DAS28 Scale Research Articles

Baricitinib and tofacitinib in patients with rheumatoid arthritis: results of regular clinical practice

ObjectiveMain objective: Describe the effectiveness and safety of baricitinib and tofacitinib in patients diagnosed with rheumatoid arthritis in our hospital. Secondary objective: Analyse whether there are differences between the two drugs in routine clinical practice. MethodTwo-year retrospective study of patients diagnosed with rheumatoid arthritis treated in our hospital with baricitinib and tofacitinib for at least 6 months. Databases: Electronic medical record and outpatient medication dispensing software. Variables collected: Demographic variables, poor prognosis factors, previous treatment, duration of treatment, concomitant treatment, DAS28, number of swollen and painful joints, pain visual analogy scale, treatment discontinuation, and adverse reactions. Effectiveness evaluation: Decreases in the DAS28 scale, the number of swollen and painful joints, and the pain Visual Analogy Scale at 6 months and 12 months after starting treatment. Safety evaluation: Detection of adverse reactions. Statistical analysis: Student t-test. ResultsA total of 44 patients were evaluated. Of these, 20 (70% women) received treatment with baricitinib and 24 (95.8% women) received tofacitinib. Baricitinib reduced the DAS28 by 2.3 and 1.7 at 6 months and 12 months, respectively, and tofacitinib reduced the scale by 2 and 1.9 at 6 months and 12 months, respectively. Baricitinib reduced the number of swollen and painful joints by 7 at both 6 months and 12 months, and tofacitinib reduced the number of swollen and painful joints by 4 and 6 at 6 months and 12 months, respectively. Baricitinib reduced the Visual Analogy Scale score by 7.8 and 6.8 at 6 months and 12 months, respectively, and tofacitinib reduced the score by 5 and 6 at 6 months and 12 months, respectively. Corticosteroid treatment was needed in 40% of patients treated with baricitinib and 62.5% of patients treated with tofacitinib. Treatment was discontinued due to loss of effectiveness in 10% of patients receiving baricitinib and 25% of patients treated with tofacitinib. Adverse reactions were experienced by 10% of patients treated with baricitinib and 12.5% of patients treated with tofacitinib. Adverse reactions led to treatment discontinuation in only 1 patient in each group. No statistically significant differences were observed between the two drugs. ConclusionsThe results show that baricitinib and tofacitinib were effective and safe in relation to all the variables analysed. Moreover, both drugs were similar in terms of effectiveness and safety for the treatment of rheumatoid arthritis in real-world clinical practice.

Results of tocilizumab treatment in patients with rheumatoid arthritis

The aim of the work was to study the results of tocilizumab (TCZ) treatment in patients with high and moderate activity of rheumatoid arthritis (RA) in addition to basic therapy. The objectives of the work are to assess the degree of RA activity before and after intravenous administration of TCZ using the DAS–28 scale, as well as to compare the effectiveness of TCZ in groups of patients with initially different degrees of activity and the radiological stage of RA. Materials and methods. The study included 58 people with an established diagnosis of RA receiving basic therapy in combination with the biological drug TCZ (India) over the period from 04.2022 to 09.2022. After the consultation decision and the patient informed consent had been obtained, intravenous infusion with a solution of TCZ at the rate of 8 mg/kg was performed once a month for up to 5 courses. Evaluation of the effectiveness of therapy was carried out by analyzing the activity of the disease with the use of DAS-28 scale (including a subjective assessment of pain on a visual analog scale, the number of painful and swollen joints and laboratory indicators of ESR, CRP) before and after each subsequent administration of the drug. Results. The radiological stage of RA correlated with the disease duration (R=0.8). In patients with initial radiological changes, the activity was lower (DAS-28 according to ESR) of RA (p=0.03). High clinical efficacy and safety of TCZ therapy in patients with an initially high and moderate degree of disease activity has been established. In all patients, there was a significant decrease in RA activity according to the DAS-28 scale (according to CRP and ESR) after TCZ injections (p<0.05). Clinical and laboratory remission occurred in 12% of subjects after the second injection, in 44% of patients – after the fourth (significantly more often than after the second injection, p=0.0274), in 37.5% – after the fifth injection of TCZ.

METHODS OF ASSESSING THE QUALITY OF LIFE OF PATIENTS WITH RHEUMATOID ARTHRITIS

The strategic goal of health care is to maintain and enhance health, prolong life expectancy and improve it’s quality. In view of this, the assessment of the quality of patients life with diseases is an important medical and social task in the context of determining the effectiveness of treatment and justification and development of preventive measures and corrective actions.
 The relevance of assessing the quality of life of patients with rheumatoid arthritis is obvious, given the prevalence among the population and the severity of the pathology, reforming the health care system, complicating factors, including the SARS-CoV-2 pandemic [1]. There is a need to include quality of life assessment in the list of mandatory research methods to study the effectiveness of pharmacological and non-pharmacological treatments for patients with rheumatoid arthritis in the dynamics, given the long course of the disease and it’s impact on daily life.
 In modern conditions, a number of methods and tools are used to assess the quality of life of patients, which have their own characteristics and benefits. Obviously, the search for more accurate methods of assessing the quality of life of this category of patients will continue, which will become the standard for assessing the effectiveness of treatment.
 Numerous studies confirm that rheumatoid arthritis causes a deterioration in all aspects of quality of life, including mental health disorders and social dysfunction. Disease activity, assessed using the DAS-28 scale [2], is the most prognostic factor in patients. It negatively correlates with quality of life and positively correlates with depression and anxiety.
 According to modern intensive changes in approaches to the organization of health care, systemic challenges such as the COVID-19 pandemic, it is important to identify and apply rapid and most effective methods of assessing the condition of patients with chronic pathology, including rheumatoid arthritis, before and after treatment. It is also important to identify the main factors that lead to a decrease in the quality of life of patients, and to develop an action plan to optimize the organization of medical care in accordance with the needs of patients.

Improving the quality of life of patients with rheumatoid arthritis after rehabilitation irrespective of the level of disease activity

Due to the exacerbation of the disease, the rehabilitation of patients with rheumatoid arthritis is often limited. The aim of the study was to analyze the impact of a comprehensive rehabilitation on a subjective perception of pain and quality of life in patients with rheumatoid arthritis depending on the level of disease activity. The study involved 58 women with rheumatoid arthritis aged 18–60, who underwent a 4-weeks comprehensive rehabilitation program. The assessment included the disease activity level on the DAS28 scale, pain intensity on the 10-point pain scale (VAS) and the value of the CRP protein. The HAQ-DI and KALU questionnaire were used to assess the quality of life. In both groups (group A—DAS28 < 4.2, group B—DAS28 ≥ 4.2) the statistically significant effects in decreasing the level of pain and improvement of quality of life were observed. This indicates the need and effectiveness of rehabilitation regardless of the level of activity of rheumatoid arthritis according to the DAS28 scale. There were no significant changes in the CRP protein level. In conclusion, the rehabilitation of patients with moderate to high disease activity is effective and the success of comprehensive rehabilitation is demonstrated by the decrease of the DAS28 score and the pain level reported by patients, as well as improving self-assessment of health and quality of life.

Influence of differentiated metabolic therapy on dynamics of quality of life in patients with rheumatoid arthritis in combination with arterial hypertension

The combination of arterial hypertension (AH) with rheumatoid arthritis (RA) significantly aggravates the course of each person. The constant use of drugs, chronic pain, disability and social connections leads to a decrease in the quality of life (QOL).Materials and methods. We examined 96 patients with stage II hypertension in combination with RA, 45 patients with stage II hypertension, and 31 healthy patients. To assess QOL, we used the MOS SF-36 questionnaire (Medical Outcomes Study-Short Form). An assessment of anxiety and depression was performed using the Hospital Anxiety and Depression Scale (HADS). RA activity was determined according to the DAS28 scale, pain assessment according to the visual analogue scale (VAS). Patients with hypertension in combination with RA received basic therapy: 83 patients ─ methotrexate, 10 patients leflunomide, 79 of them were glucocorticoids 6 (6, 8) mg methylprednisolone, all patients received ramipril 10 mg per day, amlodipine 5 (5, 10) mg per day, atorvastatin 20 mg, and differentiated metabolic therapy using meldonium 500 mg per day and L-arginine aspartate 6 g per day for twelve weeks.Aim of the research. In order to improve approaches to the treatment of patients with hypertension in combination with RA, to study the dynamics of the quality of life, the severity of anxiety and depressive disorders during complex treatment, with the inclusion of differentiated metabolic therapy, for twelve weeks.Conclusions. In the subgroups of patients receiving metabolic therapy, there was a significantly pronounced improvement in QOL for all indicators of the MOS SF-36 scale and a decrease in anxiety manifestations in terms of the HADS scale (p<0.05). The largest decrease in activity by 7 % on a DAS 28 scale of 2.65 (2.52; 2.75) points was noted in the subgroup of patients receiving meldonium, compared with the performance of the subgroup without metabolic therapy (p=0.01)

A pilot study ofcomorbidities in patients with rheumatoid arthritis at a tertiary care hospital in Northeast India

On an average, rheumatoid arthritis is associated with one or more comorbid conditions and these comorbidities are associated with various risk factors and medications use in patients with RA. The aim of this study was to assess comorbidities in patients with RA at a tertiary care hospital of Northeast India. This cross sectional study was conducted for 8 months from August 2014 to April 2015. The data was collected from medicine (unit-III) outpatient department of Gauhati Medical College and Hospital, Guwahati, Northeast India. Fifty one RA patients were found during study period. Patient’s socio-demographic characteristics, comorbidities, risk factors for comorbidities, laboratory investigations, and past & current medications use were collected during their visit to hospital. DAS28 scale was used to assess the disease activity in RA patients. Descriptive statistics were used. Non-normally distributed continuous variables are presented in median and interquartile range. The median age of RA patients was 45(IQR;15). The disease activity was found high (DAS-ESR>5.1) in 34 (66.67%) patients. The median DAS28 score was 5.64(IQR;1.44). Majority of the patients with RA were anaemic (n=34, 66.67%) followed by infection (n=7, 13.73%), thyroid disease (n=5, 9.80%), renal disease (n=4, 7.84%), osteoporosis (n=3, 5.88%), cardiovascular disease (n=3, 5.88%), lung disease (n=3, 5.88%), and vasculitis (n=1, 1.96%). The commonly reported risk factor was hypertension (19.61%) followed by diabetes (n=5, 9.80%), dyslipidemia (n=4, 7.84%), smoking (n=4, 7.84%), family history of CVD (n=2, 3.92%), and alcohol intake (n=1, 1.96%). Among DMARDS, methotrexate (92.16%) was the most commonly prescribed drug followed by hydroxychloroquine (74.51%) and sulfasalazine (27.45%). Anaemia was the most common comorbid condition found in RA patients. Disease activity was found high in anaemic patients with RA.