scholarly journals Patterns of the rheumatic disease course in the setting of a new coronavirus infection

2021 ◽  
Vol 5 (2) ◽  
pp. 84-88
Author(s):  
V.V. Vakhlevskiy ◽  
◽  
V.V. Tyrenko ◽  
I.S. Svintsitskaya ◽  
E.V. Kryukov ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Disease Process ◽  
Antirheumatic Drug ◽  
Disease Course ◽  
Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Coronavirus Infection ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug

The article describes the main pathophysiological mechanisms underlying the potential use of antirheumatic therapy in the new COVID-19 in patients with rheumatic diseases. Also, it summarizes current data on the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. To date, there are no large randomized studies on the use of antirheumatic drugs in patients with rheumatic diseases in the setting of COVID-19. Besides, there is no convincing evidence that any disease-modifying antirheumatic drug (conventional synthetic, biological, or targeted synthetic) can prevent the development of a severe COVID-19 course. At the same time, the importance of concomitant pathology (hypertension, obesity, cardiovascular diseases, diabetes mellitus) and risk factors (smoking) in the development of a severe COVID-19 course in patients with rheumatic diseases is shown. The article presents possible options for initiating and continuing treatment with antirheumatic drugs in patients with rheumatic diseases, depending on the stage of the infectious disease process. KEYWORDS: COVID-19, rheumatic diseases, disease-modifying antirheumatic drug, interleukin, tumor necrosis factor, glucocorticosteroids. FOR CITATION: Vakhlevskiy V.V., Tyrenko V.V., Svintsitskaya I.S., Kryukov E.V. Patterns of the rheumatic disease course in the setting of a new coronavirus infection. Russian Medical Inquiry. 2021;5(2):84–88. DOI: 10.32364/2587-6821-2021-5-2-84-88.

scholarly journals AB1187 TREATMENT ADHERENCE: WHAT ABOUT THE RHEUMATOLOGIST?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1884.2-1884
Author(s):  
R. Pineda-Sic ◽  
M. M. Castañeda-Martínez ◽  
I. D. J. Hernandez-Galarza ◽  
E. I. Guevara Elizondo ◽  
D. E. Flores Alvarado ◽  
...  
Keyword(s):  
Patient Education ◽  
Treatment Adherence ◽  
Rheumatic Diseases ◽  
Text Messages ◽  
Antirheumatic Drug ◽  
Adherence To Medication ◽  
Phone Calls ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug

Background:Adherence to medications among patients with rheumatic diseases is often suboptimal.1Adherence to treatment has been described to be affected by several factors.2The rheumatologist plays a crucial role in influencing adherence behavior by addressing perceptions about medication, providing information, and establishing trust in the treatment plan.3There is no record of attitudes and thoughts of Mexico’s rheumatologists about adherence to medication.Objectives:To know the rheumatologist’s attitudes regarding treatment adherence in follow up consultation.Methods:Descriptive, cross sectional study. Rheumatologists from across the country were invited to respond an electronic survey created with Google Forms, link was sent by Whatsapp ® message, responses were anonymous. The survey was constructed taking into account the main barriers of adherence related to the doctor. Seven questions were created, from one to six were multiple selections and the seven were open question1.Where do you practice medicine? 2.Do you ask all your patients about adherence medication? 3.If your answer was positive, do you ask individually for each drug? 4.How long do you spend on explaining: side effects, benefits, and mechanisms of action of drugs? 5 Do you discuss available treatment options with your patients to decide one? 6.What’s the definition of adherence? 7.Which activities can the doctor do to improve adherence to their patients?Results:Data were collected from 158 rheumatologists who completed the survey. Regarding the question where they practice medicine, 19.5% answered they work in public medical institutions, 31.8% do private practice and 48.7% work in both of them, 88.3% answered correctly adherence definition, 93% of rheumatologists ask for adherence to medication in the follow up consultation and only 86.1% do it individually for each medication, 97.4% discuss therapeutic options with their patients. The time used to explain treatment is presented in Figure 1. The interventions considered by rheumatologists to increase adherence are reported in Table 1.Table 1Interventions considered by rheumatologists to increase adherencePatient education(in follow up consultation, conferences, pamphlets)Develop rapportwith patient. (“be accessible”, “answer questions” “make the patient part of“ don’t be paternalistic or authoritarian”)Adherence measure(Use the available method, questionnaires, self-report, drug levels, electronic pillbox, pill count, etc. “Don’t matter which one, measure it!“)Interventions for no adherence reasons(phone calls, text messages, telephone alarms) fixed schedules for each medication, cognitive-behavioral therapy, access to medications)Family support networkPresented in order to frequencies and grouped by topicConclusion:Rheumatologists ask for adherence medication but more than half use a limited amount of time to explain about medication, nevertheless, they think that patient education is the best intervention to increase adherence.References:[1]Pasma, Annelieke et.al Facilitators and Barriers to Adherence in the Initiation Phase of Disease modifying Antirheumatic Drug (DMARD) Use in Patients with Arthritis Who Recently Started Their First DMARD Treatment, The Journal of Rheumatology (2013) DOI:10.3899/jrheum.140693.[2]M.F. M. Improving treatment adherence in patients with rheumatoid arthritis: What are the options? Int J Clin Rheumtol. 2015;10(5):345–56.[3]Voshaar et al. Barriers and facilitators to disease modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskeletal Disorders (2016) 17:442 DOI 10.1186/s12891-016-1289-zDisclosure of Interests:None declared

Immunosuppressants

2013 ◽  
pp. 619-629
Author(s):  
Joanna Ledingham ◽  
Sarah Westlake
Keyword(s):  
Disease Management ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Mechanism Of Action ◽  
Inflammatory Disease ◽  
Disease Process ◽  
Inflammatory Rheumatic Diseases ◽  
Combination Therapies ◽  
Beneficial Effects ◽  
Disease Modifying

A variety of immunosuppressants and disease-modifying anti-rheumatic drugs (DMARDs) with beneficial effects on inflammatory rheumatic diseases have been identified over the last 50 years. Their use for these conditions is now well established and has led to considerable improvements in disease management. Their use earlier in the inflammatory disease process and the use of combination therapies have also led to significantly improved patient outcomes. This chapter provides an overview of the immunosuppressants and DMARDs used to treat rheumatic disease, focusing particularly on those in common use and with the best evidence for efficacy. The mechanism of action, toxicity, and clinical indications are outlined. Tips for practical prescribing and for monitoring for potential complications are also included.

scholarly journals AB0129 IL-6R GENETIC VARIANTS AS PREDICTORS OF CLINICAL RESPONSE TO TOCILIZUMAB IN RHEUMATOID ARTHRITIS PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1093.1-1093
Author(s):  
L. Sainz Comas ◽  
P. Riera ◽  
P. Moya ◽  
S. Bernal ◽  
A. Lasa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Effects ◽  
Rheumatic Diseases ◽  
Laboratory Data ◽  
Antirheumatic Drug ◽  
Age At Diagnosis ◽  
Unknown Etiology ◽  
Duration Of Treatment ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug

Background:Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease of unknown etiology. Tocilizumab (TCZ) is a first-line biological disease-modifying anti-rheumatic drug (bDMARD) which inhibits Interleukin 6 (IL-6) pathway through blockade of its receptor. At present, there is a lack of evidence to recommend the treatment of one bDMARD over another.(1) Seeking for genetic biomarkers to predict response to treatment could be key towards a personalized treatment strategy in rheumatology.(2)Objectives:We aimed to evaluate whether functional single nucleotide polymorphisms (SNPs) in the IL6R gene could predict response and/or toxicity to TZC in Caucasian patients diagnosed with RA.Methods:Retrospective analytical preliminar study of a cohort of 31 patients diagnosed with RA (ACR/EULAR 2010 criteria) who received treatment with TCZ within the last 10 years. Epidemiological, clinical and laboratory data were collected. DNA was extracted from EDTA blood samples. Three SNPs in the IL-6 receptor gene (rs12083537, rs2228145, rs4329505) were genotyped by real-time PCR with TaqMan probes. The associations between polymorphisms and clinicopathological features were evaluated using parametric tests. Efficacy was assessed as the difference of DAS-28 CRP at 6 months. The toxicities recorded were hepatotoxicity, infections, hypersensibility, gastrointestinal, hematological and dyslipidemia.Results:The 31 DNA samples from patients included were mainly female (83.9%) and had a mean age at diagnosis of 46.8 years. The mean duration of treatment was 51.3 months and, previously to initiate TCZ, they received a mean of 2,6 csDMARD and 1,7 bDMARD.The more frequent adverse effects were hypertransaminasemia (22.6%) and neutropenia (32.3%). Most relevant epidemiologic and clinical data is shown in Table 1.Table 1.Clinical characteristics. RA=Rheumatoid Arthritis. CCP= anti-Cyclic Citrullinated Peptides. RF=Rheumatoid factor. csDMARDs= conventional synthetic Disease-modifying antirheumatic drug. bDMARD= biological Disease-modifying antirheumatic drug. BMI=Body Mass Index. Sc=subcutaneous. Ev=endovenous. DAS28= Disease Activity Score in 28 jointsSex (n=31), n (% women/men) 26/5 (83,9%/16,1%)Age at diagnosis (n=31), years +- SD 46,8+- 12,8Erosive RA (n=31), n(%) 14 (45,2%)Anti-CCP positive (n=31), n(%)UI+- SD 23 (74,2%)259,7 +- 137,3RF positive (n=31), n (%)UI+-SD 21 (67,7%)189,4+- 114Previous csDMARD (n=31), n°+-SD2,6 +-1,3Previous bDMARD (n=31), n°+- SD1,7 +- 1,4BMI (n=29), mean +- SD29,3+- 5,1Duration of treatment (n=31), months +-SD51,3 +- 36,3-Active treatment (n=12)-80,9+- 18,3-Finished treatment (n=19)-32,6+- 32,2Route of administration (n=31), n (%) sc/ev 11/20 (35,5/64,5)Basal DAS28 (n=30), mean+- SD5,3 +- 1,1DAS28 reduction at 6 months (n=28), mean+-SD2,9 +-1,1The univariate analyses showed that the rs2228145 variant was statistically associated with differences in DAS28 reduction at 6 months (p=0.042). Regarding efficacy, we also found a trend with the SNP rs4329505 (p=0.173), which could achieve statistical significance with the projected inclusion of more patients. No associations were found regarding adverse effects.Conclusion:The rs2228145 polymorphisms in the IL6R gene may be considered as a pharmacogenetic biomarker of TCZ response in RA patients. More studies are required in order to investigate the clinical use of pharmacogenetic biomarkers in rheumatic diseases.References:[1]Smolen, Josef S., Robert B., et al. 2020. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update.” Annals of the Rheumatic Diseases 79 (6): 685–99.[2]Tarnowski, Maciej, Agnieszka Paradowska-Gorycka, et al. 2016. “The Effect of Gene Polymorphisms on Patient Responses to Rheumatoid Arthritis Therapy.” Expert Opinion on Drug Metabolism & Toxicology 12 (1): 41–55.Disclosure of Interests:None declared

scholarly journals Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe?

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001439
Author(s):  
Cristiana Sieiro Santos ◽  
Xenia Cásas Férnandez ◽  
Clara Moriano Morales ◽  
Elvira Díez Álvarez ◽  
Carolina Álvarez Castro ◽  
...  
Keyword(s):  
General Population ◽  
Rheumatic Disease ◽  
Infection Rate ◽  
Rheumatic Diseases ◽  
Hospital Care ◽  
Biological Agents ◽  
Inflammatory Rheumatic Diseases ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying

BackgroundThe recent outbreak of COVID-19 has raised concerns in the rheumatology community about the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It is not clear whether the use of biological agents may suppose a risk or protection against SARS-CoV-2 infection; however, it has been suggested that severe respiratory forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. This prompted the use of interleukin 6 (IL-6) (tocilizumab and sarilumab) and IL-1 inhibitors (anakinra) in severe COVID-19 disease and more recently JAK1/2 inhibitor (baricitinib). Therefore, patients with rheumatic diseases provide a great opportunity to learn about the use of biological agents as protective drugs against SARS-CoV-2.ObjectivesTo estimate COVID-19 infection rate in patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) for inflammatory rheumatic diseases (RMD), determine the influence of biological agents treatment as risk or protective factors and study the prognosis of patients with rheumatic diseases receiving biological agents compared to the general population in a third-level hospital setting in León, Spain.MethodsWe performed a retrospective observational study including patients seen at our rheumatology department who received bDMARDs for rheumatic diseases between December 1st 2019 and December 1st 2020, and analysed COVID-19 infection rate. All patients who attended our rheumatology outpatient clinic with diagnosis of inflammatory rheumatic disease receiving treatment with biological agents were included. Main variable was the hospital admission related to COVID-19. The covariates were age, sex, comorbidities, biological agent, duration of treatment, mean dose of glucocorticoids and need for intensive care unit . We performed an univariate and multivariate logistic regression models to assess risk factors of COVID-19 infection.ResultsThere were a total of 4464 patients with COVID-19 requiring hospitalisation. 40 patients out of a total of 820 patients with rheumatic diseases (4.8%) receiving bDMARDs contracted COVID-19 and 4 required hospital care. Crude incidence rate of COVID-19 requiring hospital care among the general population was 3.6%, and it was 0.89% among the group with underlying rheumatic diseases. 90% of patients receiving bDMARDS with COVID-19 did not require hospitalisation. Out of the 4464 patients, 869 patients died, 2 of which received treatment with biological agents. Patients with rheumatic diseases who tested positive for COVID-19 were older (female: median age 60.8 IQR 46-74; male: median age 61.9 IQR 52-70.3) than those who were negative for COVID-19 (female: median age 58.3 IQR 48-69; male: median age 56.2 IQR 47-66), more likely to have hypertension (45% vs 26%, OR 2.25 (CI 1.18-4.27),p 0.02), cardiovascular disease (23 % vs 9.6%, OR 2.73 (1.25-5.95), p 0.02), be smokers (13% vs 4.6%, OR 2.95 (CI 1.09-7.98), p 0.04), receiving treatment with rituximab (20% vs 8%, 2.28 (CI 1.24-6.32), p 0.02) and a higher dose of glucocorticoids (OR 2.5 (1.3-10.33, p 0.02) and were less likely to be receiving treatment with IL-6 inhibitors (2.5% vs 14%, OR 0.16, (CI 0.10-0.97, p 0.03). When exploring the effect of the rest of the therapies between groups (affected patients vs unaffected), we found no significant differences in bDMARD proportions. IL-1 inhibitors, IL-6 inhibitors, JAK inhibitors and belimumab-treated patients showed the lowest incidence of COVID-19 among adult patients with rheumatic diseases. We found no differences in sex or rheumatological disease between patients who tested positive for COVID-19 and patients who tested negative.ConclusionsOverall, the use of biological disease-modifying antirheumatic drugs (bDMARDs) does not associate with severe manifestations of COVID-19. Patients with rheumatic disease diagnosed with COVID-19 were more likely to be receiving a higher dose of glucocorticoids and treatment with rituximab. IL-6 inhibitors may have a protective effect.

scholarly journals Lack of association between CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with rheumatoid arthritis

2021 ◽  
Author(s):  
Małgorzata Łączna ◽  
Damian Malinowski ◽  
Agnieszka Paradowska-Gorycka ◽  
Krzysztof Safranow ◽  
Violetta Dziedziejko ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Antirheumatic Drug ◽  
Disease Modifying ◽  
Individual Disease ◽  
Disease Modifying Antirheumatic Drug

Abstract Aim Leflunomide is a disease-modifying antirheumatic drug used in therapy for rheumatoid arthritis (RA). Previous studies indicated that oestrogens and androgens may affect the response to leflunomide in RA patients. The synthesis of androgens is regulated by cytochrome CYB5A. The aim of this study was to examine the association between the CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with RA. Methods The study included 111 women diagnosed with RA. Leflunomide was administered in monotherapy at a dose of 20 mg/day. All patients underwent a monthly evaluation for 12 months after the initiation of treatment with leflunomide. Results After 12 months of therapy, the changes in individual disease activity parameters, such as: DAS28, ESR, CRP and VAS, were not statistically significantly different between rs1790834 genotypes in the Kruskal–Wallis test. Conclusions The results of our study suggest lack of statistically significant association between the CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with RA.

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