection strategy and the “survival” of bDMARDs in patients with RRA.Methods:The retrospective study included data of 95 RRA patients (80 females, 80.8%), aged 23 to 80 years (mean age 57 years), treated with bDMARDs. Mean RA duration was 11.9±7.6 years. All patients were divided into 6 groups depending on the number of the lines of therapy (LOTs) received (from 2 to 7 consecutive bDMARDs). Totally 348 cases of bDMARDs administration were analyzed.Results:TNF-α inhibitors were most commonly used as the first and second lines of therapy: infliximab (INF) – 43 prescriptions, adalimumab (ADA) – 39, etanercept (ETC) – 25, certolizumab pegol (CZP) – 11, golimumab (GLM) - 6. Abatacept (ABA) was prescribed in 32 cases, rituximab (RTM) in 22 cases, and tocilizumab (TCZ) - in 12 cases. The following reasons for bDMARDs discontinuation were identified: lack of efficacy (LE) (55.2% of cases), adverse events (AE), including serious adverse events (14.8% of cases), administrative reasons (10.0% of cases), persistent remission (2.1% of cases), pregnancy (0.6%), and other (17.3% of cases)TNF-α inhibitors were also used in third-line bDMARDs therapies, but preference was given to drugs with a different mechanism of action: ABA-20 patients (23.2%), RTM – 20 (21.1%), TCZ – 15 (15.8%), ETC – 22 (23.2%), ADA – 9 (9.5%), INF – 4 (4.1%), CZP – 3 (3.1%). Treatment was discontinued in 74 patients (77.9%). In this cohort the following reasons for bDMARDs withdrawal were identified: LE (54.1%), AE (17.6%), administrative reasons (9.5%), remission (1.3%), and other (17.5%).The fourth line of therapy was administered in 45 patients: ABA-16 (35.6%), RTM-9 (20%), ADA – 6 (13.3%), TCZ – 5 (11.1%), ETC – 4 (8.9%), CZP – 4 (8.9%), GLM – 1 (2.2%). The reasons for discontinuation (29 patients, 64.4%) were as follows: LE (44.8%), AE (13.8%), other (41.4%).The fifth bDMARDs was used in 3 patients: TСZ-6 (46.1%), RTM – 3 (23.1%), ABA – 1 (7.7%), ETC – 1 (7.7%), ADA – 1 (7.7%), GLM – 1 (7.7%). Therapy was discontinued in 11 patients (84.6%) for the following reasons: LE (45.5%), AE (18.2%), other (36.3%).The sixth line of therapy was necessary in 4 patients: ETC (25%), GLM (25%), CZP (25%), ABA (25%) and was discontinued in 3 (75%) of them due to AE (33.3%) and other reasons (66.7%). One patient received TCZ as the seventh line of therapy.Mean duration of the first line of therapy was 7.6 ± 6.5 months, of the second line - 9.6 ± 7.5 months, of the third line - 11.5 ± 7.1 months, fourth line - 12.5 ± 8 months, fifth line - 13.4 ± 4.8 months, and sixth line - 14.6 ± 4.4 months. Statistical analysis revealed significant differences (p<0.05) in the mean duration of therapy (retention on therapy) between the 1st and 3rd, as well as the between the 1st and 4th lines of therapy. There were no significant differences in rates of bDMARDs discontinuation due to LE or AE. The rates of bDMARDs discontinuation did not differ significantly in the study groups.Conclusion:The mean retention on a drug in the 3rd and 4th lines of therapy in patients with refractory rheumatoid arthritis was significantly longer than on the 1st line of therapy. The most common reason for bDMARDs discontinuation was lack of efficacy. Additional lines of bDMARDs therapy were not associated with increasing rates of adverse events.Disclosure of Interests:None declared

scholarly journals AB0225 TUMOR NECROSIS FACTOR ALPHA (TNF-Α) INHIBITORS IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS: REASONS FOR WITHDRAWAL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1138.2-1139
Author(s):  
V. Sygyrta ◽  
E. Aronova ◽  
A. Lila ◽  
S. Glukhova
Keyword(s):  
Rheumatoid Arthritis ◽  
Common Reason ◽  
First Line ◽  
Line Therapy ◽  
Refractory Rheumatoid Arthritis ◽  
Tnf Α ◽  
Sequential Administration ◽  
On Line ◽  
Line Of Therapy ◽  
Line Drug

Background:Refractory rheumatoid arthritis (RRA) is a subtype of rheumatoid arthritis (RA), in which the sequential administration of optimal methotrexate doses in combination with glucocorticoids, and at least - two biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action during 18-24 months does not lead to a significant decrease in the inflammatory activity of RA.Objectives:to determine the reasons for the withdrawal of TNF-α inhibitors in patients with RRA.Methods:The retrospective study included data of 95 RRA patients (80 females, 80.8%), aged 23 to 80 years (mean age 57 years), treated with TNF-α inhibitors. Mean RA duration was 11.9±7.6 years. All patients were divided into 6 groups depending on the number of the lines of therapy received. A total of 154 cases of TNF-α were studied.Results:Infliximab (INF) was most often prescribed as the first line of therapy - 40 prescriptions. The reasons for the withdrawal of INF as the first bDMARDs were: insufficient effectiveness (IE) - 20 cases (50% of appointments), administrative reasons (AdmR) - 13 cases (32.5% of appointments), adverse reactions (AR) - 6 cases (15% of appointments), remission - 1 case (2.5% of appointments). In the 2nd line of therapy, INF was prescribed in only 3 cases, the drug was canceled in all cases due to IE. In 3 lines of therapy, INF was prescribed in 4 cases, the reasons for withdrawal in these cases were IE (50%, 2 cases) and AR (50%, 2 cases).Etanercept (ETC) was prescribed as the first line of therapy in 10 cases. The most common reason for withdrawal was IE in 5 cases (50% of appointments), AR - 4 cases (40%), AdmR - 1 case (10%). ETC was prescribed as a 2 line in 15 cases, the reasons for withdrawal then were: IE - 11 cases (73.3%), AR - 1 case (6.7%), AdmR - 3 cases (20%). ETC was prescribed as a 3-line therapy in 20 cases. The reasons for withdrawal were as follows: IE - 8 cases (40%), AR - 4 cases (20%), AdmR - 8 cases (40%). As a drug of 4 lines of therapy, ETC was prescribed 1 time and was canceled due to the development of AR. As the 5th line, ETC was appointed in 1 case and was canceled due to IE. ETC was assigned as line 6 in 1 case. The reason for the withdrawal was AR.Adalimumab (ADA) was prescribed as the first line of therapy in 19 cases, the reasons for withdrawal were: IE - 14 cases (73.7%), AR - 2 cases (10.5%), AdmR - 3 (15.8%). On line 2, ADA made 20 appointments, the reasons for withdrawal were: IE - 13 (65%), AR - 3 (15%), AdmR - 4 (20%). ADA was prescribed as line 3 in 8 cases, the reasons for withdrawal were: IE - 6 (75%), AR - 1 (12.5%), AdmR - 1 (12.5%). As a 4-line drug, ADA was prescribed in 4 cases and was canceled in all cases due to IE. On line 5, ADA was assigned 1 time and was discontinuation due to IE.Golimumab (GLM). He was appointed as the first line in 5 cases. The reasons for withdrawal were: IE - 1 case (20%), AdmR - 4 appointments (80%). As a 2-line drug, GLM was prescribed once and was canceled due to AdmR. The drug was not prescribed for the 3rd and 4th lines. As a 5-line therapy, it was prescribed once and was canceled due to IE.When assessing the frequency of drug withdrawal due to IE or AR, no significant differences were found between the lines of therapy. Discontinuation rates were also not statistically different in the study groups.Conclusion:The most common reason for the withdrawal of TNF-α in patients with RRA is IE. With an increase in the lines of TNF-α therapy, remission as a reason for withdrawal was not identified. As a result of the increase in the number of sequentially prescribed bDMARDs, the frequency of discontinuation of TNF-α in connection with IE did not decrease. A significant reason for cancellation is AdmR, to which we attributed the absence of the drug in the pharmacy network, financial reasons limiting the continuation oDisclosure of Interests:None declared

scholarly journals Immediate Effect of Baricitinib on Arthritis and Biological Disease-Modifying Antirheumatic Drug-Induced Psoriasis-Like Skin Lesions in Two Patients with Rheumatoid Arthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Yoshifumi Tada ◽  
Nobuyuki Ono ◽  
Syuichi Koarada
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Certolizumab Pegol ◽  
Skin Lesions ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Drug Induced ◽  
Beneficial Effects ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug

Biological disease-modifying antirheumatic drugs (bDMARDs) are very effective for treating rheumatoid arthritis (RA). However, they sometimes induce adverse events such as psoriasis-like skin lesions. We describe psoriasis-like skin lesions that developed simultaneously with an RA flare in patient 1 during treatment with abatacept and in patient 2 soon after starting certolizumab pegol. The skin lesions persisted in patient 2 despite stopping certolizumab. Baricitinib was initiated because of RA flare and resulted in immediate beneficial effects on arthritis as well as skin lesions. The RA went into remission in both patients, and the psoriasis-like skin lesions disappeared within four weeks (patient 1) and three months (patient 2).

scholarly journals Long-term effectiveness and safety of infliximab, golimumab and golimumab-IV in rheumatoid arthritis patients from a Canadian prospective observational registry

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Proton Rahman ◽  
Philip Baer ◽  
Ed Keystone ◽  
Denis Choquette ◽  
Carter Thorne ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Disease Activity ◽  
Randomized Clinical Trials ◽  
Disease Duration ◽  
Routine Care ◽  
Treatment Modalities ◽  
The Mean ◽  
Over Time

Abstract Background Long-term clinical registries are essential tools to evaluate new therapies in a patient population that differs from those in randomized clinical trials. The objectives are to describe the profile of rheumatoid arthritis (RA) patients treated with anti-TNF agents in Canadian routine care. Methods RA patients eligible for treatment with Infliximab (IFX), golimumab (GLM) or intravenous golimumab (GLM-IV) as per their respective Canadian product monographs were enrolled into the BioTRAC registry between 2002 and 2017. Study visits occurred at baseline and every 6 months thereafter. Effectiveness was assessed by changes in disease activity. Safety was evaluated by the incidence of adverse events (AEs) and drug survival. Results Of the 890 IFX-, 530 GLM- and 157 GLM-IV-treated patients, the proportion of females ranged from 77.0–86.6%, the mean ages from 55.8–57.7 and the mean disease duration from 6.5–8.6 years. A significant decrease in baseline disease duration and disease activity parameters (DAS, TJC, SJC, HAQ, AM stiffness, MDGA, PtGA, CRP, ESR) was observed over time. Treatment with IFX, GLM- and GLM-IV significantly improved all disease parameters over time. The incidence of AEs was 105, 113 and 82.6 /100 PYs and the incidence of SAEs was 11.7, 11.2 and 4.68 /100 PYs for IFX, GLM- and GLM-IV-treated patients, respectively. Conclusion Differences in baseline characteristics between patients treated with an anti-TNFs over time shows the evolution of treatment modalities over time. All treatments significantly reduced disease activity and improved functionality in a similar fashion. The incidence of adverse events was consistent with the safety profiles of IFX and GLM. Trial registration ClinicalTrials.gov Identifier: NCT00741793 (Retrospectively registered on August 26, 2008).

scholarly journals Effects of 1-year anti-TNF-α therapy on vascular function in rheumatoid arthritis and ankylosing spondylitis

2019 ◽  
Vol 40 (3) ◽  
pp. 427-436 ◽  
Author(s):  
Edit Végh ◽  
György Kerekes ◽  
Anita Pusztai ◽  
Attila Hamar ◽  
Szilvia Szamosi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
Vascular Function ◽  
Certolizumab Pegol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Cardiovascular Morbidity And Mortality ◽  
Tnf Α ◽  
Flow Mediated Vasodilation

AbstractAccelerated atherosclerosis, increased cardiovascular morbidity and mortality have been associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Vascular function, clinical and laboratory markers and the effects of anti-TNF therapy were assessed in arthritides. Fifty-three 53 patients including 36 RA patients treated with either etanercept (ETN) or certolizumab pegol and 17 AS patients treated with ETN were included in a 12-month follow-up study. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and arterial pulse-wave velocity (PWV) in all patients. All assessments were performed at baseline and 6 and 12 months after treatment initiation. A significant improvement of brachial artery FMD was observed after 6 months (p = 0.004). A tendency of FMD improvement was also observed after 12 months (p = 0.065). ccIMT did not change throughout the year. PWV significantly improved after 12 months (p = 0.034). Higher baseline ccIMT (p = 0.009) and PWV (p = 0.038) were associated with clinical non-response (cNR) versus response (cR) to biologics. Multiple analysis confirmed the association of baseline ccIMT with age (p = 0.003) and cNR (p = 0.009), as well as that of baseline PWV with age at diagnosis (p = 0.022) and current chest pain (p = 0.004). Treatment itself determined the 12-month changes in FMD (p = 0.020) and PWV (p = 0.007). In a mixed cohort of RA and AS patients, TNF inhibition improved or stabilized vascular pathophysiology. Inflammation may be associated with FMD, while, among others, cNR may influence vascular function.

scholarly journals Effectiveness and safety of 12-month certolizumab pegol treatment for axial spondyloarthritis in real-world clinical practice in Europe

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 113-124
Author(s):  
Xenofon Baraliakos ◽  
Torsten Witte ◽  
Luc De Clerck ◽  
Bruno Frediani ◽  
Eduardo Collantes-Estévez ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Adverse Events ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Axial Spondyloarthritis ◽  
Certolizumab Pegol ◽  
Signs And Symptoms ◽  
Serious Adverse Events ◽  
The Mean ◽  
One Year

Abstract Objectives The efficacy and safety of certolizumab pegol (CZP), an Fc-free, PEGylated anti-TNF, in axial spondyloarthritis (axSpA) has been established in clinical trial settings. We report CZP effectiveness and safety in European clinical practice in patients with axSpA, including radiographic (r-) and non-radiographic (nr-) axSpA. Methods CIMAX (NCT02354105), a European non-interventional multicentre prospective study, observed CZP treatment response and safety over 12 months in a real-world axSpA cohort. The primary outcome was change from baseline in BASDAI to week 52, with additional outcomes pertaining to effectiveness and safety. Patients who received ≥1 dose CZP were followed up for adverse events, and those with baseline and ≥1 post-baseline BASDAI assessment were included in effectiveness analyses. Results A total of 672 patients (r-axSpA: 469; nr-axSpA: 201; unconfirmed diagnosis: 2) from 101 sites received ≥1 dose of CZP, of whom 564 (r-axSpA: 384; nr-axSpA: 179; unconfirmed: 1) were included in the effectiveness analyses. The mean baseline BASDAI was 6.1 in the overall axSpA population and r-axSpA and nr-axSpA subpopulations. At week 52, the mean (s.d.) change in BASDAI was −2.9 (2.3; n = 439); for r-axSpA and nr-axSpA, it was −2.9 (2.2; n = 301) and −2.8 (2.4; n = 137), respectively (P &lt;0.0001 for all). Similar improvements were seen across other axSpA disease measures. In total, 37.9% (255/672) patients experienced adverse events, and 1.8% (12/672) experienced ≥1 serious adverse events. Conclusion Improvements observed in signs and symptoms of axSpA following one year of CZP treatment in real-world clinical practice were similar to those from previous randomized clinical trials, with no new safety concerns.

The Effect of Activity and Type of Rheumatoid Arthritis on the Flexible Implant Arthroplasty of the Metacarpophalangeal Joint

2002 ◽  
Vol 27 (2) ◽  
pp. 180-183 ◽  
Author(s):  
H. ISHIKAWA ◽  
A. MURASAWA ◽  
T. HANYU
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Metacarpophalangeal Joint ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Systemic Factors ◽  
Postoperative Serum ◽  
The Mean ◽  
Clinical And Radiological Results

A retrospective study was performed on 184 Swanson flexible implant arthroplasties of the metacarpophalangeal joint in 75 hands of 64 patients with rheumatoid arthritis, to investigate the influence of systemic factors on the clinical and radiological results. The mean follow-up period was 6 years. The postoperative serum C-reactive protein level was found to affect postoperative pain, and there was a larger extension lag and more subsidence of the implant in those with the mutilating type of the disease.

scholarly journals Long-Term Effectiveness and Safety of Infliximab, Golimumab and Golimumab-IV in Rheumatoid Arthritis Patients from a Canadian Prospective Observational Registry

2020 ◽  
Author(s):  
Proton Rahman ◽  
Philip Baer ◽  
Ed Keystone ◽  
Denis Choquette ◽  
Carter Thorne ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Disease Activity ◽  
Randomized Clinical Trials ◽  
Disease Duration ◽  
Routine Care ◽  
Treatment Modalities ◽  
The Mean ◽  
Over Time

Abstract Background: Long-term clinical registries are essential tools to evaluate new therapies in a patient population that differs from those in randomized clinical trials. The objectives are to describe the profile of rheumatoid arthritis (RA) patients treated with anti-TNF agents in Canadian routine care.Methods: RA patients eligible for treatment with Infliximab (IFX), golimumab (GLM) or intravenous golimumab (GLM-IV) as per their respective Canadian product monographs were enrolled into the BioTRAC registry between 2002 and 2017. Study visits occurred at baseline and every 6 months thereafter. Effectiveness was assessed by changes in disease activity. Safety was evaluated by the incidence of adverse events (AEs) and drug survival.Results: Of the 890 IFX-, 530 GLM-SC- and 157 GLM-IV-treated patients, the proportion of females ranged from 77.0-86.6%, the mean ages from 55.8-57.7 and the mean disease duration from 6.5-8.6 years. A significant decrease in baseline disease duration and disease activity parameters (DAS, TJC, SJC, HAQ, AM stiffness, MDGA, PtGA, CRP, ESR) was observed over time. Treatment with IFX, GLM-SC and GLM-IV significantly improved all disease parameters over time. The incidence of AEs was 105, 113 and 82.6 /100 PYs and the incidence of SAEs was 11.7, 11.2 and 4.68 /100 PYs for IFX, GLM-SC and GLM-IV-treated patients, respectively. Conclusion: Differences in baseline characteristics between patients treated with an anti-TNFs over time shows the evolution of treatment modalities over time. All treatments significantly reduced disease activity and improved functionality in a similar fashion. The incidence of adverse events was consistent with the safety profiles of IFX and GLM.Trial Registration: NCT00741793

Soluble vascular biomarkers in rheumatoid arthritis and ankylosing spondylitis: effects of one-year anti-TNF-α therapy

2020 ◽  
pp. jrheum.200916
Author(s):  
Anita Pusztai ◽  
Attila Hamar ◽  
Ágnes Horváth ◽  
Katalin Gulyás ◽  
Edit Végh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
Oxidized Ldl ◽  
Certolizumab Pegol ◽  
Intima Media Thickness ◽  
Serum Levels ◽  
Urokinase Plasminogen Activator Receptor ◽  
Tnf Α ◽  
One Year ◽  
Vascular Biomarkers

Objective Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with cardiovascular (CV) disease. The treatment of arthritis by tumour necrosis factor α (TNF- α) inhibitors may decrease the serum concentrations of vascular biomarkers. We determined circulating levels of oxidized LDL (oxLDL)/β2 glycoprotein I (β2GPI) complexes, antibodies to 60 kDa heat shock protein (anti-Hsp60), soluble urokinase plasminogen activator receptor (suPAR) and Brain type natriuretic peptide (BNP) fragment in sera of RA and AS patients undergoing anti-TNF treatment. Methods Fifty-three RA/AS patients were treated with etanercept (ETN) or certolizumab pegol (CZP) for one year. Circulating oxLDL/β2GPI complex (AtherOx®), anti- Hsp60 IgG and BNP8-29 fragment levels were assessed by ELISA. suPAR levels were determined by suPARnostic® Quick Triage test. Flow-mediated vasodilation (FMD), carotid intima-media thickness (IMT) and arterial pulse-wave velocity (PWV) were determined by ultrasound. Results One-year anti-TNF treatment significantly decreased oxLDL/β2GPI levels, as well as suPAR levels in patients with “critically” high suPAR levels at baseline. In RA, BNP levels were higher in seropositive vs seronegative patients. Serum levels of these vascular biomarkers variably correlated with lipids, ACPA, RF and CRP. IMT positively correlated with BNP, PWV with suPAR and anti-Hsp60, while FMD inversely associated with anti-Hsp60. In RM-ANOVA analysis, disease activity supported the effects of anti-TNF treatment on 12-month changes in oxLDL/β2GPI. IMT supported the effects of therapy on changes of anti-Hsp60 and suPAR. Conclusion These biomarkers may be involved in the pathogenesis of atherosclerosis underlying RA/AS. TNF inhibition variably affect the serum levels of oxLDL/β2GPI, suPAR and BNP.

scholarly journals Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis

2019 ◽  
Vol 39 (1) ◽  
pp. 167-175 ◽  
Author(s):  
Katalin Gulyás ◽  
Ágnes Horváth ◽  
Edit Végh ◽  
Anita Pusztai ◽  
Ágnes Szentpétery ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Ankylosing Spondylitis ◽  
Bone Loss ◽  
Bone Mineral ◽  
Certolizumab Pegol ◽  
Joint Destruction ◽  
Type I ◽  
Mineral Density ◽  
Tnf Α

Abstract Objectives Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with generalized and localized bone loss. We conducted a comprehensive study using imaging (dual-energy X-ray absorptiometry, DXA) and laboratory biomarkers in order to determine bone health and to study the effects of anti-tumor necrosis factor (TNF) biologics in RA and AS. Patients and methods Thirty-six RA and 17 AS patients undergoing 1-year etanercept (ETN) or certolizumab-pegol (CZP) therapy were studied. Bone density was assessed by DXA at baseline and after 12 months. Serum C-reactive protein (CRP), calcium, phosphate, parathyroid hormone (PTH), vitamin D3, osteocalcin, procollagen type I N-propeptide (P1NP), C-terminal telopeptide (βCTX), osteoprotegerin, sclerostin (SOST), Dickkopf-1 (DKK-1), soluble receptor activator nuclear kappa B ligand (sRANKL), and cathepsin K (cathK) levels were determined at baseline and after 6 and 12 months. Results TNF-α inhibition was clinically effective. Anti-TNF-α halted further bone loss over 1 year. In general, anti-TNF therapy significantly increased P1NP, SOST levels, and the P1NP/βCTX ratios, while decreased DKK-1 and CathK production at different time points in most patient subsets. In the full cohort and in RA, baseline and/or 12-month bone mineral density (BMD) at multiple sites exerted inverse relationships with CRP and βCTX, and positive correlation with SOST. In AS, L2-4 BMD after 1-year biologic therapy inversely correlated with baseline βCTX, while femoral neck BMD rather showed inverse correlations with CRP. Conclusions Anti-TNF therapy slowed down generalized bone loss, in association with clinical improvements, in both diseases. TNF blockade may enhance bone formation and suppress joint destruction. Anti-TNF therapy may act inversely on DKK-1 and SOST. Independent predictors of BMD were SOST and βCTX in RA, whilst CRP in AS.Key Points• One-year anti-TNF therapy halted generalized bone loss in association with clinical improvement in arthritides.• Anti-TNF therapy may inversely act on DKK-1 and SOST.• Independent predictors of BMD were SOST and βCTX in RA, while CRP in AS.

scholarly journals Profil de la polyarthrite rhumatoïde en consultation rhumatologique à Lomé (Togo)

2017 ◽  
Vol 13 (15) ◽  
pp. 125 ◽  
Author(s):  
Kakpovi K. ◽  
Koffi-Tessio V. ◽  
Houzou P. ◽  
Fianyo E. ◽  
Kolou M. ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Rheumatoid Factor ◽  
Median Duration ◽  
Carpal Bones ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Polyarthrite Rhumatoïde ◽  
The Mean ◽  
Disease Modifying

Objective: To determine epidemiological, clinical, therapeutic aspects and outcomes of rheumatoid arthritis (RA) in rheumatologic consultation at lome (Togo). Patients and method: This was retrospective study carried out from 1 stJanuary 1990 to 31 stDecember 2015 in the rheumatology department. The study included all patients suffered from RA in rheumatologic consultations and who fulfilled the 2010 ACR and EULAR’s criteria. Results: Ninety two (77 women and 15 men) out of 25.992 patients (0.3%) examined in 25 years had suffered from RA. The mean age at admission was 42 years (range: 17-82 years). The median duration of the diseases was four years (range: 14days – 20 days). The diseases onset was polyarticular with 86% of the patients and oligoarticular with the thirteen others (14%). The proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints are involved in 81,5 % of cases; and the wrists in 77,2% of cases. The rheumatoid hip was observed in four patients. Forty-two of the patients (45,6%) presented RA deformities. Bilateral MCP and IPP joint early erosion was observed in 36 patients (39,1%) and bilateral carpal diffuse osteoporosis in 44 patients (47,8%). The ankylosis of the carpal bones was observed in 26 patients (28,2 %). Rheumatoid factor was positive in 44% of patients. Methotrexate was the most commonly disease-modifying antirheumatic drugs used in 44,4% of the patients. The disease was improved in 89% of patients. Conclusion: Rheumatoid arthritis seems relatively rare in Togo. It’s diagnosis is often made at the established phase and methotrexate remains the cornerstone of the treatment.

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