Adult Arthritis Patients Research Articles

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

Reduced risk of serious pneumococcal infections up to 10years after a dose of pneumococcal conjugate vaccine in established arthritis.

To examine rates of serious pneumococcal infections up to 10years after vaccination with 7-valent conjugated pneumococcal vaccine (PCV7) in patients with arthritis compared to non-vaccinated arthritis patients. In total, 595 adult arthritis patients (rheumatoid arthritis; RA=342, 80% women and spondylarthropathy; SpA=253, 45% women) received one dose of PCV7. Mean age/disease duration were 62/16 and 51/14years, respectively. For each patient, 4 matched reference subjects were identified. At vaccination, 420 patients received bDMARDs (anti-TNF=330, tocilizumab=15, abatacept=18, anakinra=1, rituximab=56). Methotrexate was given as monotherapy (n=86) or in combination with bDMARD (n=220). 89 SpA patients received NSAIDs without DMARD. The Skåne Healthcare Register was searched for ICD-10 diagnostic codes for pneumococcal infections (pneumonia, lower respiratory tract infection, septicemia, meningitis, septic arthritis) between January 2000 and December 2018. Frequency of infections after vs before vaccination were calculated (relative risks). Relative risk ratio (RRR) and relative risk reduction (1-RRR) were calculated comparing patients vs non-vaccinated references. Kaplan-Meier and Cox regression were used to investigate time to first event and predictors of infections. Among vaccinated RA and SpA patients, there was a significant relative risk reduction of pneumonia and all serious infections; 53% and 46%, respectively. There was no significant difference in time to first pneumonia or all serious infections after vaccination between patients and references. Higher age, RA diagnosis and concomitant prednisolone were associated with infections. One dose of pneumococcal conjugate vaccine may decrease risk of serious pneumococcal infection up to 10years in patients with arthritis receiving immunomodulating treatment.

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review.

Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

Frequency of serological markers of rheumatoid arthritis in adult patients with active celiac disease.

Celiac disease (CD) and rheumatoid arthritis (RA) are multisystem autoimmune diseases affecting 1% of general populationa. Both diseases share genetic and immunological features. In this retrospective study, we aim to determine the frequency of auto-antibodies of RA in adult patients with CD. Seventy seven adult patients with active CD were included in the present study. Ninety healthy blood donors (HBD) served as control group. Anti-cyclic citrullinated peptides antibodies (CCP-Ab) and rheumatoid factors (RF; IgA, IgG and IgM) were determined by enzyme linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi-square or Fisher's exact test. Our study included 77 adult patients with active celiac disease (57 female, 20 male). Twenty-four (31.2%) active celiac patients and 7 (7.8%) blood donors had CCP-Ab or RF (31.2% vs 7.8%, p<10-4). Only two patients (2.6%) had both CCP-Ab and RF. IgA was the predominant isotype of RF in celiac patients (n=18; 23.4%) while none of healthy blood donors had RF-IgA (23.4% vs 0.0%, p<10-4). The current study has shown that CD is associated with a high frequency of RF-IgA suggesting that celiac patients could be at a higher risk of developing RA.

Apremilast Prolongs the Time to First Biologic Therapy in Japanese Patients with Psoriasis

IntroductionBiologic agents are used in patients with severe psoriasis who have not adequately responded to existing conventional systemic therapies. However, only a limited number of medical institutions in Japan are approved to use them, and their relatively high cost represents a substantial burden to patients. Apremilast is an oral phosphodiesterase-4 inhibitor approved in Japan for the treatment of psoriasis vulgaris in adult patients with an inadequate response to topical therapies and psoriatic arthritis in adult patients with active disease. To date, a large-scale real-world study of treatment patterns and costs associated with apremilast in Japan has not been conducted. The objective of this study was to assess whether apremilast can prolong time to first biologic therapy use and decrease total medical cost.MethodsUsing the Medical Data Vision hospital-based claims database, 506 psoriasis patients were propensity score matched and analyzed (apremilast: n = 253; non-apremilast: n = 253).ResultsThe incidence rate of first biologic therapy use per 1000 patient-years was significantly lower in the apremilast group than in the non-apremilast group (30.3 vs. 107.6; P < 0.001), and the total medical costs per month were significantly lower in the apremilast group than in the non-apremilast group (76,594 yen/month vs. 102,411 yen/month, P < 0.001). In a sensitivity analysis of a propensity-score-matched subset of eligible patients prescribed biologics during the follow-up period (apremilast: n = 14; non-apremilast: n = 14), the incidence of first biologic therapy use was 2,797.6 per 1000 patient-years (95% CI: 1,656.9, 4,723.6) in the non-apremilast group and 856.1 per 1000 patient-years (95% CI: 507.0, 1,445.5) in the apremilast group.ConclusionThese results suggest that apremilast prolongs the time to first biologic therapy use in patients with psoriasis, thereby reducing the total medical cost and decreasing the economic burden on patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00659-w.

New possibilities of systemic therapy of plaque psoriasis with the IL23p19 inhibitor risankizumab

Introduction. There is a trend towards rising incidence of psoriasis and increase in the degree of incidence of severe, atypical and treatment-resistant clinical forms of psoriasis in the Russian Federation. In this regard, cases of early disability of patients and deterioration of their quality of life are recorded, which determines the medical and social significance of this disease. In the last few years, a much deeper understanding of the pathogenesis of psoriasis has been gained. This is especially true of the role of T-helper 17 cells, the role of the IL-23 cytokine in the development of the disease, which has resulted in the development of new classes of biological drugs, which creation introduced significant changes in the treatment of psoriasis that has become more effective, safer and convenient for patients. More new biologics undergo clinical trials and receive approvals with each passing year. Among them is risankizumab, interleukin-23 inhibitor, which is a safe and effective drug for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis in adult patients. Interleukin-23 inhibitors are not required to be administered as often as interleukin-17 inhibitors and may have a more favourable safety profile without an increased risk of candidiasis or inflammatory bowel disease. Overall, these highly effective drugs contribute to the improvement of the long-term efficacy of psoriasis therapy due to relief of skin lesions and joint symptoms, as well as to the enhancement of patients’ quality of life and lengthening of remissions.Purpose. To analyse key information about risankizumab using the results of clinical trials published in the current scientific literature.Materials and methods. This analysis used literature sources from the international medical databases: PubMed, Cochrane Library, MEDLINE.Results. Presently, a number of phase III registrational trials of risankizumab in 2,109 patients with plaque psoriasis have been published: UltIMMa-1, UltIMMa-2, IMMvent and IMMhance, as well as an additional side by side comparative study of risankizumab with secukinumab (IMMerge) in 327 patients with plaque psoriasis. The results of these studies were used as the grounds for approval of risankizumab for the treatment of patients with moderate to severe plaque psoriasis and psoriatic arthritis by the Russian Ministry of Health on September 14, 2020. There have also been several reports of interim results of the open-label enhanced LIMMitless study, which included patients from pivotal studies. Our records show that the percentage of patients receiving risankizumab for 3 years (172 weeks) and maintaining PASI 90 and PASI 100 was 88 and 63%, respectively, and the percentage of those maintaining sPGA 0/1 was 88%.Conclusion. The analysed data showed that risankizumab is one of the most effective target drugs for the treatment of psoriasis and psoriatic arthritis, it has a favourable safety profile and a more convenient dosage regimen as compared with other genetically engineered biologic drugs (GEBD) (the recommended dose of Skyrizi is 150 mg (two 75 mg injections) administered by subcutaneous injection at week 0, week 4, and every 12 weeks thereafter).

PMS38 Tofacitinib for the Treatment of Adult Patients with Moderate to Severe ACTIVE Psoriatic Arthritis Intolerant or with Therapeutic Failure to Synthetic or Biological Disease-Modifying Drugs

The aim of this study was to evaluate the efficacy and safety of tofacitinib for the treatment of moderate to severe active psoriasis arthritis in adult patients who don’t responded or are intolerant to previous treatment with synthetic or biological disease-modifying drugs. A structured search was carried out in the Medline, Embase and Cochrane Review databases. The primary endpoint was American College of Rheumatology Response Criteria - ACR50, chosen because it is the most clinically relevant outcome. Study quality was assessed by Cochrane risk of bias tool - Rob 2. A cost-minimization analysis was performed, since studies of indirect comparison of tofacitinib with its comparators demonstrated similar effectiveness, and budget impact analysis. Two phase III studies were selected: in the study with patients previously treated with anti-TNF, ACR50 in 3 months was 15% for placebo, 30% for 5mg tofacitinib (p = 0.003), and 28% for 10mg tofacitinib ( p = 0.007); in the study of patients previously treated with synthetic disease-modifying drugs in 3 months the response rates were 10% for placebo, 28% for tofacitinib 5mg and 40% for tofacitinib 10 mg (p <0.001 for both comparisons). Cost-minimization analysis: generated a cost saving that ranged from -USD 250.86 (in relation to Adalimumab) to -USD 2,803.86 (in relation to Imfliximabe). Budget impact: cost saving in one year was –USD 7,8 million, varying in the scenarios between –USD 1.7 million to –USD 12,03 million and in five years it was –USD 45,15 million varying in the scenarios between –USD 9,85 million to –US $ 69,83 million. The few scientific evidence available, possibly due to the recent registration of this new indication with regulatory agencies, demonstrated that the drug has similar efficacy to biological disease-modifying drugs at a lower cost.

Comorbidities burden and previous exposure to biological agents may predict drug survival of apremilast for psoriasis in a real‐world setting

Apremilast is the first small molecule approved for the treatment of moderate to severe psoriasis and psoriatic arthritis in adult patients. To evaluate survival, efficacy and safety of apremilast in patients with moderate to severe psoriasis and investigate possible associations between apremilast survival and clinical parameters in a real-world setting. In this retrospective study, a total of 71 patients who started on apremilast treatment between March 2017 and December 2019 were identified and included in the study: 40 (56.3%) males and 31 (43.7%) females, with a mean age of 55.6 ± 13.8 years and a mean Body Mass Index of 28.4 ± 6.9 kg/m2 . At the end of the study 49.3% of patients remained on apremilast with mean treatment duration 67.2 ± 41.1 weeks (range 4-132). Overall, mean drug survival duration was 78.51 weeks (95% CI: 65.8-91.2 weeks). Mean drug survival was shorter when comorbidities burden was higher (P = .012) and with previous exposure of biological agents (P = .001). Previous exposure to biological agents (HR:3.86, 95% CI: 1.35-11.04, P = .012) and comorbidities burden (HR: 2.27, 95% CI: 1.25-4.12, P = .007) were independent predictors of drug discontinuation adjusting for important clinical parameters. In this real-world setting, apremilast presented better survival rates when introduced early on the onset of moderate psoriasis, especially in biologic naïve patients with less comorbidities. More prospective and larger studies are required to determine clinical parameters affecting drug survival.

Características clínicas de las artritis sépticas de pacientes adultos internados del Hospital Nacional entre los años 2015 y 2019

Características clínicas de las artritis sépticas de pacientes adultos internados del Hospital Nacional entre los años 2015 y 2019

Point-of-Care Ultrasound for the Detection of Hip Effusion and Septic Arthritis in Adult Patients With Hip Pain and Negative Initial Imaging.

Acute or recurrent hip pain in adults can be a challenging presentation in the emergency department. While ultrasound is routinely used in the evaluation of pediatric patients with hip pain and a new limp, it is not commonly used for this purpose in adult emergency medicine. This case series demonstrates the clinical utility of point-of-care ultrasound (POCUS) in adult patients with acute or recurrent hip pain because performance of POCUS was the critical action that led to the identification of pathologic hip effusions in this series of adults. This case series includes 5 patients in whom clinical suspicion existed for the presence of a hip effusion and possible septic arthritis, despite nondiagnostic radiographic findings. Ultrasound was used to detect the effusion and guide subsequent arthrocentesis, imaging, or surgical intervention. In all patients, computed tomography scans or magnetic resonance imaging scans were later used to confirm the presence of effusion. In all 5 patients (2 women and 3 men, with a mean age of 47.4years), POCUS accurately detected the presence of hip effusion. Two of 5 synovial collections were caused by septic arthritis as confirmed by synovial fluid microbiologic examination. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case series emphasizes the clinical utility of POCUS in adult patients with acute and recurrent hip pain to detect a hip effusion, particularly in patients with significant risk factors for septic arthritis. POCUS can also be used to guide further imaging, arthrocentesis, surgical consultation, and intervention.

PSY13 BUDGET IMPACT ANALYSIS OF TREATMENT OF MODERATE TO SEVERE RHEUMATOID ARTHRITIS IN ADULT PATIENTS WITH BARICITINIB IN THE RUSSIAN FEDERATION

To conduct budget impact analysis from public health system perspective of the implementation of recently authorized in the Russian Federation baricitinib in the treatment of moderate to severe rheumatoid arthritis in adult patients. We conducted budget impact analysis for public health system medicine provision, therefore we considered only direct costs for medicines. Based on available data of patient distribution through alternative treatment options in the Russian Federation, we setup current distribution in the budget impact analysis: of the total 8601 patients, 2337 received adalimumab, 4018 – golimumab, 1332 – certolizumab pegol, 512 – tocilizumab, 282 – abatacept, 130 – tofacitinib. We defined budget impact of switching to baricitinib 40% of patients from adalimumab, 15% - from certolizumab pegol, 10% - from golimumab and 5% - from tofacitinib and tocilizumab. Time horizon was 1 year. National essential drug list (wholesale) prices were used (including VAT). Exchange rate 1 euro = 72 RUB. Annual cost of treatment of one patient with adalimumab, abatacept, baricitinib, golimumab, tofacitinib, tocilizumab and certolizumab pegol is 12607 euro, 14100 euro, 9629 euro, 12511 euro, 9629 euro, 13496 euro and 13260 euro respectively. We defined budget for the treatment with adalimumab, abatacept, golimumab, tofacitinib, tocilizumab and certolizumab pegol with the current distribution of patients amounts to 105,2 mln. euro per year. Budget of the simulated distribution of patients using baricitinib, described above is 101,2 mln. euro per year. With a simulated distribution of patients, budget savings of 4 mln. euro are achieved or 3.82% of current distribution budget.

Juvenile idiopathic arthritis in adult patients: an analysis of clinical data

Aim. To study the connection of the disease with social and clinical parameters of adult patients with JIA in the anamnesis for improve the observation of them and decrease remote results.Methods. There were examined adults with JIA in the anamnesis, age – 24,3±8,3 years, the disease duration - 13,6±9,3 years, with the assessment of the diagnosis determination, disease activity in the child and adult age (JADAS, VAS), received treatment with glucocorticoids (GC) and its duration, life quality (SF-36), functional activity disorders (HAQ), psychological state, cardio-vascular risk, remote results of JIA (JADI-A, JADI-E).Result. Adult women had the more active disease by JADAS (p<0,05) and JIA remote results by JADI-A took place in them more often (p<0,05). Patients with a higher education had the more disease duration (p<0,05). The influence of social factors on the health state was more (p<0,05) in patients with a finished higher education comparing with ones with an incomplete one, although the life quality (SF-36), anxiety and depression level didn’t differ in these groups. Patients with invalidism, developed as a result of JIA had the worse general state by VAS (p<0,05), glucocorticoids were prescribed longer (p<0,05), JADI-E extra-articular results developed more often (p<0,05), although their psychological state didn’t differ from patients without invalidism. Patients, divided in groups depending on ACCP/RF, ANA, HLA-B27 presence and negative by all markers, differed by the age of the disease start, SF-36, disease activity (DAS28), remote results by JADI-E and JADI-A. The treatment duration and GC cumulative dose didn’t differ in these groups.Conclusions. 1. In female adult patients with JIA was reveled the more disease activity by JADAS and remote articular results of JIA took place more often that testify to the need of the more aggressive therapy and more accurate rheumatologists’ survey for decreasing the number of remote results of this disease. 2. Patients’ education level indicated that the influence of social factors on the health state was higher (p<0,05) in patients with a finished higher education comparing with ones with an incomplete one, although the anxiety and depression level and life quality didn’t differ in both groups, and the psychological state of adult patients with JIA invalidism was the same as in patients without invalidism that testifies to the good social adjustment of JIA patients in the adult age. 3. Clinical differences between groups of patients, divided by immunological parameters (ACCP/RF, HLA-B27, ANA), prove a hypothesis that their pathogenetic mechanisms of JIA development are different and need a differentiated approach to the diagnostics, treatment and observation

Baricitinib: First Global Approval.

Baricitinib (Olumiant™) is an orally-administered, small-molecule, janus-associated kinase (JAK) inhibitor developed by Eli Lilly and Incyte Corporation for the treatment of rheumatoid arthritis (RA), atopic dermatitis and systemic lupus erythematosus. JAKs transduce intracellular signals from cell surface receptors for various cytokines and growth factors involved in inflammation and immune function, suggesting JAK inhibitors may be of therapeutic benefit in inflammatory conditions. In February 2017, baricitinib was approved in the EU, as monotherapy or in combination with methotrexate, for the treatment of moderate to severe active rheumatoid arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drugs (DMARDs). Regulatory approval to market baricitinib as a treatment for RA has also been sought in the USA and Japan. This article summarizes the milestones in the development of baricitinib leading to this first global approval for the treatment for moderate to severe active RA in adult patients who have responded inadequately to, or are intolerant to one or more DMARDs.

Glucocorticoids in Management of Adult Rheumatoid Arthritis-Current Prescribing Practices and Perceptions of Physicians in India: GLUMAR Survey

Background: Several questions about use of glucocorticoids in rheumatoid arthritis are unanswered. Objective: Understanding perspectives of physicians regarding use of glucocorticoids in rheumatoid arthritis management. Material and methods: Rheumatologists were interviewed to understand their perspectives and experiences on use of glucocorticoids in rheumatoid arthritis treatment. Results: Of the enrolled 150 physicians, 74% reported using glucocorticoids to always in the initial treatment whereas 143 (95.4%) reported it using to always in acute exacerbations; 40% sometimes as an adjuvant to disease modifying antirheumatic drugs therapy. Oral low dose prednisolone or equivalent (<15 mg/day) is used by 101 (67.3%) physicians in up to 50% patients. Intra-articular low dose and high dose steroid injections are used by 98 (65.3%) and 55 (36.7%) physicians in up to 50% patients respectively. All physicians used oral methylprednisolone whereas prednisone, triamcinolone and hydrocortisone was used by 98.7%, 98.7% and 97.3% physicians respectively. For short term course, 92 (61.3%) physicians prescribe 5-10 mg/day of prednisone or equivalent. Clinical improvement is excellent and very good according to 36.7% and 44.0% physicians. Functional improvement is excellent and very good according to 26.7% and 38.7% respectively. Weight gain, puffiness of face, fluid retention, osteoporosis, hyperglycemia, hypertension, nausea, weakness, infection, cataract, sleep disturbances, psychosis and glaucoma were the adverse events reported by 121 (80.7%), 115 (76.7%), 100 (66.7%), 87 (58%), 81 (54%), 56 (37.3%), 51 (34.4%),46 (30.7%),44 (29.3%), 36 (24%),29 (19.3%), 23 (15.3%) and 19 (12.7%) physicians in past six months respectively. Conclusion: Steroids usage for the treatment of rheumatoid arthritis in adult patients is very common among rheumatologists in India. According to this physicians´s opinion based survey, overall tolerability, safety and patient compliance with oral GCs is fair to excellent. Short term use is not a major concern from safety point of view.

The risk of pneumococcal infections after immunization with pneumococcal conjugate vaccine compared to non-vaccinated inflammatory arthritis patients

Objectives: To examine the risk of putative pneumococcal infections in adult arthritis patients on different anti-rheumatic drugs immunized with heptavalent pneumococcal conjugate vaccine (Prevenar 7; PCV7) and non-vaccinated individually matched arthritis patients.Method: All individuals in a cohort of 505 patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA) receiving different anti-rheumatic treatments were immunized with a single dose of PCV7 (exposed group). Of these, 497 patients (RA = 248; SpA = 249) were included. For each vaccinated patient, we identified four reference subjects (n = 1988) from the same geographic area, individually matched for age, gender, and diagnosis. These were considered unexposed to conjugated pneumococcal vaccination. The Skåne Healthcare Register (SHR) was searched for all individuals seeking health care for putative pneumococcal infections occurring 4 years before vaccination and up to 4.5 years after vaccination using ICD-10 diagnostic codes. The following infections were considered as serious cases: pneumonia, other lower respiratory infections, meningitis, sepsis, and septic arthritis. The relative risk (RR) of infection was calculated as the number of events after/number of events before vaccination. Ratios of relative risk (RRRs) were calculated between vaccinated and non-vaccinated groups of patients. A generalized estimating equation (GEE) was used to handle correlated data for several events in the same individual.Results: Although statistically non-significant, the point estimate of the RRR [0.55, 95% confidence interval (CI) 0.25–1.22] suggested a reduced risk of serious pneumococcal infections in vaccinated patients compared to the unexposed group.Conclusions: Vaccination with PCV7 tended to reduce the risk of putative serious pneumococcal infections by about 45% compared to non-vaccinated patients in this observational cohort study.

A95: The Risk of Dyslipidemia in Pediatric Arthritis Patients Is Similar to That of Adult Patients With Arthritis

Background/Purpose:Patients with autoimmune diseases run a higher risk for dyslipidemia due to chronic inflammatory processes and immune dysregulation. This phenomenon has been recognized to a certain extent in adult arthritis patients but has not been previously explored in pediatric arthritis patients. The objective of this study is to compare the frequency of dyslipidemia in children with Juvenile Rheumatoid Arthritis (JRA), children with Non‐Specific Arthritis (NOSA), adults with Rheumatoid Arthritis (RA), and adults with Osteoarthritis (OA). Determining differences amongst these groups is important in understanding the connection between arthritis and dyslipidemia risk, especially in the pediatric population.Methods:After IRB approval, patient's in this retrospective data base study were gathered from chart review of consecutive patient's with JRA, NOSA, RA, and OA who presented to the pediatric rheumatology and adult rheumatology clinics at an academic center. Outcomes of interest that were compared included total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), cholesterol: HDL ratio, non‐HDL, and very low density lipoprotein (VLDL). Other demographic information compared included patient age, sex, and use of biologic DMARD. Comparisons between groups were made using the Fisher's Exact Test and multiple testing adjustments were made by controlling for the False Discovery Rate.Results:There were 32 pediatric patients (40.6% male) ranging from age 2–17 (median 11 years). Out of 32 pediatric patients, 22 had JRA and 10 had non‐ specific arthritis (NOSA). Furthermore, there were 82 adult patient's (18.3% male) ranging from age 30–85 (median 63 years). Out of these, 49 had diagnosis of RA while 33 had diagnosis of OA. In the pediatric cohort, more JRA patients than NOSA had abnormal LDL values (68.2% and 0.0%, p value = 0.005) and non‐HDL values (50.0% and 0.0%, p value = 0.05). Other lipid parameters were not significantly different. Between the pediatric cohort and adult cohort, the pediatric cohort had greater percentages of abnormal LDL (46.9% and 19.5%, p value = 0.05), TG (93.8% and 24.4%, p value &lt;0.001), and VLDL (62.5% and 15.9%, p value &lt;0.001). No significant difference in lipid parameters between patients with RA and OA. There was also no significant difference in lipid parameters between those with or without RF/CCP positivity, male sex, or biologic DMARD use.Conclusion:Pediatric JRA patients were more likely to have an abnormal lipid panel, specifically LDL and non–HDL, as compared to NOSA patients. Interestingly, pediatric patients had higher rates of abnormal LDL, triglycerides, and VLDL. This suggests that the concern for dyslipidemia in the adult population should also be shown to pediatric patients with JRA. Additional studies are needed to determine whether modification of cardiovascular risk in pediatric patients with chronic inflammatory disease is beneficial in preventing clinically significant premature atherosclerosis.

The Juvenile Idiopathic Arthritis Patients Run a Higher Risk for Dyslipidemia as Compared to Adults with Arthritis

Objective: We compared dyslipidemia frequencies among children with Juvenile Idiopathic Arthritis (JIA), with Reactive Arthritis (ReA), adults with Rheumatoid Arthritis (RA), & osteoarthritis (OA) to determine their comparative cardiovascular risks. Methods: A retrospective chart review was made for 32 pediatric arthritis (JIA and ReA; 13 males: ages: 2-17 yrs.) & 82 adult (RA and OA; 15 males; ages: 30-85 yrs.) arthritis patients. We statistically compared these groups for total cholesterol (CHO), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), CHO/HDL ratio, non-HDL, very low density lipoproteins (VLDL), and the effects of biologics therapy. Results: Pediatric JIA patients were more likely to have abnormal LDL (p=0.0003) & non-HDL (p= 0.006) levels. Pediatric patients were more likely than adult patients to have abnormal LDL (p = 0.005), TG (p < 0.001), and VLDL (p < 0.001) levels. There were no significant differences in lipid profiles for RF/CCP positivity, males, or disease-modifying anti-rheumatic drugs (DMARDs) use. Patients who received biologics were less likely to have elevated CHO (p = 0.03) and VLDL (p = 0.05) levels. Conclusion: Pediatric arthritis patients were more likely to have abnormal lipid profiles. RF/CCP positivity, gender, and DMARDs use had no effect on the prevalence of dyslipidemia, whereas biologics had some protective value. Pediatric arthritis patients were more likely to have abnormal CHO/HDL ratios, and LDL, TG, and VLDL levels compared to adult arthritis patients. Thus, pediatric arthritis patients may have a high cardiovascular risk and might benefit from routine lipid screening and lipid lowering therapy.

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy

To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P < 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology.

Associations between the American College of Rheumatology pediatric response measures and the continuous measures of disease activity used in adult rheumatoid arthritis: A secondary analysis of clinical trial data from children with Polyarticular‐Course Juvenile Idiopathic Arthritis

To measure associations between the American College of Rheumatology (ACR) pediatric criteria for improvement and the continuous measures of disease activity used for rheumatoid arthritis in adult patients with polyarticular-course juvenile idiopathic arthritis (JIA). In this retrospective analysis of 2 etanercept trials, disease activity was calculated at baseline, 3 months, and 6 months using the Disease Activity Score (DAS), the DAS based on 28 joints (DAS28), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). The ACR pediatric response and the European League Against Rheumatism (EULAR) response were also determined for the 3-month and 6-month evaluations. Data were analyzed in 94 patients with JIA independent of the treatment arm. Correlation coefficients between measures were calculated for each visit. The areas under the receiver operating characteristic curve (AUC of ROC) were calculated to assess the discriminative properties of the scores for the ACR pediatric response measures. The mean DAS, DAS28, CDAI score, and SDAI score were 3.7, 4.7, 30.8, and 36.4, respectively, at baseline, corresponding to high levels of disease activity (CDAI/SDAI) or moderate levels of disease activity (DAS/DAS28). At 3 months, the mean scores corresponded to low (DAS/DAS28) or moderate (CDAI/SDAI) disease activity. At 6 months, the mean scores corresponded to low disease activity (DAS/DAS28/CDAI) or moderate disease activity (SDAI). Most children met the criteria for a good or moderate EULAR response at 3 months and 6 months. The correlation between continuous outcome measures and each pediatric core set component was moderate to very good. The AUC of ROC values for each measure were high (range 0.76-0.98). Good correlation and discriminative abilities were seen between the DAS, DAS28, CDAI, and SDAI for the ACR pediatric criteria for improvement. These disease activity measures may be useful for research and clinical care in polyarticular-course JIA.

Tocilizumab

Tocilizumab (RoActemra or Actemra) is a recombinant humanized monoclonal antibody that acts as an interleukin (IL)-6 receptor antagonist. Intravenous tocilizumab 8 mg/kg (and no less than 4.8 mg), in combination with methotrexate, is approved in the EU for the treatment of moderate to severe active rheumatoid arthritis in adult patients with inadequate response to, or who are intolerant of, prior disease-modifying anti-rheumatic drug (DMARD) or tumour necrosis factor (TNF) antagonist therapy. It may also be administered as monotherapy in patients intolerant of methotrexate or in whom methotrexate therapy is inappropriate. Tocilizumab is also approved in Japan for the treatment of polyarticular-course juvenile idiopathic arthritis, systemic-onset juvenile idiopathic arthritis and Castleman's disease. Intravenous tocilizumab was effective and generally well tolerated when administered either as monotherapy or in combination with conventional DMARDs in several well designed clinical studies in adult patients with moderate to severe rheumatoid arthritis. Tocilizumab-based therapy was consistently more effective than placebo, methotrexate or other DMARDs in reducing disease activity, and some trials also showed significant benefits with tocilizumab in terms of reducing structural joint damage and improving health-related quality of life (HR-QOL). Notably, tocilizumab-based therapy was effective in patients with long-standing disease in whom anti-TNF therapy had previously failed. More data are required to determine the comparative efficacy and safety of tocilizumab versus other biological agents and to establish their relative cost effectiveness. However, the present data suggest that tocilizumab is an important emerging treatment option in adult patients with moderate to severe rheumatoid arthritis.