scholarly journals AB0676 THE ROLE OF ACPA AND ANA IN SPONDYLOARTHRITIS: HOW THE AUTOIMMUNE DYSREGULATION CAN AFFECT THE COURSE OF DISEASE AND THERAPEUTIC SUCCESS OF MONOTHERAPY DMARDS AND bDMARDs

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1633.1-1633
Author(s):  
D. Cici ◽  
C. Rotondo ◽  
A. Corrado ◽  
S. Berardi ◽  
N. Mansueto ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Start Time ◽  
Disease Manifestation ◽  
Therapeutic Success ◽  
Course Of Disease ◽  
Drug Survival ◽  
Comorbidity Index ◽  
Citrullinated Protein ◽  
Axial Involvement

Background:Occasional findings of anti-citrullinated-protein-antibodies (ACPA) and anti-nuclear-antibodies (ANA) were rarely described in literature on Psoriatic Arthritis (PsA) and on Spondyloarthritis (SpA) in general. How these autoimmune dysregulations can affect the course of them is not yet understood.Objectives:The aim of our study is to evaluate if the presence of ACPA and ANA can determine different disease subsets and influence the DMARDs monotherapy (methotrexate) drug survival (DSM) and b-DMARDs multi-failure patients (MF).Methods:We conducted a retrospective study on patients with Psoriatic Arthritis (PsA) and Spondyloarthritis that fulfilled the ASAS and CASPAR criteria. Patients with diagnosis of connective tissue disease and rheumatoid arthritis and patients ≤ 18 years old were excluded from the study. For each patient, the following variables were considered: age, ACPA, ANA, time between arthritis onset and start of DMARDs (start-time), DSM, switch to b-DMARDs (sw-bDMARDs), arthritis subset (oligoarticular (OA), polyarticular (PA), enthesitis (EA), axial involvement (AI)), number of comorbidities (NC), Charlson Comorbidity Index (CCI).Results:150 patients (55% with PsA and 45% with another SpA) were included in the study. No differences were found in age, ANA rate, ACPA rate, start-time, OA, PA, EA, AI, NC and CCI between the PsA and SpA groups.In the whole group of patients, the ACPA+ subjects(11%) had a significant increase of NC (2.47 ± 1.5 vs 1.6 ± 1.4, p=0.035), a trend to higher CCI, to switch to b-DMARDs, and to be MF compared to those without ACPA. In the same group, the ANA+ patients (12%) showed shorter DSM (233.5 wk ± 45.9 vs 548.0 wk ± 56.8, p=0.362) with similar trend in each subgroup (PsA and SpA).In SpA group, the ACPA+ patients(6,3%) had a trend to shorter DSM (269.0 weeks ± 125vs 603.96 wk± 92.8, p=0.492),to higher sw-bDMARDs, and to be MF, higher NC and CCI compared to those without ACPA. No differences in clinical subset (OA, PA, EA, AI) were observed. In the same group the ANA+ patients had significant higher rate of PA (100% vs 65%, p=0.026) rather than OA (0% vs 35%, p=0.025). No significant differences were found in NC, CCI, MF.In the PsA group, ACPA+ patients showed a trend to develop PA and EA subsets, shorter DSM (187.5 wk ± 48.7 vs 299.6 wk ± 31.4, p=0.415), higher rate to sw-bDMARDs and to be MF. The ANA+ PsA patients had higher trend to develop PA and AI subsets rather than OA and EA. All ANA+ patients were MF (100% vs 42%, p=0.046).Conclusion:The ACPA and ANA positivity in PsA and SpA patients could be suggestive of more severe clinical disease manifestation, higher frequency of comorbidities and lower predicted 10-year survival (CCI). Moreover, this autoimmune dysregulation could be associated with worse drug survival in monotherapy with methotrexate and higher chance to be MF. Therefore, they can be taken into account for clinical management of these patients.Disclosure of Interests:None declared

scholarly journals OP0129 Drug survival on anti-tnf-alpha in psoriatic arthritis patients with axial involvement and analysis of predictors

2018 ◽  
Author(s):  
S. Lopriore ◽  
F. Cacciapaglia ◽  
S. Perniola ◽  
M.G. Anelli ◽  
G. Lopalco ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Tnf Alpha ◽  
Drug Survival ◽  
Axial Involvement

scholarly journals AB0740 SECOND-LINE BIOLOGIC DMARDs SURVIVAL IN PSORIATIC ARTHRITIS. DATA FROM A SPANISH THIRD-LEVEL HOSPITAL.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1665.2-1666
Author(s):  
J. Arroyo Palomo ◽  
I. Del Bosque Granero ◽  
A. Corral Bote ◽  
B. A. Blanco Cáceres ◽  
J. Bachiller-Corral
Keyword(s):  
Survival Analysis ◽  
Psoriatic Arthritis ◽  
Second Line ◽  
Hla B27 ◽  
First Line ◽  
Drug Survival ◽  
Kaplan Meier ◽  
Level Hospital ◽  
Necrosis Factor ◽  
Axial Involvement

Background:Psoriatic arthritis (PsA) covers a wide spectrum of disease manifestations, including arthritis, enthesitis, dactylitis and axial spondylitis. This range of symptoms presents a challenge to the treating physician. Biologic disease-modifying antirheumatic drugs (bDMARDs) have proven effective through randomized clinical trials; and most international PsA guides include them as main option upon first-line treatment failure. However, studies regarding drug efficacy after bDMARD switching are scarce, lower response rates and drug survival on consecutive lines has been explored in previous research.Objectives:To assess bDMARDs survival after first-line failure in PsA patients treated in a third-level hospital and to determine baseline clinical and laboratory parameters associated with drug survival.Methods:We conducted a retrospective, single-centre study. 47 patients who received a second-line bDMARD were included, with diagnosis of PsA according to the criteria of an expert rheumatologist. All patients were studied according to a standard protocol. Data regarding bDMARD prescribed, baseline characteristics, axial or peripheral involvement and immunological profile (included both HLA-B27 and HLA-Cw6) were extracted. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at bDMARD start were included, as well. Kaplan-Meier, log-rank analyses and Cox regression models were applied.Results:Of 47 patients receiving a second bDMARD, 55,3% (26) were female and mean (S.D.) age was 40,6 (12,52) years. Median (interquartile range) disease duration was 10,1 (3,7-14,8) years. Prescribed drugs were Adalimumab (ADL) (36,2%, 17), Etanercept (ETN) (27,6%, 13), Infliximab (IFX) (6,4%, 3), Golimumab (GOL) (10,6%, 5), Certolizumab (CTZ) (4,3%, 2), Secukinumab (SCK) (8,5%, 4) and Apremilast (APR) (6,4%, 3). 42,3% cases suffered from axial involvement, rest of the sample (57,6%) presented a pure peripherical form of PsA. HLA-B27 and -Cw6 were assessed in 80,9% (38) and 68,1% (32), respectively; of whom, HLA-B27 carriers were 10,5% and HLA-Cw6 positive, 46,9%. Mean CRP level was 10,25 mg/L and mean ESR was 23,17 mm. Patients showed mean and median global drug retention of 44,57 (29,8-59,3) and 23 months. At 12-month visit, drug survival was 70%, 47% at 24 months, and 33% at 4 years from onset. Mean drug persistence by bDMARD prescribed was: ADL, 62,1 months; ETN, 51,9 months; IFX, 39 months; GOL, 22,8 months; CTZ, 9,5 months; SCK, 13,5 months; and APR, 16,3 months. Through log-rank analyses, differences in drug retention were investigated by several variables. Female sex (30,35m, 16,5-44,2 m.) was identified as statistically significant different than male patients (62,5m, 35,6-89,4m, p=0,021). Although not significant, other differences were remarkable: non-axial involvement, HLA-Cw6 negativity, HLA-B27 positivity and CRP level over 5 mg/L. No differences were found between altered and normal ESR patients.Conclusion:Second-line bDMARD survival is lower in female PsA patients, according to our data and previous bibliography. Despite our reduced sample and possible bias, non-axial involvement, absence of HLA-Cw6, presence of HLA-B27 and higher levels of CRP at biologic onset might be predictors of better drug persistence. Further investigations are required on this field.References:[1]Glintborg B et al. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy. Results from the Danish Nationwide DANBIO Registry. Arthritis Rheum 2013:65(5):1213-23.[2]Stober C et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2018:57(1):158-163.Table 1. Kaplan–Meier survival analysis of persistence according to sex.Table 2. Kaplan Meier survival analysis of persistence according to HLA-Cw6.Disclosure of Interests:None declared

scholarly journals Anti-cyclic-citrullinated-protein-antibodies in psoriatic arthritis patients: how autoimmune dysregulation could affect clinical characteristics, retention rate of methotrexate monotherapy and first line biotechnological drug survival. A single center retrospective study.

2021 ◽  
Vol 12 ◽  
pp. 204062232098672
Author(s):  
Cinzia Rotondo ◽  
Addolorata Corrado ◽  
Daniela Cici ◽  
Stefano Berardi ◽  
Francesco Paolo Cantatore
Keyword(s):  
Retrospective Study ◽  
Psoriatic Arthritis ◽  
Clinical Characteristics ◽  
Retention Rate ◽  
Statistical Significance ◽  
Severe Disease ◽  
First Line ◽  
Drug Survival ◽  
Biotechnological Drugs ◽  
Citrullinated Protein

Aim: Occasional findings of anti-cyclic-citrullinated-protein-antibodies (anti-CCP) were rarely observed in psoriatic arthritis (PsA). The aim of our study is to evaluate whether the presence of anti-CCP can determine different clinical subsets and influence methotrexate monotherapy survival, and biotechnological drug retention rate. Methods: We conducted a retrospective study on PsA patients. All patients were required to fulfill the CASPAR criteria for PsA, and to present juxta-articular osteo-proliferative signs at X-ray. The exclusion criteria were age less than 18 years old, satisfaction of rheumatoid arthritis classification criteria, and seropositivity for rheumatoid factor. Clinical characteristics, anti-CCP titer, drug survival and comorbidities information were recorded for each patient. Statistical significance was set at p ⩽ 0.05. Results: Of 407 patients with PsA screened 113 were recruited. Twelve patients were anti-CCP positive. Methotrexate monotherapy survival was shorter in patients with anti-CCP (150 ± 48.3 weeks versus 535.3 ± 65.3 weeks; p = 0.026) [discontinuation risk hazard ratio (HR) = 2.389, 95% confidence interval (CI) 1.043, 5.473; p = 0.039] than those without. Significant shorter survival of first-line biotechnological drugs (b-DMARDs) was observed in the anti-CCP positive group than in that without (102.05 ± 24.4 weeks versus 271.6 ± 41.7 weeks; p = 0.005) with higher discontinuation risk (HR = 3.230, 95% CI 1.299, 8.028; p = 0.012). A significant higher rate of multi-failure (more than second-line b-DMARDs) was found in anti-CCP positive patients than in those without (50% versus 14%, p = 0.035). Conclusion: Anti-CCP in PsA could be suggestive of more severe disease, with worse drug survival of both methotrexate monotherapy and first-line b-DMARDs, and higher chance to be b-DMARDs multi-failure. So, they can be considered for more intensive clinical management of these patients.

Axial disease

2018 ◽  
Author(s):  
Ennio Lubrano
Keyword(s):  
Psoriatic Arthritis ◽  
State Of The Art ◽  
Imaging Techniques ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Radiological Findings ◽  
Psoriatic Disease ◽  
Axial Disease ◽  
The Difference ◽  
Axial Involvement

This chapter summarizes the state of the art for axial involvement in psoriatic arthritis (axial PsA). The definition and measurement of axial PsA still remain problematic and this, in turn, could affect the best approach of recognition and treatment of this intriguing subset of the psoriatic disease. Axial PsA has been studied over the last few years looking at the difference in function and radiological findings compared mainly to Ankylosing Spondylitis (AS), trying to differentiate it from a coincidental AS with psoriasis. Moreover, an assessment on a possible Diffuse Idiopathic Skeletal Hyperostosis (DISH) in PsA patients and clinical-radiological differences to axial PsA has been evaluated. The role of potential new imaging techniques, such as MRI, in the assessment of axial PsA has been considered in this chapter. The diagnosis and treatment of axial PsA has been reported by using the data obtained from the literature.

scholarly journals AB0826 PROBABILITY OF SURVIVAL OF USTEKINUMAB IN PSORIATIC ARTHRITIS: A REAL CLINICAL PRACTICE COHORT COMPOSED OF 64 PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1717.1-1717
Author(s):  
E. Raya ◽  
P. Morales-Garrido ◽  
I. Jiménez-Moleón
Keyword(s):  
Monoclonal Antibody ◽  
Psoriatic Arthritis ◽  
Maximum Efficiency ◽  
Interleukin 12 ◽  
Unknown Etiology ◽  
Efficacy And Safety ◽  
Phase 3 ◽  
Probability Of Survival ◽  
Drug Survival ◽  
Axial Involvement

Background:Psoriatic arthritis (PsA) is an inflammatory disorder of unknown etiology. Several domains are affected as peripheral or axial joints, enthesitis, dactylitis, nails as well as skin. Diverse cytokines have been described in the pathology of PsA as TNFα, IL-17 and IL-23. Ustekinumab (UST) is a fully human IgG1κ monoclonal antibody to interleukin 12/23. Its efficacy and safety have been tested in several clinical trials and registries. Nevertheless data from real word evidence studies is needed to understand the effectiveness, safety and behavior of UST in a different population of patients from randomized controlled trialsObjectives:Analyze the persistence of UST 45 and 90 mg along 52 weeks of treatmentMethods:Drug survival, effectiveness and security of UST were studied in a population of 64 PsA patients treated in the period between August 2014 to October 2019. Drug survival was defined as the time from initiation to discontinuation (stop/switch) of bDMARDs. For the determination of drug survival, Kaplan-Meier survival curves and Cox-regression analyses were used. Effectiveness was described as a reduction in the use of corticosteroids and in the levels of CRP along the study. All adverse events were recorded during the studyResults:64 patients were included with a mean follow-up of 57,2 weeks. At baseline the mean age was 47,8 years (8,9). 54,7% of patients were women and 45,3% were male. 31,3% were obese. Mean disease duration was 7,9 (5,0) years. 45,3% presented peripheric arthritis; 32,8% axial involvement; 31,3% enthesitis; 80% psoriasis. Patients were 45% bDMARDs-naïve; had a previous bDMARDs in 20,3% and ≥ than two bDMARDs in 34,4%. 30% of the patients had co-therapy with methotrexate and 29,7% of patients received corticosteroid therapy. Mean CRP was 7,9 (12,7) mg/L. The global probability of survival for UST was 96%, 83,9% and 60% at week 12, 24 and 52 respectively. High UST dosage was associated with favorable drug survival (at 52W: UST 45 mg=40,1%; UST 90 mg=75,8%; UST 45 to 90 mg*=88,9%) (p=0,008). The bDMARDS-naïve population also correlated with favorable UST survival (at 52W: bDMARDS-naïve=66,1% vs bDMARDS-experienced=56,7%), however no statistical significance was found (p=0,196). No difference in survival was observed among patients with or without axial involvement (W52: axial=58,2% vs non-axial=61,6; p=0,869). UST produced a reduction in the use of corticosteroids (30% vs 16%) and CRP levels (8,7 vs 7,7). Differences were greater in patients treated more than 28 weeks (maximum efficiency described for UST) (corticosteroids: 26% vs 16%; CRP levels: 8,5 vs 4,4). 4,9% of the patients suffered an AE. Most of them were non-serious AE: infections (3,3%) or headache (1,6%). The main cause of treatment discontinuation was lack of efficacy (30%), followed by primary failure (9,4%) and just a 3% due to AEConclusion:The persistence of UST was dose-dependent and greater for the UST 90 mg dosage and for the population of bDMARD-naïve patientsDrug survival of UST in the population of patients with axial involvement seems similar to the population of patients without axial affection which provide evidence of the efficacy of the IL23 inhibition in the axial domain of PsAUST decreased the use of corticosteroids and CRP levels along treatmentThe security profile of UST was to the drug. Only few non-serious AE reported during this study*UST 45 to 90 mg, patients who change from UST 45 to UST 90 mg dosageReferences:[1]Ritchlin C. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3. Ann Rheum Dis 2014;73:990–9[2]McInnes IB. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 2013;382:780–9Disclosure of Interests:None declared

Role of FLT3 gene mutations in acute myeloid leukemia: effect on course of disease and results of therapy

2019 ◽  
Vol XIV (1) ◽  
Author(s):  
A.M. Radzhabova ◽  
S.V. Voloshin ◽  
I.S. Martynkevich ◽  
A.A. Kuzyaeva ◽  
V.A. Shuvaev ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Gene Mutations ◽  
Course Of Disease ◽  
Acute Myeloid
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