Do we have good activity indices in systemic sclerosis?

2021 ◽  
Vol 17 ◽  
Author(s):  
Laura Groseanu ◽  
Sorana Petrescu ◽  
Andra Balanescu ◽  
Violeta Bojinca ◽  
Daniela Opris-Belinski ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Systemic Sclerosis ◽  
Disease Activity ◽  
Activity Index ◽  
Group Activity ◽  
Joint Involvement ◽  
Skin Involvement ◽  
Active Disease ◽  
Activity Indices

Background: No fully validated index is available for assessing overall disease activity in systemic sclerosis (SSc). Objectives: To estimate the effect of disease activity as measured by different disease activity indices on the risk of subsequent organ damage. Methods: The European Systemic sclerosis study group activity index (EScSG AI), the European Scleroderma Trials and Research Group Activity Index (r-EUSTAR AI), 12 point activity index proposed by Minier (12point AI) were calculated for 91 patients; the CRISS (The Composite Response Index for Systemic Sclerosis) for patients included after 2016. Data were analysed by parametric and non-parametric tests and logistic regression. Results: EscSG AI, r-EUSTAR AI and 12point AI correlated with lung involvement. EScSG AI and r-EUSTAR AI correlated with diffuse skin involvement. EscSG AI correlated with digital ulcers and diffuse cutaneous involvement and r-EUSTAR AI with renal crisis. Bivariate analysis showed an inverse correlation between the three disease activity scores and forced vital capacity (FVC) (p<0.001) and diffusing capacity for carbon monoxide (DLCO) (p<0.001) and positive correlation with pulmonary fibrosis (p<0.001), modified Rodnan skin score (mRSS) (p<0.001), health assessment questionnaire (HAQ) (p<0.001), systolic pulmonary pressure (sPAP) (p<0.001), C-reactive protein (CRP) (p<0.001) and capillaroscopy scoring (p<0.001) at both baseline visit and at the 3-year follow-up visit. Logistic regression revealed that baseline EScSG AI adjusted for gender and age and that baseline 12-point AI both adjusted and unadjusted predicted worse skin involvement at 3-year follow-up; while adjusted EScSG AI predicted decreasing of DLCO. Also, 12-point AI predicted decline of FVC and higher HAQ scores at 3-year follow up; while baseline r-EUSTAR AI was able to predict muscular deterioration, decline of FVC and the increase of HAQ score during 3 years of following. An active disease according to EScSG AI at first visit predicted progression of joint involvement while an active disease at baseline showed by r-EUSTAR AI predicted muscular deterioration, FVC and DLCO worsening, as well as an increasing in HAQ score during the follow-up period. r-EUSTAR AI was the only score to predict the decrease of FVC in a multiple regression prediction model [OR= 1.306 (1.025, 1.665), p=0.31] while baseline EScSG AI best predicted worsening of DLCO [OR=1.749 (1.104, 2.772), p=0.017]. Conclusion: Our study could not establish a gold standard to assess disease activity in SSc; especially EscSG AI and r-EUSTAR AI could quantify and predict major organ involvement in daily practice. CRISS can be useful as an outcome measure for patients with short disease duration included in clinical studies.

THU0356 DISEASE ACTIVITY ASSESSMENT IN SYSTEMIC SCLEROSIS PATIENTS BASED ON THE CURRENTLY AVAILABLE ACTIVITY INDICES AND THE PHYSICIAN GLOBAL ASSESSMENT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 409.1-409
Author(s):  
T. Minier ◽  
V. Lóránd ◽  
Z. Bálint ◽  
D. Komjati ◽  
G. Nagy ◽  
...  
Keyword(s):  
Disease Activity ◽  
Global Assessment ◽  
Activity Index ◽  
Activity Assessment ◽  
One Year ◽  
Active Disease ◽  
The Eu ◽  
Disease Activity Assessment ◽  
Activity Indices

Background:Disease activity assessment is crucial in defining the appropriate therapy and to monitor the efficacy of treatment in systemic sclerosis.Objectives:We aimed to test the performance of the ’old’ European Scleroderma Trials and Research Group (EUSTAR) Activity Index (old-AI) (1), the ’new’ EUSTAR activity index (new-AI) (2), and the scleroderma activity index derived from the old-AI (Pecs-AI) (3). We compared the three indices to the disease activity based on the physician’s global assessment (PGA). We also assessed the correlations with the change in modified Rodnan Skin Score (MRSS), FVC and arthritis after one year follow-up.Methods:We evaluated 77 patients (50 diffuse /dcSSc/ and 27 limited cutaneous SSc /lcSSc/ patients) from a single tertiary clinical center. Cohort enrichment was performed to increase the number of patients with early disease and dcSSc. Seventy-two patients were re-evaluated after one year. Nine patients had overlap syndromes: rheumatoid arthritis (n=3), Sjögren syndrome (n=2), polymyositis (n=2), and mixed connective tissue disease (n=2). The overall disease activity was evaluated using both composite indices (old-AI, Pecs-AI, new-AI) and the PGA of disease activity, based on the blinded evaluation of a single physician (LV). In addition to the minimal essential data from the EUSTAR database we also performed detailed assessment of the musculoskeletal involvement evaluating measures of hand function, DAS28 scores, and the Clinical Disease Activity Index (CDAI) (4).Results:Three times more patients with active disease were identified by the new-AI compared to the old-AI at baseline investigation (n=37, 48.7%, vs. n=11, 14.3%). Two patients (18%) with active disease based on the old-AI were missed by the new-AI. Pecs-AI index identified 15 patients (19.5%) with active disease (cut-off >2.75 points). Active disease was equally frequent in dcSSc and lcSSc patients based on old-AI, but was more frequent in dcSSc patients based on the new-AI in the whole cohort, and also after excluding overlap cases.Patients with active disease based on the old-AI had more frequently rheumatoid factor (6/9, vs. 12/45, p=0.047), and DLCO<70% (11/11, vs. 36/65, p<0.01). Active disease based on the new-Al was associated with current cyclophosphamide treatment (9/37, vs.2/39, p=0.023), and diabetes mellitus (7/30, vs. 0/39, p<0.01). The PGA correlated moderately at both baseline and one year follow-up examination with the old-AI (rho: 0.519, and rho: 0.692, respectively, p<0.001), the new-AI (rho: 0.401, and rho: 0.429, respectively, p<0.001), and the Pecs-AI (rho: 0.425, and rho: 0.593, respectively, p<0.001).CDAI correlated significantly with the old-AI (rho: 0.345, and rho: 0.283, respectively, p<0.05) and the Pecs-AI (rho: 0.363, and rho: 0.324, respectively, p<0.05) at both the baseline and one-year follow-up investigations, but showed no consistent correlation to the new-AI or PGA.Conclusion:The two validated disease activity indices indentify different patient groups. Joint involvement is potentially underrepresented in the new EUSTAR activity index. Active disease is also present in lcSSc and should be assessed regularly in these patients.References:[1]Valentini G, et al. Ann Rheum Dis 2003; 62: 901-3.[2]Valentini G, et al. Ann Rheum Dis 2017;76:270–276.[3]Minier T, et al. Rheumatology (Oxford) 2010;49(6):1133-45.[4]Lorand V, et al. Rheumatology (Oxford). 2016;55(10):1849-58.Acknowledgments:This work was supported by the EU Seventh Framework Program [FP7/2007-2013] under Grant Agreement n° 305495 (DeSScipher), by the Hungarian Scientific Research Fund (contract n°: 112939), and the EU under the Grant Agreement n° PEPSYS GINOP-232-15-2016-00050.Disclosure of Interests:Tünde Minier Speakers bureau: Actelion, Abbvie, MSD, Pfizer, Lilly, Roche, Veronika Lóránd: None declared, Zsófia Bálint: None declared, Dalma Komjati: None declared, Gabriella Nagy Speakers bureau: MSD, Antonietta Kovács: None declared, Orsolya Koncz: None declared, Cecília Varjú Consultant of: Boehringer Ingelheim RCV GmbH & Co KG, Speakers bureau: Lilly, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Gabor Kumanovics Consultant of: Boehringer, Teva, Speakers bureau: Roche, Lilly, Novartis, Balazs Nemeth: None declared

SAT0053 ESTIMATING REAL-WORLD UNMET NEEDS FOR REACHING REMISSION IN THE FIRST YEAR FOLLOWING EARLY RA DIAGNOSIS: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 958-959
Author(s):  
O. Schieir ◽  
S. J. Bartlett ◽  
M. F. Valois ◽  
L. Bessette ◽  
G. Boire ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Disease Activity ◽  
First Year ◽  
Research Support ◽  
Clinical Nurse ◽  
Early Ra ◽  
Sat 1 ◽  
Active Disease ◽  
Activity Indices

Background:Several composite RA disease activity indices are commonly used in clinical practice and research. Different disease activity indices however can be inconsistent in classifying remission (REM).Objectives:1) Compare remission prevalence across 4 common RA indices; 2) compare changes in remission across indices; and, 3) Identify predictors of persistent active disease across all indices, in real-world early RA patients over 1 year follow up.Methods:Data were from patients with early RA (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2018. Participants had active disease at enrolment, were treated with csDMARDs and completed standardized clinical assessments every 3-months. Remission status was assessed using 4 indices: 1) DAS28< 2.6 OR DAS28CRP < 2.5, 2) CDAI ≤ 2.8, 3) SDAI≤ 3.3, and 4) ACR/EULAR Boolean remission – SJC28, TJC28, CRP, PGA all ≦1. T-tests/ chi-squared tests were used to compare differences in remission prevalence by 1 year, and changes in remission before and after a QI program. Logistic regression was used to identify predictors of persistent active disease on all 4 indices.Results:1202 adults were eligible for this analysis. At enrolment, 877 (73%) were women, mean (sd) age was 55 (14), average disease activity was high (DAS28 5.1 (1.4); CDAI 27 (14); SDAI 29 (15)). Prevalence of remission by 12-months follow up was 14-21% higher when estimated with the DAS28 compared with CDAI, SDAI and Boolean criteria, and 378 (31%) did not achieve remission according to any of the 4 indices (Fig 1). Improvement in remission after a QI program however was similar across all 4 indices(~+15-17%). In adjusted logistic regression, Persistent active disease across all measures was most strongly associated with positive serostatus and smoking in men, and with obesity and more tender joints in women. Pain and lower education were predictors in BOTH men and women (Table 2)Table 1.Multivariable Logistic Regression Predicting Persistent Active Disease by 12-months across ALL RA indicesConclusion:In the absence of a single “best measure” that also takes in to account the patient’s perspective, we estimate unmet needs for achieving remission in the first year of follow up in 1 in 3 ERA patients who did not achieve remission by ANY of the 4 indices.References:[1] Kuriya B, Sun Y, Boire G, Haraoui B, etal. Remission in Early Rheumatoid Arthritis – A Comparison of New ACR/EULAR Remission Criteria to Established Criteria.J Rheumatol2012;39:1155-1158.Disclosure of Interests:Orit Schieir: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared

scholarly journals Increased abundance of proteobacteria in aggressive Crohn’s disease seven years after diagnosis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
M. K. Vester-Andersen ◽  
H. C. Mirsepasi-Lauridsen ◽  
M. V. Prosberg ◽  
C. O. Mortensen ◽  
C. Träger ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Activity Index ◽  
Aggressive Disease ◽  
Intestinal Dysbiosis ◽  
Inflammatory Bowel ◽  
Microbiota Diversity ◽  
Active Disease

Abstract Intestinal dysbiosis in inflammatory bowel disease (IBD) patients depend on disease activity. We aimed to characterize the microbiota after 7 years of follow-up in an unselected cohort of IBD patients according to disease activity and disease severity. Fifty eight Crohn’s disease (CD) and 82 ulcerative colitis (UC) patients were included. Disease activity was assessed by the Harvey-Bradshaw Index for CD and Simple Clinical Colitis Activity Index for UC. Microbiota diversity was assessed by 16S rDNA MiSeq sequencing. In UC patients with active disease and in CD patients with aggressive disease the richness (number of OTUs, p = 0.018 and p = 0.013, respectively) and diversity (Shannons index, p = 0.017 and p = 0.023, respectively) were significantly decreased. In the active UC group there was a significant decrease in abundance of the phylum Firmicutes (p = 0.018). The same was found in CD patients with aggressive disease (p = 0.05) while the abundance of Proteobacteria phylum showed a significant increase (p = 0.03) in CD patients. We found a change in the microbial abundance in UC patients with active disease and in CD patients with aggressive disease. These results suggest that dysbiosis of the gut in IBD patients is not only related to current activity but also to the course of the disease.

scholarly journals OP0052 FACTORS ASSOCIATED WITH REMISSION AT 5 YEARS OF FOLLOW-UP IN EARLY ONSET AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE DESIR COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 27.1-28
Author(s):  
L. Pina Vegas ◽  
E. Sbidian ◽  
D. Wendling ◽  
P. Goupille ◽  
S. Ferkal ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Activity Index ◽  
Sensitivity Analyses ◽  
Factors Associated ◽  
Tnfα Inhibitors ◽  
Baseline Factors ◽  
Active Disease

Background:The disease course of axial SpA (axSpA) is highly variable and can be characterized by ongoing axial inflammation and radiographic progression associated with restricted mobility of the spine, reduced function and disability leading to impairment in quality of life. Control of disease activity is a primary aim in axSpA management. To assess disease activity the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) is often considered as a reference tool. The data on remission are spare in axSpA and the identification of long-term remission factors, enabling the patient’s management to be adapted, seems necessary but remains unclear.Objectives:To evaluate the proportion of patients in remission according to ASDAS-CRP at 5 years of follow-up, to describe their characteristics in comparison with patients with active disease at that time, and to identify baseline factors associated with remission at 5 years of follow-up.Methods:We included all patients from the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort with available data on ASDAS-CRP at 5-year follow-up and TNFα inhibitors exposure. Patients in remission, defined as an ASDAS-CRP<1.3, and with active disease were compared according to their main demographic, clinical, biological and radiological characteristics. A logistic model stratified on TNFα inhibitors exposure was used in the main analysis. Sensitivity analyses among patients with axSpA diagnosis confirmed by rheumatologist at 5-years were performed.Results:A total of 614 patients were followed in the DESIR cohort at M60. After excluding those with missing data on ASDAS score (n= 163) and TNFα inhibitors exposure (n= 2), analyzed patients were 449 (73%). Excluded patients had similar baseline characteristics to those included in the analysis. Among patients unexposed to TNFα inhibitors (n=247), 77 (31%) were in remission (37,8±8,3 years; 55% men, 58% NSAID users), 170 (69%) weren’t (39,8±8,6 years; 42% men, 81% NSAID users). Among exposed patients (n=202), 34 (17%) were in remission (36,1±8,1 years; 71% men, 29% NSAID users), 168 (83%) weren’t (39,5±9,0 years; 41% men, 63% NSAID users) (Figure 1). Overall, patients in remission were more frequently men, HLA-B27+, with high education and lower BMI at 5-year of follow-up. The baseline factors associated with remission at 5 years of follow-up from the multivariate analysis are presented in Table 1.Table 1.Baseline factors associated with remission at 5-year follow-up (multivariate analysis)TNFα: Tumor Necrosis Factor alpha; ORa: adjusted Odd Ratio; 95%IC: 95% confidence interval; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BMI: Body Mass Index.Conclusion:The overall remission rate at 5 years was 25%, 31% among patients unexposed to TNFα inhibitors and 17% among those exposed. This study reveals the difficulty in achieving 5-year remission in recent axSpA, especially in the most active forms at baseline; socio-educational factors and overweight also appear to be related.Acknowledgements:L Pina Vegas received a Master 2 grant from the French Society of Rheumatology (Bourse Master 2ème Année 2019)Disclosure of Interests:Laura Pina Vegas: None declared, Emilie Sbidian: None declared, Daniel Wendling: None declared, Philippe Goupille: None declared, Salah Ferkal: None declared, Philippe Le Corvoisier: None declared, Bijan Ghaleh: None declared, Alain Luciani: None declared, Pascal Claudepierre Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, Pfizer, Roche-Chugai, Bristol-Myers Squibb, MSD, UCB, Novartis, Janssen, Lilly, Celgene (consulting fees, less than 10,000 $ each)., Employee of: Roche Chugai, Sanofi Aventis, Celgene, Pfizer, MSD, Novartis and BMS (investigator).

scholarly journals OP0173 REDUCTION OF SKIN FIBROSIS IN SYSTEMIC SCLEROSIS ON RITUXIMAB TREATMENT. LONG-TERM FOLLOW-UP

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 104.1-104
Author(s):  
L. Garzanova ◽  
L. Ananyeva ◽  
O. Koneva ◽  
O. Ovsyannikova ◽  
O. Desinova ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Activity ◽  
Cumulative Dose ◽  
Activity Index ◽  
Disease Activity Index ◽  
Skin Fibrosis ◽  
Oral Aperture ◽  
Long Term Follow Up

Background:A sound experience has been accumulated up to date with the use of rituximab (RTХ) for treatment of systemic sclerosis (SSc). Some studies reported improvement of skin fibrosis following treatment with RTХ, but long-term follow-ups are really few.Objectives:to evaluate the effect of RTХ on the manifestations of skin fibrosis in patients (pts) with SSc in the long-term follow-up.Methods:This prospective study included 71 pts aged 46 years (17-66) on average, 59 (83%) pts were females, mean disease duration was 5,6±4,4 years, and mean follow-up - 42 months (12-72) (mo). Diffuse SSc was established in 42 (59%) pts. All pts received glucocorticoids in low doses. 45% of pts were receiving immunosuppressants at study entry. The following parameters were evaluated: Rodnan skin score (mRSS), interdigital space(IDS) (the distance between the tips of 1 and 5 fingers at maximum extension), oral aperture (OAp) and activity index (EScSG-AI) over the periods: 12-18 mo, 24-30 mo, 36-42 mo, 48-54 mo and 60-72 mo after initiation of RTX therapy. The results are presented as: mean values, delta (Δ), median, upper and lower quartiles.Results:RTX therapy resulted in significant decrease of disease activity index, which statistically significantly correlated with decrease of mRSS - the main indicator of the severity of skin fibrosis (r=0,39;p=0,001). Changes in parameters by follow-up periods are presented in the Table 1.Table 1.Changes in clinical and instrumental parameters at RTX treatment (delta; median; lower quartile; upper quartile).Parameters12-18 mo (n=71)24-30 mo (n=55)36-42 mo (n=36)48-54 mo (n=24)60-72 mo (n=17)ΔmRSS3,32 [3.3; 0; 8]5,4 [3; 0; 10]5,1 [3,5; 0; 9]5,3 [3; 0; 10]7,3 [5; 1; 14]p=0,001p=0,001p=0,001p=0,001p=0,001ΔOAp, cm0,24 [0,1; 0; 0,5]0,26 [0,1; 0; 0,6]0,39 [0,2; 0; 0,8]0,31 [0.3; 0; 0,7]0,36 [0,2; 0; 0,8]p=0,0009p=0,0006p=0,004p=0,006p=0,009ΔActivity index (EScSG-AI)1,49 [1,5; 0; 2,5]1,64 [1,5; 0; 2,5]1,11 [1; 0; 2]2 [2; 1; 3]2,17 [2; 1,5; 2]p=0,001p=0,001p=0,0001p=0,0001p=0,0001Cumulative dose of RTX, g1,43±0,62,97±0,83,45±1,33,96±1,15,15±1,7Decreasing of mRSS statistically significantly correlated with increasing cumulative dose of RTX (r=0,29;p=0,01). Decreasing disease activity index correlated with increasing cumulative dose of RTX (r=-0,37; p=0,01). IDS improvement was documented at all assessment time periods, although statistically insignificant.Conclusion:The results of this study confirm reported positive effect of RTX on the reduction of skin fibrosis in SSc. Long-term follow-up demonstrated steadily decreasing skin fibrosis and improvement of microstomia with increasing oral aperture in parallel with a decrease of the disease activity index and increasing cumulative dose of RTX.Disclosure of Interests:None declared

The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Xuerong Deng ◽  
Xiaoying Sun ◽  
Wenhui Xie ◽  
Yu Wang ◽  
Zhuoli Zhang
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Clinical Disease ◽  
Joint Involvement ◽  
Clinical Disease Activity ◽  
Hands And Feet ◽  
Activity Indices

Abstract Background: Rheumatoid arthritis (RA) is chronic inflammatory arthritis with multi-joint involvement, especially small synovial joints in hands and feet. So far, the synovitis of which joint in hands or feet is better correlated with clinical disease activity indices is unknown; the correlation of synovitis detected by ultrasound in an individual joint with global disease activity is unclear either.Objectives: To explore the correlation between the ultrasound-detected synovitis in metacarpophalangeal (MCP), metatarsophalangeal (MTP), proximal interphalangeal (PIP) joints and the clinical disease activity indices in patients with RA.Methods: 30 joints, including bilateral MCP, PIP and MTP, were scanned for synovitis by ultrasound, semi-quantitatively scored for gray scale(GS) and power Doppler(PD). The correlation between Disease Activity Score-28 joints(DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and ultrasound-detected synovitis score in each joint was assessed using Spearman’s rank correlation test. Results: 211 RA patients were included in this study. The whole GS scores of all MCP joints showed highest correlation with all clinical disease activity indices (r=0.403-0.452, p<0.01), followed by PIPs (r=0.318-0.331, p<0.01) and MTPs (r=0.277-0.301, p<0.01). Likewise, the whole PD scores of all MCP joints also showed highest correlation with the disease activity (r=0.332-0.396, p<0.01), followed by PIPs (r=0.211-0.242, p<0.01), and MTPs (r=0.198-0.222, p<0.01). The highest correlation of GS score with DAS28-ESR (r=0.411, p<0.01), DAS28-CRP (r=0.459, p<0.01), SDAI (r=0.444, p<0.01) was observed in MCP3 joint, while with CDAI (r=0.421, p<0.01) in MCP2 joint. The highest correlation of PD score with DAS28-ESR (r=0.353, p<0.01), DAS28-CRP (r=0.399, p<0.01), CDAI (r=0.368, p<0.01), SDAI (r=0.377, p<0.01) was in MCP5 joint. Conclusions: The ultrasound-detected synovitis at MCP joints, especially MCP2, MCP3, and MCP5 joints, was best correlated with composite disease activity of RA, in contrast to PIP and MTP joints. MCP joints should take greater weight in clinical disease activity assessment.

scholarly journals SAT0501 EARLY START OF BIOLOGICAL TREATMENT IN JUVENILE IDIOPHATIC ARTHRITIS: DOES A THERAPEUTIC WINDOW EXIST IN REAL LIFE?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1207.2-1207
Author(s):  
A. García Fernández ◽  
A. Briones-Figueroa ◽  
L. Calvo Sanz ◽  
Á. Andreu-Suárez ◽  
J. Bachiller-Corral ◽  
...  
Keyword(s):  
Disease Activity ◽  
Biological Treatment ◽  
Real Life ◽  
Therapeutic Window ◽  
Systemic Jia ◽  
Active Arthritis ◽  
The Impact ◽  
Active Patients ◽  
Active Disease

Background:Biological therapy (BT) has changed the treatment and perspectives of JIA patients but little is known about when is the best moment to start BT and the impact of this prompt iniciation.Objectives:To analyze the response to BT of Juvenile Idiophatic Arthritis (JIA) patients according to the time when the BT was started.Methods:A retrospective, descriptive study was conducted on JIA patients followed up in a referal hospital that started BT up to 24 months after diagnosis from 2000 to 2018. Disease activity was measured, at 2 years after diagnosis, according to Wallace criteria for remission (absence of: active arthritis, active uveitis, fever, rash or any other manifestation attributable to JIA, normal CRP and ESR, PGA indicating no active disease) for at least 6 months.Results:55 JIA patients that started BT up to 24 months from diagnosis were analyzed. 69,1% were girls with a median age at diagnosis of 8 years old IQR(3-13), median age at the start of BT of 9 years old IQR(3-13). Regarding JIA categories: 25,5% were Oligoarticular Persistent (OligP), 18,2% Systemic JIA (sJIA), 16,4% Entesitis related Arthritis (ERA), 12,7% Psoriatic Arthritis (APso) and Polyarticular RF- (PolyRF-), 5,5% Oligoarticular Extended (OligE) and Polyarticular RF+ (PolyRF+), 3,6% Undifferentiated (Und). 20% of patients had uveitis during followup. Conventional DMARD (cDMARD) was indicated in 83,6% of patients (95,7% Methotrexate) at diagnosis [median 0 months IQR(0-2,3)]. At the end of followup (2 years) only 30,9% of patients continued with cDMARDs. The main causes of discontinuation were: adverse events (46,7%), remission (36,7%). TNF inhibitors were precribed in 81,8% of patients and 18,2% of patients recieved two BT during the first 2 years from diagnosis. 54,5% of BT were indicated during the first 6 months from diagnosis, 27,3% from 7 to 12 months, 12,7% from 13 to 18 months, 5,5% from 19 to 24 months.After 2 years from diagnosis, 78,2% of patients were on remission and 21,8% active. Among patients with active disease: 75% had arthritis, 16,7% had uveitis and 8,3% had both. There were no differences regarding disease activity among patients with uveitis and neither taking cDMARDs. Regarding JIA categories: 66,7% of OligE, 57,1% of PolyRF- and 57,1% of APso patients were active at 2 years from diagnosis when compared to the other categories (p=0.004).Patients on remission at 24 months from diagnosis started sooner the BT than active patients [CI 95% (0,46-8,29) p=0,029]. The time when the BT was started was correlated to the activity at 2 years (K= 0,294 p=0,029). When the BT was prescribed after 7,5months from diagnosis it was correlated, in a COR curve, with a higher probability of active disease at 2 years (S= 0,67 E= 0,63). There was a correlation, among patients on remission at 2 years, between prompt start of BT and less time to reach remission (K= -0,345 p=0,024). Patients with active disease at 2 years, regardless of moment of BT iniciation, required more BT during follow-up (p=0,002).Conclusion:Prompt iniciation of BT was correlated with a better outcome. JIA patients that started BT early after diagnosis had a higher probability of remission after 2 years. Starting BT after 7,5 months was correlated with a higher probability of active disease at 2 years. Active disease at 24 months was correlated with persistent active disease during follow-up.Disclosure of Interests:None declared

scholarly journals AB0806 DOES VITAMIN D INFLUENCE THE ACTIVITY OF THE DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1704.1-1705
Author(s):  
L. Montolio-Chiva ◽  
A. V. Orenes Vera ◽  
M. Aguilar-Zamora ◽  
C. Vergara-Dangond ◽  
I. Vázquez-Gómez ◽  
...  
Keyword(s):  
Vitamin D ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Functional Capacity ◽  
Inverse Correlation ◽  
Hypovitaminosis D ◽  
Joint Involvement ◽  
Average Value ◽  
Vitamin D Levels

Background:Several studies have shown an inverse relationship between vitamin D levels (25OHD) and disease activity in patients with rheumatoid arthritis (RA). However, the existing data in patients with psoriatic arthritis (PsA) are poor, and they use the DAS28 index as a peripheral joint activity marker by extrapolation with RA.Objectives:To analyze the relationship between 25OHD levels, disease activity and functional capacity in patients with PsA.Methods:Transversal, observational, descriptive study. We included PsA patients with peripheral joint involvement. We collected demographic variables (gender, age), clinical variables [follow-up, received treatments, TJC (68), SJC (68), VAS] and analytical variables (25OHD, CRP, ESR). We usedDisease activity in psoriatic arthritis(DAPSA) score to measure disease activity, and theHealth assessment questionnaire(HAQ) to determine functional capacity. Levels of 25 OHD <20 ng/ml and between 20-30 ng/ml were considered deficient and insufficient, respectively. Statistical analysis was made with SPSS 22.0. The descriptive analysis results were expressed as percentage and mean ± SD. We used Pearson’s correlation to assess the association between quantitative variables and T test to compare means between dichotomous variables.Results:125 patients were included, the majority women (60.8%), with an average age of 55.4 (SD 12.2) years. The average follow-up was 75.5 (SD 68.3) months. 97.6% of patients had received DMARDs and 40.8% biologics, and almost half of the patients (42.7%) took calcium and 25OHD supplements. The average value of 25OHD was 27.1 (SD 12.1) ng/ml, with 30% of patients having 25OHD deficit and 63.3% insufficiency. The majority of patients had an acceptable disease control, with a mean DAPSA of 10.5 (SD 7,9); and mean of CRP, ESR, TJC and SJC was 6.1 (SD 3.7) mg/l, 10.2 (SD 9.9) mm/h, 1.3 (SD 2.5) and 0.7 (SD 2.1), respectively. The average value of HAQ was 0.6 (SD 0.7). We observed an inverse correlation between 25OHD levels and joint counts, TJC (p=0.02) and SJC (p=0.03). On the other hand, patients with hypovitaminosis D presented a tendency to get higher scores in DAPSA index (P=0.07). We do not observe any relationship between 25OHD and HAQ.Conclusion:As can be seen in our sample, low values of 25OHD are related to increased disease activity in patients with PsA.Disclosure of Interests:L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

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