scholarly journals OP0165 RISK FOR UVEITIS EVENTS AFTER WITHDRAWAL OF DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN THE TREATMENT OF PATIENTS WITH EXTENDED OLIGOARTHRITIS OR RHEUMATOID FACTOR NEGATIVE POLYARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 99-100
Author(s):  
J. Klotsche ◽  
A. Klein ◽  
M. Niewerth ◽  
T. Kallinich ◽  
D. Windschall ◽  
...  
Keyword(s):  
Rheumatoid Factor ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Children And Adolescent ◽  
Disease Characteristics ◽  
Treatment Data ◽  
History Of ◽  
Disease Modifying ◽  
Long Term Observation

Background:Juvenile idiopathic arthritis (JIA) associated uveitis is an extra-articular manifestation of the JIA disease that may cause vision-threatening complications and an uncontrolled uveitis may even lead to blindness. Uveitis occurs in up to 20% of patients with JIA, depending on the JIA category. The majority of patients develop uveitis within the first two years after JIA symptom onset, but uveitis can continue into adulthood.Objectives:The main objective of this study was to analyze the risk for uveitis events after discontinuing disease-modifying antirheumatic drugs (DMARD) in patients with extended oligoarthritis and rheumatoid factor (RF)-negative polyarthritis.Methods:Data of the two ongoing multicenter biologic registers: German Biologics in Pediatric Rheumatology (BiKeR) and the Juvenile arthritis Methotrexate/Biologics long-term Observation (JuMBO) were used to analyze the adverse-event (AE) and events of special interest (ESI) reports about uveitis events during treatment and after discontinuation of DMARDs. Biker started recruitment of children and adolescent patients with JIA exposed to biological (b) or conventional (cs) DMARD’s in 2001. The patients were further followed in JuMBO after reaching the age of 18 or transitioning to an adult rheumatologist. Disease characteristics, treatment data, AE’s and ESI’s were reported by the pediatric or adults rheumatologist, respectively.Results:A total of 2,041 patients with RF-negative polyarthritis (n=1,280) or extended oligoarthritis (n=761) were included into the analyses. The mean follow-up of this study was 7.6 years (SD 5.3). About half of the patients were enrolled in BiKeR with start of etanercept (1,137, 55.7%), followed by 635 (31.1%) patients with start of methotrexate (MTX) monotherapy or adalimumab (ADA, n=198, 9.7%). A history of uveitis was reported for 238 (11.7%) patients at enrolment in BiKeR. More patients with a history of uveitis treated with ADA were included in BiKeR initiating ADA (n=98 of 238, 41.2%). Patients with uveitis had a lower age at JIA onset in comparison to patients without uveitis (mean 3.6 (SD 3.0) versus 7.0 (SD 4.5) years). A total of 142 recurrent (84% of 169) uveitis events were reported in 93 patients and for 27 patients (1.3% of 2,041) was an incident uveitis reported during follow-up. More than one uveitis event was reported for 32 patients with a maximum number of 4 uveitis flares in 3 patients. Nineteen uveitis flares (11.2% of 169) were reported for patients after the age of 18. The longer the time since DMARD discontinuation the fewer uveitis events occurred. Uveitis events were significantly more often reported in the first 24 months after MTX discontinuation (<6 months: OR=3.19, 95%CI: 1.70 to 5.96; 6 to <12 months: OR=2.06, 95%CI: 1.01 to 4.66; 12 to <24 months: OR=2.20, 95%CI: 1.14 to 4.25) and in the first three months after biological DMARD discontinuation (OR=5.4, 95%CI: 1.56 to 18.33). Patients with a MTX dose of ≤ 10 mg/m2 at last MTX intake had a higher likelihood for uveitis events (OR=1.40, 95%CI: 1.02 to 1.92).Conclusion:This is the first study that analyzed the risk of uveitis after DMARD withdrawal. Uveitis relapses are common. Patients who discontinued DMARD therapy were at high risk for uveitis within the first 3 to 24 months after discontinuation. Rheumatologists and ophthalmologists should be aware about this risk which should lead to a regular uveitis screening after DMARD withdrawal.Disclosure of Interests:Jens Klotsche: None declared, Ariane Klein: None declared, Martina Niewerth: None declared, Tilmann Kallinich: None declared, Daniel Windschall: None declared, Johannes-Peter Haas: None declared, Frank Weller-Heinemann Speakers bureau: Pfizer, Abbvie, SOBI, Roche, Novartis, Toni Hospach: None declared, Frank Dressler: None declared, Kirsten Minden: None declared, Gerd Horneff: None declared

scholarly journals Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

2020 ◽  
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E. Machado-Duque ◽  
Andres Gaviria-Mendoza ◽  
Juan Manuel Reyes ◽  
Natalia Castaño Gamboa
Keyword(s):  
Rheumatoid Arthritis ◽  
Pharmacological Treatment ◽  
Healthcare Costs ◽  
Cost Of Care ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Healthcare Resources ◽  
Conventional Dmards ◽  
Disease Modifying

Abstract Introduction/objectives The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib. Method This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider. Results We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377. Conclusions In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs. Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.

scholarly journals A rare case of tuberculosis-induced hypercalcemia

2020 ◽  
Vol 30 (3) ◽  
pp. 471-474
Author(s):  
Loris Wauthier ◽  
Xavier Theunssens ◽  
Patrick Durez ◽  
Catherine Fillée ◽  
Diane Maisin ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Rare Case ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Atypical Case ◽  
Severe Hypercalcemia ◽  
Laboratory Investigations ◽  
Disease Modifying ◽  
25 Oh Vitamin D

Laboratory investigations of hypercalcemia involve testing of various biochemical parameters such as parathyroid hormone (PTH), 25-(OH) Vitamin D (25-(OH) VitD), 1,25-(OH)2 Vitamin D3 (calcitriol) and PTH related peptide (PTHrp). We herein present an atypical case of severe hypercalcemia in a patient with rheumatoid arthritis who has been treated for years by various biological disease-modifying antirheumatic drugs (DMARDs) and suddenly presented with general state alteration, oedema and ulceration of her right ankle. We illustrate how tuberculosis (TB) can cause high calcitriol concentration and subsequently lead to potentially severe hypercalcemia. Moreover, we highlight the importance of TB testing and follow-up in patients treated with biological DMARDs.

scholarly journals Anti-Cyclic Citrullinated Peptide and Rheumatoid Factor (Prevalence and Association) in Saudi Rheumatoid Arthritis Patients

2018 ◽  
Vol 25 (2) ◽  
pp. 1-10
Author(s):  
Mohammad-Ayman A. Safi ◽  
Dhiya T. Houssien
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatoid Factor ◽  
Disease Duration ◽  
Direct Impact ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying Drugs ◽  
Disease Modifying ◽  
Citrullinated Peptide

To assess the prevalence and association of anti-cyclic citrullinated peptides and rheumatoid factor in Saudi rheumatoid arthritis patients.Over three years (February 2011 - February 2014). Demographic and clinical features, drugs, rheumatoid factor-positivity, and anti-cyclic citrullinated peptides-positivity were recorded for 205 Saudi rheumatoid arthritis patients (185 females; mean age was 45 years and mean disease duration was 5 years). Anti-cyclic citrullinated peptides and rheumatoid factor were assessed in serum. Disease activity scores for 28 joints was used. There were 36% rheumatoid factor+ve and 45% anti-cyclic citrullinated peptides+ve. 21.5% of the rheumatoid factor-ve subjects were anti-cyclic citrullinated peptides+ve. 13.3% of the rheumatoid factor positive patients were anti-cyclic citrullinated peptides-ve and 86.7% were anti-cyclic citrullinated peptides+ve. Significant association (P < 0.05) of anti-cyclic citrullinated peptides-positivity and rheumatoid factor-positivity with each other, and with gender, use of disease–modifying antirheumatic drugs, hydroxychloroquine and methotrexate. No direct impact of anti-cyclic citrullinated peptides status on the disease activity scores for 28 joints or its constituents (P > 0.5); nevertheless, anti-cyclic citrullinated peptides positive patients appear to represent a greater need for combination disease modifying drugs. 

scholarly journals Patients With Rheumatoid Arthritis With an Inadequate Response to Disease‐Modifying Antirheumatic Drugs at a Higher Risk of Acute Coronary Syndrome

2021 ◽  
Author(s):  
Chung‐Yuan Hsu ◽  
Yu‐Jih Su ◽  
Jia‐Feng Chen ◽  
Chi‐Chin Sun ◽  
Tien‐Tsai Cheng ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Ischemic Stroke ◽  
Inadequate Response ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Coronary Syndrome ◽  
Disease Modifying

Background Cardiovascular disease is the most common cause of death in patients with rheumatoid arthritis. It is believed that using disease‐modifying antirheumatic drugs (DMARDs) to control inflammation can reduce the risk of cardiovascular disease. In this study, we investigated whether patients who responded differently to DMARDs might sustain different cardiovascular events. Methods and Results We designed a cohort study using the Chang Gung Research Database. We identified 7114 patients diagnosed with rheumatoid arthritis. After strict exclusion criteria, we collected 663 individuals as an inadequate response to DMARDs group. Then, 2034 individuals were included as the control group. The end point was composite vascular outcomes, including acute coronary syndrome or ischemic stroke. We used the inverse probability of treatment weighting to keep the covariates between these 2 groups well balanced. We compared the risk of these outcomes using the Cox proportional hazards model. The mean follow‐up time was 4.7 years. During follow‐up, there were 7.5% and 6.4% of patients with composite vascular outcomes in the DMARD‐inadequate response and control groups, respectively. There was no significant difference in the risk of composite vascular outcomes (95% CI, 0.94–1.41) and ischemic stroke (95% CI, 0.84–1.36). The risk of acute coronary syndrome was significantly higher in the DMARD‐inadequate response group (hazard ratio, 1.45; 95% CI, 1.02–2.05). Conclusions Patients with DMARD‐inadequate response rheumatoid arthritis have a higher risk of developing acute coronary syndrome than those whose disease can be controlled by DMARDs.

Biologic Disease-modifying Antirheumatic Drug (bDMARD)-induced Neutropenia: A Registry from a Retrospective Cohort of Patients with Rheumatic Diseases Treated with 3 Classes of Intravenous bDMARD

2017 ◽  
Vol 44 (6) ◽  
pp. 844-849 ◽  
Author(s):  
Francisco Espinoza ◽  
Pierre Le Blay ◽  
Bernard Combe
Keyword(s):  
Rheumatic Diseases ◽  
Retrospective Cohort ◽  
Concomitant Treatment ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Drug Survival ◽  
History Of ◽  
Severe Infections ◽  
Risks Factors ◽  
Disease Modifying

Objective.To examine the rate, risks factors, and consequences of neutropenia induced by intravenous (IV) biologic disease-modifying antirheumatic drugs (bDMARD).Methods.We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by IV abatacept (ABA), infliximab (IFX), or tocilizumab (TCZ).Results.Rheumatoid arthritis (RA) was the most frequent diagnosis (72%). Fifty-two patients (10.4%) experienced at least 1 episode of neutropenia. No episodes of grade 4 neutropenia were documented. TCZ was more frequently related to neutropenia than ABA or IFX (18.6% vs 3.8% and 2.8%, respectively, p < 0.001). The following factors were identified as predictors of experiencing neutropenia with IV bDMARD: history of neutropenia with methotrexate (MTX; synthetic DMARD; OR 1.56, 95% CI 1.17–7.14), concomitant treatment by MTX (OR 1.21, 95% CI 1.01–2.64), and TCZ treatment (OR 2.72, 95% CI 1.53–9.05). Patients experiencing a TCZ-induced neutropenia did not show a higher risk of severe infections; however, this group had a shorter drug survival (9 mos vs 20 mos, p < 0.02) compared with TCZ patients without neutropenia.Conclusion.Among 3 different classes of IV bDMARD, TCZ is associated with the higher risk of neutropenia. No increased frequency of infection episodes was documented in this group.

scholarly journals Active rheumatoid arthritis with multiple pulmonary nodules failure to multiple remissive therapy: Which is the solution?

2021 ◽  
Vol 30 (3) ◽  
pp. 125-128
Author(s):  
Ileana Cosmina Filipescu ◽  
◽  
Milena Man ◽  
Simona Rednic ◽  
◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Active Rheumatoid Arthritis ◽  
Pulmonary Nodules ◽  
Lung Nodules ◽  
Imaging Studies ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
History Of ◽  
Disease Modifying ◽  
Anti Fungal

We describe the case of a 63-year-old nonsmoker woman, with a long history of active seropositive rheumatoid arthritis, failure to multiple disease-modifying antirheumatic drugs due to both loss of efficacy and adverse drug reaction. She was exposed to silicon dust some years ago and has many pulmonary nodules, revealed by imaging studies as multiple cavitary lung nodules. Her initial pathological samples were negative for any infections and treatment against tuberculosis and anti-fungal therapy did not improve the appearance of the nodules. After an extensive reevaluation of pulmonary nodules, the Baricitinib treatment was started.

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