scholarly journals Diagnostic Challenges and Management Update in Rheumatoid Arthritis

2020 ◽  
Author(s):  
Mihail Virgil Boldeanu ◽  
Adrian Răzvan Ionescu ◽  
Valeriu Horațiu Popoviciu ◽  
Andreea Lili Bărbulescu ◽  
Ștefan Cristian Dinescu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Targeted Therapies ◽  
Joint Destruction ◽  
Biologic Agents ◽  
Diagnostic Methods ◽  
Cytokine Receptors ◽  
Treat To Target ◽  
Janus Kinases ◽  
Multiple Factors ◽  
Systemic Inflammatory Disease

Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling pathways of various cytokine receptors.

scholarly journals Rheumatoid arthritis: problems of treatment at the present stage

2018 ◽  
Vol 12 (4) ◽  
pp. 65-70
Author(s):  
N. V. Chichasova
Keyword(s):  
Rheumatoid Arthritis ◽  
Biologic Agents ◽  
Control Treatment ◽  
Treat To Target ◽  
Present Stage ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Synthetic Dmards ◽  
Disease Modifying ◽  
Set Up

The possibilities of rheumatoid arthritis therapy have been significantly expanded today. In addition to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic agents (BAs), and a targeted synthetic DMARD, a control treatment strategy has been put into practice.The paper demonstrates successes in the early prescription of csDMARD and the implementation of treat-to-target principles – to achieve the goal after 6 months in 50% of patients receiving subcutaneous methotrexate and 45% of those using a Leflunomide generic. During this therapy, there is a lower need for BAs and targeted synthetic DMARDs. The priority problem is to train general practitioners in methods for the early detection of RA and to set up schools for these patients.

scholarly journals Tocilizumab Was Effective in Repairing the Large Geode in a Patient with Rheumatoid Arthritis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Takuya Izumiyama ◽  
Yu Mori ◽  
Eiji Itoi
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Treatment Effect ◽  
Interleukin 6 ◽  
Present Report ◽  
Joint Destruction ◽  
Chronic Arthritis ◽  
Biologic Agents ◽  
Lateral Epicondyle ◽  
Interleukin 6 Receptor

Rheumatoid arthritis is characterized by multiple chronic arthritis subsequently inducing joint destruction. Although subchondral geode is a well-known feature of high-disease activity, a large geode is rare. Moreover, the treatment effect of biologic agents in the repair of large geode has not been reported. The present report shows the significant effect of interleukin-6 receptor blocker, tocilizumab, in repairing the large geode in the left humeral lateral epicondyle. This case implies that tocilizumab might be an effective treatment in patients with rheumatoid arthritis even with large geode.

Vasculitis

2016 ◽  
pp. 839-848
Author(s):  
Matthew J. Koster ◽  
Kenneth J. Warrington
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Bowel Disease ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Inflammatory Disease ◽  
Joint Destruction ◽  
Age Related ◽  
Systemic Inflammatory Disease ◽  
Inflammatory Bowel ◽  
Reiter Syndrome

Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by joint destruction. It affects 0.03% to 1.5% of the population worldwide. Women are affected 3 times more frequently than men. Its incidence peaks between the ages of 35 and 45 years; however, the age-related prevalence of the disease increases even after age 65 years. Conditions in the spondyloarthritis spectrum include ankylosing spondylitis, reactive arthritis (Reiter syndrome), arthritis related to inflammatory bowel disease, and psoriatic arthritis.

scholarly journals Reconsidering the Role of Melatonin in Rheumatoid Arthritis

2020 ◽  
Vol 21 (8) ◽  
pp. 2877 ◽  
Author(s):  
Iona J. MacDonald ◽  
Chien-Chung Huang ◽  
Shan-Chi Liu ◽  
Chih-Hsin Tang
Keyword(s):  
Rheumatoid Arthritis ◽  
Clock Gene ◽  
Joint Destruction ◽  
Preclinical Models ◽  
Synovial Proliferation ◽  
Janus Kinases ◽  
Clock Gene Expression ◽  
Joint Disorder ◽  
Over Time

Rheumatoid arthritis (RA) is an inflammatory joint disorder characterized by synovial proliferation and inflammation, with eventual joint destruction if inadequately treated. Modern therapies approved for RA target the proinflammatory cytokines or Janus kinases that mediate the initiation and progression of the disease. However, these agents fail to benefit all patients with RA, and many lose therapeutic responsiveness over time. More effective or adjuvant treatments are needed. Melatonin has shown beneficial activity in several animal models and clinical trials of inflammatory autoimmune diseases, but the role of melatonin is controversial in RA. Some research suggests that melatonin enhances proinflammatory activities and thus promotes disease activity in RA, while other work has documented substantial anti-inflammatory and immunoregulatory properties of melatonin in preclinical models of arthritis. In addition, disturbance of the circadian rhythm is associated with RA development and melatonin has been found to affect clock gene expression in joints of RA. This review summarizes current understanding about the immunopathogenic characteristics of melatonin in RA disease. Comprehensive consideration is required by clinical rheumatologists to balance the contradictory effects.

scholarly journals JAK inhibitors impair GM-CSF-mediated signaling in innate immune cells

2020 ◽  
Author(s):  
Yuya Fujita ◽  
Naoki Matsuoka ◽  
Jumpei Temmoku ◽  
Makiko Yashiro Furuya ◽  
Tomoyuki Asano ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Immune Cells ◽  
Innate Immune ◽  
Cytokine Receptors ◽  
Human Neutrophils ◽  
Innate Immune Cells ◽  
Jak Inhibitors ◽  
Inhibitory Effects ◽  
Janus Kinases ◽  
Gm Csf

Abstract Background: Innate immune cells play a crucial role in the pathophysiology of rheumatoid arthritis (RA) via release of cytokines. Small-molecule inhibitors of Janus kinases (JAKi) are clinically efficacious in patients with RA. However, the isoform-specific action of each JAKi is difficult to assess, since JAKs form heterodimeric complexes with cytokine receptors. We assessed the effects of several JAKi on GM-CSF-primed human innate immune cells.Results: Treatment with JAKi (tofacitinib, baricitinib, upadacitinib) prevented GM-CSF-induced JAK2/STAT5 phosphorylation at higher concentrations (400nM) in THP-1 cells. Whereas compared with barcitinib or upadacitinib, the inhibitory effects of tofacitinib on the GM-CSF-induced JAK2/STAT5 phosphorylation were weak at lower concentrations ( < 100nM). All JAKi inhibited GM-CSF-induced IL-1b production by human neutrophils. However, the inhibitory effects of baricitinib on IL-1b production were larger compared to those of tofacitinib or upadacitinib at lower concentrations ( < 100nM). Similarly, all JAKi inhibited GM-CSF-induced caspase-1(p20) production by human neutrophils.Conclusion: We conclude that incubation with JAKi prevents GM-CSF-mediated JAK2/STAT5 activation in human innate immune cells. Although baricitinib and upadacitinib almost completely blocked GM-CSF-mediated JAK2/STAT5 signaling, the inhibitory effects of tofacitinib were weaker at lower concentrations suggesting that variation exists among these JAKi. in the inhibition of JAK2 signaling pathways.

scholarly journals Recommendations of the Brazilian Society of Rheumatology for the use of JAK inhibitors in the management of rheumatoid arthritis

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Karina Rossi Bonfiglioli ◽  
Licia Maria Henrique da Mota ◽  
Ana Cristina de Medeiros Ribeiro ◽  
Adriana Maria Kakehasi ◽  
Ieda Maria Magalhães Laurindo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intracellular Signaling ◽  
Treatment Algorithm ◽  
Efficacy And Safety ◽  
Jak Inhibitors ◽  
Janus Kinases ◽  
Low Disease Activity ◽  
Brazilian Society ◽  
Systemic Inflammatory Disease

AbstractRheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017.

scholarly journals Long-term Glucocorticoid Use in Rheumatoid Arthritis

2020 ◽  
pp. jrheum.201137
Author(s):  
Maarten Boers ◽  
Theodore Pincus
Keyword(s):  
Rheumatoid Arthritis ◽  
Older Patients ◽  
Biologic Agents ◽  
Treat To Target ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
The Mean ◽  
Disease Modifying ◽  
Over Time

We read with interest the article by Hanly and Lethbridge concerning long-term patterns of glucocorticoid (GC) use in older patients with rheumatoid arthritis (RA)1. Their report indicates that GC use has remained relatively stable over time, in contrast to greater use of disease-modifying antirheumatic drugs and biologic agents in the treat-to-target directive. They also report that rheumatologists prescribe lower doses than other physicians, and that the mean dose for rheumatologists has decreased over time.

scholarly journals POS1182 MANAGEMENT OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS DURING THE COVID-19 PANDEMIC: EVIDENCE FROM THE ITALIAN EPICENTER

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 872.1-872
Author(s):  
F. Ingegnoli ◽  
A. F. Luppino ◽  
G. Cincinelli ◽  
E. Favalli ◽  
R. Caporali
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Control Strategy ◽  
Targeted Therapies ◽  
Activity Index ◽  
Real Life ◽  
Treat To Target ◽  
Tight Control ◽  
Face To Face

Background:Despite significant improvement in the RA management, up to twenty percent of patients with rheumatoid arthritis (RA) have a difficult-to-treat (D2T) disease. The COVID-19 related mitigation policies, for instance quarantine, and consequent difficult access to in-person visits, laboratory and imaging investigations, adversely affected the follow up of rheumatic patients. Although pandemic-imposed limitations could have negatively influenced disease management particularly in D2T patients, to what degree these restrictions affected the treat-to target (T2T) and tight-control strategy in this subgroup of RA patients has not been investigated yet.Objectives:To evaluate whether the switch to telehealth imposed by COVID-19 pandemic was effective in the management of D2T RA patients treated with targeted therapies.Methods:This observational retrospective real-life study was conducted from November 2019 through September 2020. Among RA patients treated with targeted therapies, RA D2T patients according to EULAR definition (1) were identified. Clinical Disease Activity Index (CDAI) of these patients was analysed retrospectively before, during and after lockdown (LD). During LD period, patients could choose whether to receive home drug delivery or to maintain their face-to-face consultations, and in the former rheumatologists provided virtual care. To evaluate the effect of LD on the percentage of patients in remission, logistic mixed effects regression models were fitted, with CDAI remission as response variable.Results:Data were extracted from a longitudinal observational registry, and at baseline, 52 patients treated with targeted therapies were classified as D2T RA. Among them, during pre-LD, LD, and post-LD 11.54% (N=6), 53.49% (N=23), and 46.15% (N=24) had CDAI remission/low disease activity, while 46 (88.46%), 20 (46.51%) and 28 (53.85%) had CDAI moderate/high. All the patients completed the follow-up. Median values of CDAI during pre-LD, LD, and post-LD were 14.5 [IQR 12-21], 9 [IQR 5.5-16], and 11 [IQR 6-19.2] respectively (see Figure 1 below).Conclusion:Telephone-based tight control strategy ensured satisfactory management of D2T RA treated with targeted therapies. This temporary approach has been a feasible compensation for the decline of face-to-face visits also in this challenging group of RA patients, thus reassuring for future months before the end of pandemic.References:[1]Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80(1):31-35.Disclosure of Interests:Francesca Ingegnoli: None declared, Angela Flavia Luppino: None declared, Gilberto Cincinelli: None declared, Ennio Favalli Speakers bureau: AbbVie, Sanofi-Genzyme, Lilly, UCB, Pfizer, Novartis, Janssen, Paid instructor for: Roche, MSD, Consultant of: Lilly, Galapagos, Roberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly,Janssen, MSD.

scholarly journals Treatment strategy for patients with rheumatoid arthritis

2020 ◽  
Vol 63 (7) ◽  
pp. 422-430
Author(s):  
Soo-Kyung Cho ◽  
Yoon-Kyoung Sung
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Targeted Therapies ◽  
Functional Disability ◽  
Joint Destruction ◽  
Joint Damage ◽  
Chronic Inflammatory Disease ◽  
Biologic Dmards

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints, causing joint destruction, functional disability, and reduced quality of life in patients. The aim of RA treatment is to decrease the inflammation, prevent joint damage, and improve patientsʼ quality of life while minimizing progression of the disease. Both early detection and intervention with disease-modifying anti-rheumatic drugs (DMARDs) have been reported to improve therapeutic outcomes. Treatment with DMARDs should be started immediately after the diagnosis is established, with methotrexate as the best initial drug of choice. Disease activity should be regularly monitored. Targeted therapies can be considered in patients with persistent active disease despite methotrexate therapy. Remission or low disease activity is the preferred treatment target. There are two major classes of DMARDs: conventional synthetic DMARDs and the targeted therapies specific to pro-inflammatory cytokines including biologic DMARDs and small molecule inhibitors. Recently, the importance of shared decision making, in which patients and clinicians make decisions together, and education of the patient has been emphasized in the treatment strategies of RA. This review summarizes the effectiveness and safety of the DMARDs currently available for RA treatment. Recommendations for RA management would also be discussed in this article.

scholarly journals Reduced skeletal muscle independently predicts 1-year aggravated joint destruction in patients with rheumatoid arthritis

2020 ◽  
Vol 12 ◽  
pp. 1759720X2094622
Author(s):  
Jian-Zi Lin ◽  
Yin Liu ◽  
Jian-Da Ma ◽  
Ying-Qian Mo ◽  
Chu-Tao Chen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Skeletal Muscle ◽  
Radiographic Progression ◽  
Dynamic Change ◽  
Joint Destruction ◽  
Dynamic Monitoring ◽  
Treat To Target ◽  
Bioelectric Impedance Analysis ◽  
Cross Sectional

Background: Numerous cross-sectional studies have reported the associations between rheumatoid arthritis (RA) and reduced skeletal muscle. We firstly explored the dynamic change of skeletal muscle and its effect on RA clinical outcomes in a real-world prospective cohort. Methods: Consecutive RA patients were treated according to the treat-to-target strategy and completed at least 1-year follow up. Clinical data and muscle index (assessed by bioelectric impedance analysis) were collected at baseline and visits at 3, 6, 9 and 12 months. Myopenia was defined by appendicular skeletal muscle mass index ⩽7.0 kg/m2 in men and ⩽5.7 kg/m2 in women. A 1-year radiographic progression as primary outcome was defined by a change in the total Sharp/van der Heijde modified score ⩾0.5 units. Results: Among 348 recruited patients, 315 RA patients (mean age 47.9 years, 84.4% female) completed 1-year follow up. There were 143 (45.4%) RA patients showing myopenia at baseline. Compared with those without baseline myopenia, RA patients with baseline myopenia had higher rate of 1-year radiographic progression (43.4% versus 21.5%, all p < 0.05). Baseline myopenia was an independent risk factor for 1-year radiographic progression with adjusted odds ratio (AOR) of 2.5-fold, especially among RA patients in remission at baseline both defined by Disease Activity Score in 28 joints (DAS28) including C-reactive protein (DAS28-CRP) or erythrocyte sedimentation rate (DAS28-ESR) with AOR of 18.5~42.9-fold. Further analysis of six subtypes of dynamic skeletal muscle change showed that newly acquired myopenia at endpoint was associated with radiographic progression (AOR of 5.4-fold). Conclusions: Reduced skeletal muscle is an independent predicting factor for 1-year aggravated joint destruction, especially in remission RA. The importance of dynamic monitoring of skeletal muscle and muscle improvement therapy are worth exploration.

Sign in / Sign up

Export Citation Format

Share Document