Immunogenicity of antitumor necrosis factor therapy in patients with spondyloarthritis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ines Mahmoud ◽  
Leila Rouached ◽  
Aicha Ben Tekaya ◽  
Olfa Saidane ◽  
Selma Bouden ◽  
...  
Keyword(s):  
Protective Factor ◽  
Activity Index ◽  
Disease Activity Index ◽  
Disease Modifying Antirheumatic Drugs ◽  
Cross Sectional ◽  
Multicentric Study ◽  
Antidrug Antibody ◽  
Significant Difference ◽  
Factor Therapy ◽  
Necrosis Factor

AbstractObjectivesTo evaluate the serum dosage of the biomedicine (DBM) and the incidence of antidrug antibody (ADA) against antitumor necrosis factor (TNF) in spondyloarthritis, and to demonstrate the influence of these parameters on the clinical efficiency.MethodsWe conducted a cross-sectional multicentric study including patients with spondylarthritis (SpA) under antiTNF (infliximab [INF], etanercept [ETA] and adalimumab [ADL]) for at least 6 months. A dosage of the ADA and DBM were practiced by the immuno-enzymatic essay.ResultSeventy one patients were recruited. Disease modifying antirheumatic drugs (DMARDs) were associated with anti-TNF in 30%. ADA was positive in 54% for INF, 33% for ADL and 0% for ETA with a significant difference(p<0.0001). Immunogenicity was correlated to a bad therapeutic response (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]≥4)(p=0.04). The DBM was inversely correlated with the rate of ADA for patients treated with INF(p<0.0001) and ADL(p<0.0001). The DBM was also inversely correlated with BASDAI of INF(p=0.03) and ADL (p=0.01). ADA was significantly associated with an anterior switch of anti TNF(p=0.04), the use of INF(p=0.002), presence of coxitis(p=0.01) and higher body mass index (BMI)(p=0.007). DMARDs associated with anti TNF were not a protective factor for positive ADA. In a multivariate study, only INF and BMI were independent factors of positive ADA.ConclusionThe ADA formation lowered the DBM and favored the therapeutic failure.

scholarly journals Effect of Anticitrullinated Protein Antibody Status on Response to Abatacept or Antitumor Necrosis Factor-α Therapy in Patients with Rheumatoid Arthritis: A US National Observational Study

2017 ◽  
Vol 45 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Leslie R. Harrold ◽  
Heather J. Litman ◽  
Sean E. Connolly ◽  
Sheila Kelly ◽  
Winnie Hua ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Treatment Response ◽  
Activity Index ◽  
Disease Activity Index ◽  
Secondary Outcome ◽  
Patient Profile ◽  
Significant Difference ◽  
Factor Α ◽  
Necrosis Factor

Objective.Assess whether baseline anticyclic citrullinated peptide antibodies (anti-CCP) status is associated with treatment response in patients with rheumatoid arthritis (RA) initiating abatacept (ABA) or a tumor necrosis factor-α inhibitor (TNFi).Methods.Using the Corrona RA registry, patients were identified who initiated ABA or a TNFi (June 2004–January 2015), had a followup visit 6 months (± 3 mos) after initiation, and anti-CCP measured at or prior to initiation. Primary outcome was mean change in Clinical Disease Activity Index (CDAI) from initiation to 6 months. Treatment response was evaluated based on a typical patient profile (female, aged 57 yrs, body mass index of 30 kg/m2, baseline CDAI of 20, 1 prior biologic, and no comorbidities other than RA). Secondary outcomes included remission and low disease activity.Results.There were 566 ABA initiators [anti-CCP+ (≥ 20 units/ml): n = 362; anti-CCP− (< 20 units/ml): n = 204] and 1715 TNFi initiators (anti-CCP+: n = 1113; anti-CCP−: n = 602). Differences between treatment groups included baseline disease duration, CDAI, and prior biologic use. At 6 months, anti-CCP+ ABA initiators were associated with significantly greater CDAI response versus anti-CCP− ABA initiators; no significant difference was observed for TNFi initiators. When considering a typical RA patient profile, CDAI response was greater in anti-CCP+ versus anti-CCP− ABA initiators; anti-CCP+ versus anti-CCP− TNFi initiators were similar. Secondary outcome responses were also greater in anti-CCP+ versus anti-CCP− ABA initiators; TNFi initiators did not differ by anti-CCP status.Conclusion.In a US-based clinical practice setting, anti-CCP status was associated with a differential treatment response to ABA, but not TNFi.

P006 AFTER-HOURS PATIENT PHONE CALLS TO GI FELLOWS WITHIN AN IBD MEDICAL HOME

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S47-S48
Author(s):  
Jennifer Rodriguez ◽  
Jeffrey Dueker ◽  
Siobhan Proksell ◽  
Eva Szigethy ◽  
Marc Schwartz ◽  
...  
Keyword(s):  
Disease Activity ◽  
Medical Home ◽  
Activity Index ◽  
Disease Activity Index ◽  
Cross Sectional ◽  
Phone Calls ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
After Hours ◽  
Sectional Imaging

Abstract Objective The Inflammatory Bowel Disease (IBD) Medical Home is a care delivery model that provides a comprehensive, patient-centered, coordinated care environment, previously shown to lead to an approximate 50% reduction in unplanned care. However, the frequency and nature of IBD medical home patient phone calls to gastroenterology (GI) fellows after-hours, and the contribution to unplanned care from these encounters, is unknown. Methods We included all patients that were seen in the IBD medical home between 7/1/2015 to 6/30/2016 (n = 293) and examined all phone call activity in the subsequent year: 7/1/2016 to 6/30/2017. After-hours phone calls were defined as documented calls that were routed to on-call GI fellows when the clinic is closed. The details of each after-hours encounter were reviewed, and were categorized by the reason for call, training year of the GI fellow, advice given to patient, and unplanned care outcomes. For comparison, we also tracked frequency of patient calls for symptoms during clinic hours. Demographic information, disease type, disease activity index, quality of life (QoL), and depression/anxiety scores documented most recently to the start of the observation period were included in the analysis. Comparisons were made using Chi-square, T-tests and non-parametric median tests. Results 259 of 293 patients (86.7%) had any documented phone interaction. Only 36 patients (12.3%) placed a total of 63 after-hours phone calls to GI fellows, with calls for symptoms representing the majority (71.4%). Among calls for symptoms (n = 45), patients were advised by GI fellows to present to the emergency department (ED) 44.4% of the time. There was no significant difference in ED recommendations by fellow training level (p = 0.17). Of the 20 ED encounters advised by fellows, 9 (45%) did not result in admission; and 2 patients had new cross-sectional imaging. Of the 11 admissions, 10 also had new cross-sectional imaging, with generation of 10 inpatient IBD consults, as well as 1 surgery for seton placement. After-hours callers were more likely to have Crohn’s disease and higher GAD-7 scores, with trends towards lower SIBDQ scores and higher PHQ-9 scores, but similar disease activity index scores, number of clinic visits, and demographics, compared to patients who called with symptoms during clinic hours (Table 1). Conclusions Among patients established within an IBD medical home model, a small population of patients called after hours resulting in frequent recommendation to present to the ED from GI fellows, however it is unknown if these encounters meaningfully changed their IBD care. Higher psychosocial complexity may influence this care behavior. Further studies of triage processes and educational initiatives aimed at GI fellows may help minimize unplanned ED and inpatient care in this patient population.

Diagnostic Value of Urinary Dysmorphic Erythrocytes in SLE Patients with Three Different Methods

2021 ◽  
Vol 28 (1) ◽  
pp. 41
Author(s):  
Ersa Bayung Maulidan ◽  
Ferdy Royland Marpaung
Keyword(s):  
Lupus Erythematosus ◽  
Activity Index ◽  
Clinical Manifestations ◽  
Disease Activity Index ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
Sensitivity Specificity ◽  
Dysmorphic Erythrocytes

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with various clinical manifestations. Lupus nephritis isthe most common severe manifestation with a poor prognosis. Hematuria is included in the Lupus Activity Criteria Count(LACC) and SLE Disease Activity Index (SLEDAI). Phase Contrast Microscope (PCM) availability as a recommended instrumentfor dysmorphic erythrocytes evaluation is exclusive, thus causing this examination to be performed rarely. This study aimedto investigate the diagnostic value of dysmorphic erythrocytes in SLE patients with hematuria using Low Condenser LightMicroscope (LCLM), PCM, and UF-500i. This research was a cross-sectional study with consecutive sampling; 58 fresh urinesamples were examined with UF-500i during May-July 2019. Percentage of dysmorphic erythrocytes were evaluated usingLCLM and PCM. Difference percentages of dysmorphic erythrocytes were analyzed using the Wilcoxon Signed Ranks test,degree of agreement by Kappa coefficient, cut-off, sensitivity, and specificity by ROC curve. Dysmorphic erythrocytepercentage in LCLM and PCM showed a significant difference (p < 0.001) and a low degree of agreement (Kappa=0.373).Dysmorphic erythrocyte cut-off with LCLM was 7.5% (sensitivity 70%, specificity 68%) and PCM was 6.5% (sensitivity 74%,specificity 65%). Dysmorphic? flagging from UF-500i showed a sensitivity, specificity, PPV, NPV of 78%, 52%, 58% and 73%,respectively. LCLM can be considered a substitute for PCM for evaluating dysmorphic erythrocytes with its cut-off, so theclinician will be more alert to abnormalities that cause hematuria. Further research with larger samples and definitediagnosis with a kidney biopsy is needed to obtain more accurate results.

scholarly journals Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042246
Author(s):  
Sanjoy K Paul ◽  
Olga Montvida ◽  
Jennie H Best ◽  
Sara Gale ◽  
Attila Pethö-Schramm ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Type 2 Diabetes ◽  
T Cell ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

ObjectiveTo explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participantsFive treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.ResultsIn the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.ConclusionsTreatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.

scholarly journals AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1627.2-1627
Author(s):  
F. I. Abdelrahman ◽  
M. Mortada
Keyword(s):  
Ankylosing Spondylitis ◽  
Social Life ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Diagnosis Delay ◽  
Functional Index ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

scholarly journals AB0669 PARTICULARITIES OF TUNISIAN FEMALE AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1629.2-1629
Author(s):  
K. Ben Abdelghani ◽  
Y. Gzam ◽  
A. Fazaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Age At Onset ◽  
Disease Onset ◽  
Disease Activity Index ◽  
Reactive Protein ◽  
Significant Difference ◽  
The Mean

Background:Axial spondyloarthritis (ax-SpA) is a chronic rheumatic disease that mainly affects men. However, the female form of ax-SpA remains insufficiently studied.Objectives:The aim of this study was to determine the clinical characteristics, the disease activity and the functional impact of female ax-SpA in comparison with male ax-SpA.Methods:This is a retrospective study including patients diagnosed with ax-SpA fulfilling the criteria of the Assessment of SpondyloArthritis international Society (ASAS) 2009.Clinical parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) were compared between groups of female and male ax-SpA.Results:Two hundred ax-SpA patients were included with 31% of female (n=62) and a mean age of 43,3 ± 11,2 years.The mean age at onset of symptoms was 31,8 ± 8,9 years for women and 25,3 ± 9,1 years for men (p <0,0001). The mean age at diagnosis was 36,4 ± 9,6 years for women and 31,7 ± 10,4 years for men (p = 0,003). Ax-SpA with juvenile onset was noted in 1,7% of women and 12,1% of men (p = 0,02). Male ax-SpA were significantly more smokers (46.8% vs 5.4%; p <0.001). The mean duration of morning stiffness was 11,3 ± 9,2 minutes for women versus 21,6 ± 19,3 minutes for men (p = 0,005).The mean ESR was 42,4 ± 29,8 mm for women and 28,3 ± 23,4 mm for men (p = 0,001). Radiographic sacroiliitis was present in 69,3% of women versus 84,7% of men (p = 0,01). The use of anti-TNF alpha was less frequent in women (29% vs 48,5%; p = 0,01).Our study didn’t found a statistically significant difference in peripheral manifestations, extraarticular manifestations, CRP, BASDAI and BASFI between the two groups.Conclusion:Female ax-SpA seems to have a better prognosis than male with older age in disease onset, less inflammation, less radiographic sacroiliitis and less use of biological treatments.References:[1]Rusman T, et al. Curr Rheumatol Rep. 2018; 20(6).[2]Siar N, et al. Curr Rheumatol Rev. 2019;Disclosure of Interests:None declared

scholarly journals AB0637 EFFICACY OF COMEDICATION OF CONVENTIONAL SYNTHETIC DMARDS WITH TNF BLOCKERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1613.3-1614
Author(s):  
K. Ben Abdelghani ◽  
Y. Gzam ◽  
A. Fazaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Partial Remission ◽  
Axial Spondyloarthritis ◽  
Combined Therapy ◽  
Response To Treatment ◽  
Tnf Alpha ◽  
Disease Modifying Antirheumatic Drugs ◽  
Significant Difference ◽  
Synthetic Dmards ◽  
The Mean ◽  
Necrosis Factor

Background:Tumour necrosis factor blockers (anti-TNFs) are typically used in axial spondyloarthritis (ax-SpA) when the disease has not responded adequately to conventional therapy. However, the effects of the comedication conventional synthetic disease modifying antirheumatic drugs (csDMARDs) with anti-TNFs are inconclusive.Objectives:The aim of this study was to evaluate the efficacy of comedication csDMARD and anti-TNF compared with anti-TNFs on monotherapy.Methods:A descriptive retrospective study including 85 patients with ax-SpA according to the criteria of the group ASAS on 2009 and having received anti-TNFs between January 2000 and October 2019.The patients were divided on two groups, those who had received combined therapy with cs-DMARDs and those who had received anti-TNFs on monotherapy.The response to treatment was assessed with the ASAS 40 response and partial remission at 3 and 6 months of treatment and was compared between the two groups.Results:Our populations consists of 67 men and 18 women with a mean age of 44,4 ± 10,9 years. The mean period of evolution was 12,3 ± 9,1 years and 52,2% of patients were HLA-B27 positive. The ax-SpA was associated with peripheral arthritis, enthesitis and dactylitis in 17,6%, 17,6% and 1,2% respectively.Fifty-nine patients (69,4%) were treated with anti-TNF alpha on monotherapy and 26 patients (30,6%) had combined therapy. The ASAS 40 response was achieved in 45,6% of patients at 3 months and 64,1 % of them at 6 months of anti-TNFs treatment. Among them, 7,4% had obtained partial remission at 3 months and 20,3% at 6 months of treatment.There was statically significant difference between the two groups on the ASAS 40 response or the partial remission at 3 and 6 months of treatments.Conclusion:The comedication therapy with csDMARDs does not influence the efficacy of anti-TNFs in ax-SpA patients suggesting no benefit in the concomitant use of these drugs in clinical practice.References:[1]Simone Det al. J Rheumatol Suppl. 2015;93:65–9.Disclosure of Interests:None declared

scholarly journals The Relationship between Mental Health with the Level of Empathy Among Medical Students in Southern Thailand: A University-Based Cross- Sectional Study

2021 ◽  
Vol 73 (12) ◽  
pp. 832-840
Author(s):  
Katti Sathaporn ◽  
Jarurin Pitanupong
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Protective Factor ◽  
Cross Sectional Study ◽  
Clinical Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Difference ◽  
High Level

Objective: To determine the level of and factors associated with empathy among medical students.Materials and Methods: This cross-sectional study surveyed all first- to sixth-year medical students at the Facultyof Medicines, Prince of Songkla University, at the end of the 2020 academic year. The questionnaires consisted of:1) The personal and demographic information questionnaire, 2) The Toronto Empathy Questionnaire, and 3) ThaiMental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathylevel were assessed via chi-square and logistic regression analyses.Results: There were 1010 participants with response rate of 94%. Most of them were female (59%). More than half(54.9%) reported a high level of empathy. There was a statistically significant difference in empathy levels betweenpre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). The assessment ofemotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic respondingscores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicatedthat female gender, pre-clinical training level, and minor specialty preference were factors associated with empathylevel. The protective factor that significantly improved the level of empathy was having fair to good mental health.Conclusion: More than half of the surveyed medical students reported a high level of empathy. The protective factorthat improved the level of empathy was good mental health. However, future qualitative methods, longitudinalsurveillance, or long-term follow-up designs are required to ensure the trustworthiness of these findings.

The Association Between Disease Activity and Duration in Systemic Sclerosis

2010 ◽  
Vol 37 (11) ◽  
pp. 2299-2306 ◽  
Author(s):  
JENNIFER G. WALKER ◽  
RUSSELL J. STEELE ◽  
MIREILLE SCHNITZER ◽  
SUZANNE TAILLEFER ◽  
MURRAY BARON ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Activity ◽  
Disease Duration ◽  
Activity Index ◽  
Disease Onset ◽  
Depression Scale ◽  
Disease Activity Index ◽  
Cross Sectional ◽  
Diffuse Disease ◽  
Patient Reported

Objective.The absence of a standardized disease activity index has been an important barrier in systemic sclerosis (SSc) research. We applied the newly derived Valentini Scleroderma Disease Activity Index (SDAI) among our cohort of patients with SSc to document changes in disease activity over time and to assess possible differences in activity between limited and diffuse disease.Methods.Cross-sectional study of a national cohort of patients enrolled in the Canadian Scleroderma Research Group Registry. Disease activity was measured using the SDAI. Depression scores were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D).Results.A total of 326 out of 639 patients had complete datasets at the time of this analysis; 87% were female, of mean age 55.6 years, with mean disease duration 14.1 years. SDAI declined steeply in the first 5 years after disease onset and patients with diffuse disease had 42% higher SDAI scores than patients with limited disease with the same disease duration and depression scores (standardized relative risk 1.42, 95% CI 1.21, 1.65). Patients with higher CES-D scores had higher SDAI scores relative to patients with the same disease duration and disease subset (standardized RR 1.22, 95% CI 1.14, 1.31). Among the 10 components that make up the SDAI, only skin score (standardized OR 0.59, 95% CI 0.43, 0.82) and patient-reported change in skin (standardized OR 0.64, 95% CI 0.45, 0.92) decreased with increasing disease duration. High skin scores (standardized OR 32.2, 95% CI 15.8, 72.0) were more likely and scleredema (standardized OR 0.58, 95% CI 0.37, 0.92) was less likely to be present in patients with diffuse disease. High depression scores were associated with positive responses for patient-reported changes in skin and cardiopulmonary function.Conclusion.Disease activity declined with time and patients with diffuse disease had consistently higher SDAI scores. Depression was found to be associated with higher patient activity scores and strongly associated with patient self-response questions. The role of depression should be carefully considered in future applications of the SDAI, particularly as several components of the score rely upon patient recall.

Periodontitis Severity Affects the Clinical Response to Biological Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A 1-Year Follow-up Study

2021 ◽  
Author(s):  
Tetsuo Kobayashi ◽  
Satoshi Ito ◽  
Akira Murasawa ◽  
Hajime Ishikawa ◽  
Koichi Tabeta
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Response ◽  
Activity Index ◽  
Disease Activity Index ◽  
Positive Association ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Case Definitions ◽  
Synthetic Dmards ◽  
Disease Modifying

ABSTRACT Objectives To assess whether periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs) for 1 year in rheumatoid arthritis (RA) patients. Methods Data were collected from 50 RA patients who had received corticosteroids, conventional synthetic DMARDs, or non-steroidal anti-inflammatory drugs before (baseline) and after 1 year of bDMARD therapy in a retrospective study. Rheumatologic conditions were compared between the two periodontitis severity groups according to the periodontal inflamed surface area (PISA) or Centers for Disease Control Prevention (CDC)/ American Academy of Periodontology (AAP) case definitions Results Twenty-eight patients with no or mild periodontitis showed significantly greater decreases in changes in Clinical Disease Activity Index (CDAI) and tender and swollen joint count in comparison to 22 patients with moderate and severe periodontitis (p = 0.02, p = 0.01, and p = 0.03). Both bivariate and multivariate analyses revealed a significantly positive association between the baseline CDC/AAP definitions and CDAI changes (p = 0.005 and p = 0.0038). However, rheumatologic conditions were comparable between 25 patients each in the low and high PISA groups. Conclusions Baseline periodontitis severity according to the CDC/AAP definitions is associated with the clinical response to bDMARDs for 1 year in RA patients.

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