Define Disease Activity Research Articles

AB0922 Disease activity assessment in ankylosing spondylitis: Basdai or asdas?

BackgroundRecently, a new index, the Ankylosing Spondylitis Disease activity Score (ASDAS), has been shown to be a validated and highly discriminatory instrument in assessing disease activity.ObjectivesTo evaluate the performance of...

OP0108 Clinical and laboratory findings in a cohort of italian patients with adult onset still’s disease

BackgroundAdult onset Still’s disease (AOSD) is a rare systemic inflammatory syndrome characterized by high daily spiking fever, arthritis/arthralgias and salmon colour rash. Beyond the famous triad of symptoms it is...

AB0109 The soluble form of CD18 is associated with clinical findings, CRP and MRI activity in spondyloarthritis

BackgroundLack of measures of disease activity and prognosis is a key challenge in spondyloarthritis (SpA). Several soluble biomarkers have been proposed, but very few have been found to relate to...

FRI0080 Glucocorticoids and methotrexate have a synergistic working on decrease of rheumatoid arhtritis disease activity

BackgroundRecent research has shown that response to glucocorticoids (GC) predicts the effectiveness of DMARD induction therapy including methotrexate (MTX).[1] Moreover, GC use has been associated with higher intracellular concentrations of...

Defining disease activity and damage in patients with small-vessel vasculitis

The complexity of small-vessel vasculitis requires repeated evaluations of disease activity and damage. Clinical assessment, including regular restaging of disease, is important for management of therapeutic interventions; similarly, assessment tools must be standardized and validated for use in the clinical trial setting. The Outcome Measures in Rheumatology group promotes validated outcomes measures for use in trials. Validated tools for use in clinical trials include the Birmingham Vasculitis Activity Score and the Vasculitis Damage Index. In addition, health-related quality of life assessments underscore the importance of patient-ranked issues in assessing and treating vasculitis. Improvements in the clinical treatment of vasculitis will arise from research that is supported by refined and validated assessment tools.

Disease activity assessment in childhood vasculitis: development and preliminary validation of the Paediatric Vasculitis Activity Score (PVAS)

BackgroundRare chronic childhood vasculitides lack a reliable disease activity assessment tool. With emerging new treatment modalities such a tool has become increasingly essential for both clinical practice and therapeutic trials...

Imaging and Clinical Measurements

A variety of clinical and imaging parameters have been well validated and standardized for assessment in patients with spondyloar-thritis during longitudinal follow-up in clinical practice and research. Outstanding questions were identified by the working group and include further assessment of the most appropriate method for assessment of disease activity and what cutoff is appropriate before access to advanced and costly biologic agents. The Ankylosing Spondylitis Disease Activity Score instrument may have advantages over the Bath Ankylosing Spondylitis Disease Activity Index, but this requires further study. A Bath Ankylosing Spondylitis Disease Activity Index cutoff of 4 has never been validated and also requires further evaluation. It is unclear what constitutes expert opinion for the purposes of defining disease activity. In particular, the role of magnetic resonance imaging requires further investigation.

Small bowel MR enterography: problem solving in Crohn's disease.

Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn’s disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.Main Messages• MR enterography (MRE) is the preferred imaging investigation to assess Crohn’s disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used.• MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging.• MRE can help define disease activity, a key question in the management of Crohn’s disease.• MRE can help distinguish between inflammatory, stricturing and penetrating disease.• MRE can demonstrate both mural and extramural complications.

Pentraxin-3 as a Marker of Disease Activity in Takayasu Arteritis

Because pentraxin-3 (PTX3) is produced by immune and vascular cells in response to proinflammatory signals, it may be a useful biomarker for defining disease activity in patients with Takayasu arteritis. To compare PTX3 levels in patients who have Takayasu arteritis with those in healthy and infected controls, and to compare accuracy of PTX3 levels with that of C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) for distinguishing active and inactive disease. Cross-sectional, noninterventional study conducted between September 2005 and October 2008. Immunology and rheumatology clinic at a university hospital in Italy. 57 consecutive patients with Takayasu arteritis and known disease activity, 57 healthy blood donor controls, and 15 patients with acute infection. Disease activity by clinical criteria; plasma PTX3 and CRP levels and ESR. 27 patients had active Takayasu arteritis; 30 had inactive disease. Levels of PTX3 were higher in patients with active disease (median, >2.14 ng/mL [range, 0.57 to 48.18 ng/mL]) than in those with inactive disease (median, 0.63 ng/mL [range, 0.00 to 1.64 ng/mL]) and were higher than in healthy patients (median, 0.11 ng/mL [range, 0 to 1.20 ng/mL]) or those with acute infection (median, 0.26 ng/mL [range, 0 to 0.75 ng/mL]). A plasma PTX3 level greater than 1 ng/mL was more accurate than normal thresholds of CRP or ESR for distinguishing active from inactive disease. The study excluded patients with unknown or equivocal disease status. Plasma levels of PTX3 could help distinguish active from inactive Takayasu arteritis but should not be adopted for clinical use until the findings are confirmed in a broader spectrum of patients whose disease activity is unknown or equivocal before testing.

Magnetic Resonance Imaging Bone Edema Is Not a Major Feature of Gout Unless There Is Concomitant Osteomyelitis: 10-year Findings from a High-prevalence Population

Magnetic resonance imaging (MRI) is commonly used in autoimmune inflammatory arthritis to define disease activity and damage, but its role in gout remains unclear. The aim of our study was to identify and describe the MRI features of gout. Over a 10-year period we identified patients with gout who underwent MRI scanning of the hands or feet. Scans were reviewed for erosions, synovitis, tenosynovitis, tendinosis, bone edema, and tophi by a musculoskeletal radiologist and 2 rheumatologists in a blinded manner. MRI features in patients with uncomplicated gout were compared with features where concomitant osteomyelitis was diagnosed. A total of 47 patients with gout (51 scans) were included: 33 (70%) had uncomplicated gout and 14 (30%) had gout complicated by osteomyelitis. MRI features included tophi in 36 scans (71%), erosions in 35 (69%), bone edema in 27 (53%), synovitis in 15 (29%), tenosynovitis in 8 (16%), and tendinosis in 2 (4%). Uncomplicated gout and gout plus osteomyelitis did not differ for most MRI features. However, "severe bone marrow edema" was much more common in gout plus osteomyelitis, occurring in 14/15 scans (93%) compared with 3/36 scans (8%) in uncomplicated gout (OR 154.0, 95% CI 14.7-1612, p < 0.0001). Sensitivity and specificity of "severe bone edema" for concomitant osteomyelitis were 0.93 (95% CI 0.68-0.99) and 0.92 (95% CI 0.78-0.98), respectively. MRI reveals that gout affects the joints, bones, and tendons. Bone edema in patients with chronic tophaceous gout is frequently mild and this contrasts with the "severe bone edema" observed in patients with concomitant osteomyelitis.

How I treat HIV-associated multicentric Castleman disease

HIV-associated plasmablastic multicentric Castleman disease is an increasingly frequent diagnosis. Kaposi sarcoma herpesvirus is found in the monotypic polyclonal plasmablasts that characterize this disease. Unlike Kaposi sarcoma, the incidence does not correlate with CD4 cell count or use of highly active antiretroviral therapy. It is a relapsing and remitting illness, and diagnostic criteria are emerging that define disease activity based on the presence of a fever and raised C-reactive protein coupled with a list of clinical features. Treatment protocols increasingly stratify therapy according to performance status and organ involvement. I advocate rituximab monotherapy for good performance status patients without organ involvement and rituximab with chemotherapy for more aggressive disease. The success of antiherpesvirus agents in controlling active disease is limited, but valganciclovir may have a role as maintenance therapy in the future.

Chronic periaortitis

Chronic periaortitis is a rare fibroinflammatory disorder which affects the abdominal aorta and may spread into the retroperitoneum, often encasing the ureters. An aneurysma of the abdominal aorta and vasculitis of the thoracic aorta and of supra-aortic vessels may also coexist. Chronic periaortitis can be idiopathic or secondary to different triggers such as drugs, tumors and infections. Abdominal and/or low back pain is the hallmark symptom. Laboratory markers of inflammation are usually increased. The diagnosis rests on computerized tomography or magnetic resonance imaging, which typically show a retroperitoneal mass displacing the aorta anteriorly and the ureters medially. Positron-emission tomography may assist in defining disease activity and extension. Chronic periaortitis should be differentiated from other fibrosing disorders of various origins. Histology is required in atypical cases to secure the diagnosis. Treatment is based on high-dose steroids with a tapering scheme combined with immunosuppressive agents in refractory or relapsing disease. In case of ureter obstruction early DJ-catheter placement is required. Operative interventions to relieve ureter obstruction are rarely necessary provided immunosuppressive treatment is timely instituted.

Leflunomide Treatment in Elderly Patients with Rheumatoid or Psoriatic Arthritis

Disease-modifying antirheumatic drugs (DMARDs) play a crucial role in the treatment of persistent chronic synovitis, such as active rheumatoid arthritis (RA) and spondyloarthritis, by inducing or maintaining disease remission, reducing the frequency of flares or relapses, and allowing corticosteroids to be tapered while maintaining disease control. The aim of this retrospective study was to evaluate the safety of, and adherence to treatment with, leflunomide in elderly RA and psoriatic arthritis patients compared with younger patients. A total of 90 Italian patients (80 with active RA and 10 with psoriatic arthritis) were retrospectively examined at entry and after 24 months' follow-up. Patients were divided into two groups according to age: those aged <or=65 years (n = 50) and those aged >65 years (n = 40). Each patient was analysed for clinical, demographic and laboratory parameters in order to evaluate liver, renal and haematological toxicity. Disease Activity Score including a 28-joint count (DAS28) and physician global assessment of disease activity (MD global) were measured to define disease activity. During the 24-month follow-up period, 30 patients (33.3%) discontinued leflunomide: 17 patients (34.0%) in the group of patients aged <or=65 years and 13 patients (32.5%) in those aged >65 years. There were no differences in treatment withdrawal between the two groups. Overall, 10 patients (11.1%) in the entire study population discontinued leflunomide for lack of efficacy, while 21 (23.3%) discontinued the drug because of adverse effects (one patient withdrew because of both inefficacy and adverse effects). There were no significant differences in efficacy or adverse effects between patients aged <or=65 years and patients aged >65 years. There was also no significant difference in survival rates of leflunomide treatment when patients aged <or=65 years were compared with patients aged >65 years (p = 0.94). There were no significant differences in withdrawal rates in the overall population when leflunomide monotherapy was compared with leflunomide combination therapy. There were also no significant differences in the types of adverse effects associated with monotherapy or combination therapy when the two age groups were compared. Leflunomide is a useful and well tolerated DMARD for the treatment of RA and psoriatic arthritis in the elderly. The safety profile of, and adherence to, leflunomide is not different in older patients with chronic inflammatory joint diseases such as RA or psoriatic arthritis to that observed in younger patients.

BILAG, SLEDAI, SIS, ECLAM, WAM, SLAM …. Thank you MAM

Lupus (2007) 16, 849‐851 http://lup.sagepub.com Many years ago the late Peter Cook and Dudley Moore wrote a sketch in which the characters spoke to each other mostly in abbreviations along the lines . . . ‘Good evening JB wasn’t it you I saw driving the BMW in SW2 last week? Are you OK?’ ‘Yes, PC that was me I was in a bit of hurry; spot of D&V coming off the P&O cruise from NYC …’ and so on …. Reading the current lupus literature in relation with lupus disease assessment draws an inevitable comparison given the plethora of abbreviations and acronyms especially for disease activity indices. This situation, however, should not be regarded as wholly bad given what went before, which was frankly anarchy. As has been pointed out 1 in the twenty years or so leading up to the mid-80s some sixty attempts at defining disease activity in patients with lupus were published that were of little value since the authors did not attempt to validate them, demonstrate their reproducibility or show they could be used in large numbers of collaborating centres. I should perhaps, put my hand up here as being at least as guilty as anybody else, as three of these early attempts were mine! Things began to change in the mid-80s when groups in the UK, Toronto and Boston began to take the assessment of lupus patients seriously. The Boston and Toronto groups went along a conventional global score path attempting to develop accurate and reliable global scores that were arrived at by consensus, tested on real and paper patients and in a variety of collaborating centres. Thus Matt Liang developed the Systemic Lupus Activity Measures (SLAM) global score 1 and

Serum nitric oxide metabolites and disease activity in patients with systemic sclerosis

There is no surrogate marker in serum for defining disease activity in scleroderma (SSc). Nitric oxide (NO), which regulates vasodilation and possesses pro-inflammatory actions, has been implicated in the pathogenesis of SSc. We compared serum NO(x) (total nitrate and nitrite) level in SSc patients to healthy controls and evaluated its correlation with detailed symptomatology and scoring systems for various organ involvement. Symptoms and physical findings that suggested disease activity in regard to various organs were documented. Lung function test, high-resolution computed tomographic (HRCT) scan of thorax and echocardiography were performed. Serum NO(x) was measured by chemiluminescence. Serum NO(x) levels in SSc (n = 43) were significantly higher (72.4 +/- 47.8 microM) than age- and sex-matched controls (n = 41; 37.1 +/- 13.5 microM; p < 0.001). Serum NO(x) were not found to be associated with lung fibrosis defined by lung function parameters or inflammation and fibrosis scores on HRCT. Twenty-two patients were found to have elevated serum NO(x) level defined as mean +/- 2 SD of normal controls. Logistic regression analysis revealed that age (OR 1.12, p = 0.02) and elevated pulmonary arterial pressure (PAP) (n = 9; OR 145.3, p = 0.01) were predictive factors for elevated serum NO(x). Prednisolone use was associated with lower serum NO(x) level (OR 0.06, p = 0.04). Elevated PAP of increasing severity was found to be associated with higher level of serum NO(x) (p = 0.004 by trend). Serum NO(x) in SSc patients were elevated compared to healthy controls. Serum NO(x) level was determined by multiple factors including age, prednisolone use, and elevated PAP.

Contrast–enhanced ultrasonography in Crohn’s disease

The purpose of this study was to demonstrate the diagnostic efficacy of contrast-enhanced power Doppler (CEPD) after ultrasound (US) with colour power Doppler (CPD) in defining disease activity in patients with ileal Crohn's disease in the acute phase and during treatment follow-up. The study included 15 patients with ileal Crohn's disease, 12 of whom were examined in the acute phase of their illness and then 30-60 days after treatment. Three patients were studied during clinical quiescence. All patients were examined prior to treatment with US-CPD study and then with contrast-enhanced power Doppler (CEPD) examination (CEPD) with the use of US contrast agent (SonoVue, Bracco), together with clinical assessment and laboratory tests. Disease activity was defined by the Crohn's Disease Activity Index (CDAI) and some of the most sensitive biohumoural markers. After initial US, CPD and CEPD were performed to assess enhancement of the thickened bowel wall with the use of a reference box and a semiquantitative scoring system. The CEPD study is more reliable then US-CPD in the diagnosis of Crohn's disease and statistically agrees significantly with clinical and laboratory indices for disease activity. This study demonstrates the importance of US-CPD in the follow-up of patients with Crohn's disease and suggests systematic use of the US contrast agent, which can improve diagnostic performance of abdominal US study. It also provides more information about patients both in the acute phase and during follow-up, thus improving treatment planning and better monitoring of treatment efficacy.

Ultrasound and Magnetic Resonance Imaging Assessmentof Active Bowel Segments in Crohn's Disease

AIM: Determining bowel disease activity in Crohn's patients can be difficult on clinical and laboratory assessment. Endoscopy is invasive and barium studies use ionising radiation. The aim of this study was to compare ultrasound and magnetic resonance imaging (MRI) in detecting Crohn's disease activity in the small or large bowel. MATERIALS AND METHODS: Thirty patients, previously diagnosed with Crohn's disease, had bowel ultrasound and MR imaging, and were deemed active or inactive on each test. The ‘gold standard’ was based on clinical assessment and one or more of the following: endoscopy, barium studies or surgery. RESULTS: For determining Crohn's disease activity, the sensitivities and specificities of bowel ultrasound and MRI were 87% and 100%, and 87% and 71%, respectively. Significant parameters that defined disease activity were bowel wall thickening on ultrasound and MRI, and contrast enhancement of the bowel wall and mesenteric vascularity/stranding on MRI. CONCLUSION: Ultrasound and MRI were both sensitive for determining Crohn's disease activity in the bowel, but MRI with gadolinium enhancement was less specific. Miao Y. M. et al. (2002).Clinical Radiology57, 913–918.

Sonographie bei Morbus Crohn

In inflammatory bowel diseases sonography can depict the transformations in the bowel wall structure as well as extramural changes. Certain patterns of altered stratification can be defined which can be helpful in determining disease activity. Crohn's disease is extending very often into the mesenteries and to the serosa, omentum and peritoneum on the other side. Sonography will detect fistulas, abscesses, omental cake and ascites for example. Extraintestinal manifestations like those of the biliary tree, the pancreas, the kidneys can be seen. Color doppler sonography will be able to define disease activity. In differentiating Crohn's disease from infectious enterocolitis and diverticulitis as well as other rare disorders sonography can be useful.

Risk-Benefit Assessment of Glatiramer Acetate in Multiple Sclerosis

Glatiramer acetate, formerly known as copolymer 1, is a mixture of synthetic polypeptides composed of four amino acids. Glatiramer acetate has been shown to be effective in preventing and suppressing experimental autoimmune encephalitis (EAE), the animal model of multiple sclerosis (MS). Therefore it was tested in several clinical studies, where it was found to slow the progression of disability and to reduce the relapse rate and the magnetic resonance imaging (MRI)-defined disease activity and burden in relapsing-remitting MS. As a daily standard dose, 20mg of glatiramer acetate is injected subcutaneously. After injection, glatiramer acetate undergoes rapid degradation to amino acids and shorter peptides; so it is not possible to measure any systemic plasma concentrations or excretion rates. Two major mechanisms have been proposed to explain the effects of glatiramer acetate in EAE and MS: the induction of glatiramer acetate-reactive T helper 2 (Th2)-like regulatory suppressive cells and the interference with T cell activation as an altered peptide ligand. The most common adverse effects were mild injection site reactions (erythema, inflammation and induration). The most remarkable adverse event is the acute and transient immediate postinjection reaction manifested by flushing, chest tightness, palpitations and dyspnoea. Other reported adverse effects are transient chest pain and lymphadenopathy. Antibodies to glatiramer acetate induced during treatment do not interfere with its clinical effects. In several controlled clinical studies, glatiramer acetate has been shown to provide consistent, reproducible clinical benefits in the target population of patients with relapsing-remitting MS. The safety profile and risk-benefit ratio are excellent. Overall, glatiramer acetate is very well tolerated and has an excellent risk-benefit profile in patients with relapsing-remitting MS.

Cyclosporin A treatment of refractory rheumatoid arthritis.

Ten patients with rheumatoid arthritis were entered into a 24-week pilot study of oral cyclosporin A at a starting dosage of 6 mg/kg/day, followed by a 12-week washout period. Significant improvement in clinical parameters was observed at 12 weeks and 24 weeks (P less than 0.02 versus baseline for joint pain and joint swelling indexes and patient and physician assessments; P less than 0.04 versus baseline in the numbers of painful/tender joints and swollen joints). Adverse reactions were varied: renal impairment occurred in all patients and hypertension occurred in 7. All patients demonstrated an increase in defined disease activity at cessation of treatment and through the washout period. Cyclosporin A is clinically effective in the treatment of patients with refractory rheumatoid arthritis, but its value as an intervention therapy is limited by its toxicity.