Disease-modifying Antirheumatic Drug Therapy Research Articles

Efficacy of anti-interleukin-1 treatment in colchicine-resistant arthritis in patients with familial Mediterranean fever.

In the familial Mediterranean fever (FMF) clinic, arthritis is among the most common symptoms, and it generally responds well to colchicine treatment. However, cases of patients with chronic prolonged colchicine-resistant arthritis have been reported, and there are inadequate studies on the treatments to be used for such patients. This study included 18 patients diagnosed with FMF who had colchicine-resistant chronic arthritis and received anti-interleukin (IL)-1 treatment for at least 1 year. The clinical and laboratory data of the patients were retrospectively retrieved from the database of our hospital. Remission was achieved in arthritis attacks in 16 of 18 patients who started anti-IL-1 therapy because of colchicine-resistant chronic arthritis. The clinical and laboratory values of the other 2 patients improved, but complete remission could not be achieved. The treatment dose of colchicine was reduced with anti-IL-1 therapy. In addition to the improvement in arthritis symptoms, remission was achieved in other clinical findings of FMF by anti-IL-1 therapy. In this study, with an average follow-up time of 33 months, no adverse effects requiring discontinuation were observed in any patient. Anti-IL-1 therapy is effective and reliable in the treatment of colchicine-resistant chronic FMF arthritis. The efficacy of anti-IL-1 therapy was realized without concomitant disease-modifying antirheumatic drug therapy, despite the reduction in colchicine dose.

Proliferative synovitis, an ultrasound pattern associated with ACPA-positive patients and erosive disease in rheumatoid arthritis.

To analyse ultrasound (US) differences between rheumatoid arthritis (RA) patients according to autoantibody status and characterise the clinical and radiological features associated with the US pattern of seropositive patients. We collected demographic and clinical data and bilateral hand US images of RA patients. We defined an extreme proliferative US pattern, encompassing synovial hypertrophy grade II-III with Power Doppler signal, which we called US proliferative synovitis (US PS). To better characterise US PS, MRI of the dominant hand and immunostaining of synovial biopsies were made in subgroups of 42 and 23 patients, respectively. We included 205 RA patients (84.8% seropositive). No significant differences in disease activity were found according to autoantibody status. US PS was found in 55.5% of seropositive and 16.1% of seronegative patients (p=0.0001). In the multivariate analysis, erosions [OR 4.90 95% CI (2.17-11.07), p=0.0001] and ACPA [OR 3.5 95% CI (1.39-10.7), p=0.009] but not RF status [OR 0.74 95% CI (0.31-1.71), p=0.483] were independently associated with US PS. After a mean follow-up of 46 months, US PS was independently associated with changes in therapy (OR 2.63, 95% CI 1.20-5.77, p=0.016). Ninety-four per cent of joints with US PS had RAMRIS synovitis sub-index grade 2-3. US PS was significantly associated with higher synovial vessel density (p=0.042). In RA patients, US PS was associated with ACPA status, erosive disease and an enhanced need to change disease-modifying anti-rheumatic drug therapy in the long-term. At synovial level, this US pattern was characterised by higher vessel density.

COVID-19 pandemic management and the rheumatology patient.

We discuss the evidence behind mask use, including evidence for homemade masks, social distancing, and the local coronavirus disease-2019 (COVID-19) epidemics in countries that initially employed more limited public health interventions. Given the absence of data for specific interventions in the rheumatic disease population, we reviewed the evidence available for the general population. The risk of poor outcomes with COVID-19 in patients with rheumatic diseases is a potential concern given the immunosuppression associated with these conditions and disease-modifying anti-rheumatic drug therapy, as well as advancing age and many of the comorbidities present in such patients. Infection prevention is key, for both individual patients and their community. Given the data collected from the general population, we recommend ongoing proper mask use, social distancing, and hand hygiene for patients with rheumatic diseases and encourage providers to counsel these patients in prevention strategies and attempt to dispel abundant misinformation.

Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand: A cross-sectional study.

Objective:This study was aimed to analyze the prescription pattern of disease modifying anti-rheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA) in a tertiary care teaching hospital in Uttarakhand, India.Methodology:This cross-sectional study was conducted in 150 RA patients who were given DMARD therapy. Patient's demographic details, drugs prescribed with their dosage and administration routes and the usage of complementary and alternative medicine (CAM) therapy were recorded to study the prescription pattern.Results:Overall, 4 DMARDs were prescribed in all the studied patients: Methotrexate (n = 150), hydroxychloroquine (n = 35), leflunomide (n = 5), and adalimumab (n = 1). Single DMARD therapy with methotrexate was prescribed to 110 (73.3%) followed by double therapy with methotrexate + hydroxychloroquine in 35 (23.3%), triple therapy (methotrexate + hydroxychloroquine + leflunomide) in 4 (2.7%) and triple therapy with biological DMARD (methotrexate + hydroxychloroquine + leflunomide + adalimumab) in 1 (0.7%) patient. Adjuvant therapy drugs included: Prednisolone (n = 150), folic acid (n = 150), naproxen (n = 150), calcium (n = 150), vitamin D (n = 150) and indomethacin (n = 40). Of the total, 61.4% patients also took complimentary alternative medicine (CAM) therapy.Conclusion:Our study concludes that the most commonly prescribed DMARDs in our setting, to patients of RA, in descending order of frequency were methotrexate, followed by hydroxychloroquine, leflunomide and lastly adalimumab. A total of five adjuvant medications were commonly prescribed to all patients. There was a high prevalence of self-medicated CAM therapy in the majority of these patients.

Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus.

BackgroundThere is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA.MethodsPreliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method.ResultsFourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse.ConclusionThese QIs can be used to assess and improve the quality of health care for patients with RA.

Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study

Background:The prediction of the individual’s response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is challenging and often limited. Here we evaluated the influence of patients’ expectations towards a change in treatment with DMARD on clinical outcome in RA.Methods:One hundred patients (74 female) with RA (2010 ACR/EULAR classification criteria) and an upcoming change in DMARD treatment due to non-response or adverse effects were included. Patients’ treatment beliefs, health-related quality of life and treatment expectations were measured using the Beliefs about Medicines Questionnaire (BMQ), the Short Form 36, and self-designed questions about expectations before treatment initiation (T0), and DAS28-CRP was calculated at T0 and after 4 months (T4). Associations between patients’ beliefs and expectations and changes in DAS28-CRP (T0 to T4, ΔDAS28-CRP) were explored by regression analyses after multiple imputation.Results:A total of 99 patients were included, of whom 84 completed all questionnaires. Thirty-six percent of all variability in treatment response (ΔDAS28-CRP) was explained by expectations assessed with the questionnaires and the C-reactive protein (CRP)-value at T0. Among these, the expected improvement rate, with 10.5%, as well as the CRP-value at T0, with 10.6%, had the greatest positive effect whereas the fear of adverse effects, with 11.4%, and the BMQ.concern scale, with 9.0%, had the greatest negative impact on ΔDAS28.Conclusion:Patients’ expectations towards newly induced DMARD therapies influence clinical response and may serve as possible explanatory factors for treatment response affecting subjective and objective outcome parameters.Clinical trial registration number:DRKS00017005

Psychological impact of coronavirus disease 2019 pandemic on patients with rheumatological disorders: A web-based cross-sectional multicentric survey

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in uncertainty and negative psychological outcomes for patients with autoimmune rheumatic diseases for several reasons. It is essential to understand the level of anxiety among rheumatic disease patients at the current situation of COVID-19.Objectives and Methods: A web-based cross-sectional multicenter survey was done across 5 rheumatology centers in India. The study duration was between 9th May and May 16, 2020. The questionnaire included consent, demographic details, medication history, opinion about tele rheumatology services, and anxiety score measured by Beck Anxiety Inventory.Results: The survey was sent to 2987 patients, there were 933 responses, and 581 were complete (male = 175). Complete responses were considered for data analysis. Rheumatoid arthritis was the most frequent (50.6%) diagnosis followed by other conditions. Most of the patients (43%) were on combination disease-modifying anti-rheumatic drug therapy, 12.7% of patients were on biological drugs, and 23.9% of patients were on glucocorticoids (GCs). Statistically significant higher anxiety scores were observed in females (8.79 ± 9.3), fibromyalgia patients (19.78 ± 14.8), patients on GCs (9.26 ± 8.8), and biological agents (10.65 ± 10.6). Difficulty in meeting rheumatologists and getting medications was expressed by 327 (56.2%) and 73 (29.7%) respondents, respectively.Conclusion: The findings of the study revealed that anxiety is a major concern in patients with autoimmune rheumatic diseases. Fibromyalgia patients and those who were on GC and biological drugs were found to have more anxiety levels compared to other groups of patients. There is a need to intensify the awareness and address the mental health issues.

Long-term safety and efficacy of sirukumab for patients with rheumatoid arthritis who previously received sirukumab in randomised controlled trials (SIRROUND-LTE)

ObjectiveInterleukin (IL)-6 is a pleiotropic cytokine involved in the pathophysiology of rheumatoid arthritis (RA). Sirukumab is a human monoclonal antibody that binds to IL-6 with high affinity and specificity.MethodsThis long-term...

Risk of tuberculosis in patients with spondyloarthritis: data from a centralized electronic database in Hong Kong

Background/ objectiveTuberculosis (TB) is one of the most infectious comorbidities in spondyloarthritis (SpA). Our goals were to determine the crude incidence rate of and risk factors for TB in SpA.MethodClinical data of 2984 patients with SpA from 11 rheumatology centres were reviewed. This included demographics, duration of follow-up, comorbidities including diabetes, chronic kidney disease, chronic heart disease, chronic lung disease, stroke and malignancies, date of diagnosis of tuberculosis, use of non-steroidal anti-inflammatory drugs, duration of glucocorticoid therapy for more than 6 months, conventional (cDMARD) and biological (bDMARD) disease modifying anti-rheumatic drug therapies. Crude incidence rates were reported. Cox regression models were used to determine the risk factors for TB in patients with SpA.ResultsForty-three patients had TB, of which 4 (9.3%) were extra-pulmonary. The crude incidence rate of TB was 1.57 in patients with SpA, compared with 0.58 in the general population in Hong Kong. Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001). Age was associated with decreased risk (HR 0.93; p < 0.001).ConclusionIncidence of TB was higher in patients with SpA. Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB. Rheumatologists should avoid prolonged use of glucocorticoids and consider DMARDs other than infliximab in the treatment of at-risk patients.

A retrospective review of the adverse effects of biological therapy and reasons for its discontinuation in a resource-limited setting.

Biological disease-modifying antirheumatic drug therapies have become the gold standard of treatment for refractory rheumatic conditions in well-resourced countries. There is a significant risk of infection and reactivation of latent infections, in particular tuberculosis, with the use of biological therapies. Their safety and reasons for discontinuation in a resource-limited environment are still unclear. The primary objective was to describe the nature and frequency of adverse events as well as the main reason for discontinuation of biological treatment. We conducted a retrospective, descriptive folder review of all patients started on biological therapy for rheumatic conditions from November 2011 to December 2016. A total of 31 patients were included. The rheumatic diseases included in the study were ankylosing spondylitis (AS) (35%), rheumatoid arthritis (RA) (19%), systemic lupus erythematosus (16%), juvenile idiopathic arthritis (13%), vasculitides (10%) and psoriatic arthritis (7%). Adverse events occurred in 26 patients (84%). Serious adverse events occurred in 14 patients (45%) with recurrent uveitis being the most common, occurring in 5 patients (16%). One patient developed pulmonary tuberculosis (PTB). Discontinuation or switching of biological therapy occurred in 13 patients (42%), with the main reasons being serious adverse events in 7 patients (23%) and treatment failure in 6 (19%). The median (interquartile range (IQR)) Bath Ankylosing Spondylitis Disease Activity Index score improved from 6.4 (5 - 7.4) to 2.8 (0.9 - 5.0), a statistically significant difference of -3.5 (p=0.001) (95% confidence interval (CI) -5.3 - -1.7) over a median (IQR) of 20 (9 - 30) months in the AS group. The median (IQR) Clinical Disease Activity Index score improved from 39 (34.5 - 43) to 21 (18.7 - 25.5), a statistically significant difference of -17.4 (p=0.044) (95% CI -34.1 - -0.7) over a median (IQR) of 39 (21 - 50) months in the RA group. Recurrent uveitis occurred in almost half of the patients with AS and was also the main reason for discontinuation of biological therapy. We did not document an increased risk of PTB. Disease activity scores showed significant improvement. The study is limited by the small number of patients on biological therapy, a reflection of the impact of severe resource constraints.

Association of Dysregulated Central Pain Processing and Response to Disease-Modifying Antirheumatic Drug Therapy in Rheumatoid Arthritis.

To determine the association between dysregulated central pain processing and treatment response in rheumatoid arthritis (RA). One hundred eighty-two participants with active RA were followed up for 12 weeks after starting a disease-modifying antirheumatic drug (DMARD). To assess central pain processing, participants underwent quantitative sensory testing (QST), including assessment of pressure pain thresholds (PPTs) at the trapezius muscles, temporal summation, and conditioned pain modulation (CPM). QST measures were categorized as high central dysregulation versus low central dysregulation. The association between baseline central dysregulation and treatment response, as defined by the European League Against Rheumatism (EULAR) response criteria, was assessed using multiple logistic regression adjusted for demographic characteristics, RA-related variables, and psychosocial variables. A good EULAR response was achieved in fewer participants with high CPM dysregulation than participants with low CPM dysregulation (22.5% versus 40.3%; P = 0.01). A similar trend, though not significant, was noted when central dysregulation was assessed with PPT and temporal summation. The adjusted odds ratios (ORs) for the association between high central dysregulation and good EULAR response were 0.59 for PPTs (95% confidence interval [95% CI] 0.28-1.23), 0.60 for temporal summation (95% CI 0.27-1.34), and 0.40 for CPM (95% CI 0.19-0.83). In a model examining the combined effects of dysregulated temporal summation and CPM, dysregulation of both measures was associated with lower odds of achieving a good EULAR response (OR 0.23 [95% CI 0.07-0.73]). Low CPM was significantly associated with lower odds of achieving a good EULAR response, suggesting that inefficient descending inhibitory mechanisms may be a potential treatment target for further study.

Blood pro-resolving mediators are linked with synovial pathology and are predictive of DMARD responsiveness in rheumatoid arthritis

Biomarkers are needed for predicting the effectiveness of disease modifying antirheumatic drugs (DMARDs). Here, using functional lipid mediator profiling and deeply phenotyped patients with early rheumatoid arthritis (RA), we observe that peripheral blood specialized pro-resolving mediator (SPM) concentrations are linked with both DMARD responsiveness and disease pathotype. Machine learning analysis demonstrates that baseline plasma concentrations of resolvin D4, 10S, 17S-dihydroxy-docosapentaenoic acid, 15R-Lipoxin (LX)A4 and n-3 docosapentaenoic-derived Maresin 1 are predictive of DMARD responsiveness at 6 months. Assessment of circulating SPM concentrations 6-months after treatment initiation establishes that differences between responders and non-responders are maintained, with a decrease in SPM concentrations in patients resistant to DMARD therapy. These findings elucidate the potential utility of plasma SPM concentrations as biomarkers of DMARD responsiveness in RA.

Upadacitinib in rheumatoid arthritis: a profile of its use

Upadacitinib (Rinvoq™), an oral Janus kinase (JAK) 1 inhibitor, is approved as monotherapy or in combination with nonbiological disease-modifying antirheumatic drugs (DMARDs), including methotrexate, in adult patients with moderate to severely active rheumatoid arthritis (RA) who have responded inadequately to, or who are intolerant to one or more DMARD. Across phase 3 trials in patients with RA, once-daily upadacitinib treatment was generally well tolerated and associated with rapid and clinically relevant disease remission or low disease activity when administered as monotherapy or in combination conventional synthetic DMARDs (csDMARDs), including in patients who were intolerant to or had an inadequate response to prior csDMARDs or biological DMARD (bDMARD) therapy. In addition, in head-to-head trials, upadacitinib was more effective than both adalimumab in patients with an inadequate response to methotrexate and abatacept in patients with an inadequate response to or intolerance to bDMARDs. The clinical benefits of upadacitinib, including slowing progression of joint damage, were maintained over the longer term and no new safety signals were identified.

Conventional and Biologic Disease-Modifying Antirheumatic Drugs Are Not Associated With Increase in or Progression of Cervical Neoplasia Among Patients With Spondyloarthritis.

Using a centralized electronic database, we investigated the risk of cervical neoplasia (CN) and progression of cervical intraepithelial neoplasia (CIN) among patients with spondyloarthritis (SpA) receiving disease-modifying antirheumatic drugs (DMARDs). A total of 951 patients with SpA were reviewed. Incidence and progression of CN and clinical data including age, ethnicity, smoking and drinking status, dates of first and last follow-up, history of psoriasis, inflammatory bowel disease, medications used, mean dose and duration of medications, and comorbidities were reviewed. Cox regression models were used to evaluate the individual risk of DMARDs with CN and the risk of CIN progression. During a mean follow-up duration of 9.2 ± 5.9 years, 34 patients had developed CN, which translates to an incidence for development of CN in patients with SpA of 3.9 per 1000 patient-years. Univariate Cox regression analyses showed no differences in clinical characteristics (psoriasis hazards ratio [HR] = 0.92, p = 0.82; inflammatory bowel disease HR = 0.05, p = 0.61; diabetes mellitus HR = 2.82, p = 0.21; chronic kidney disease HR = 0.39, p = 0.35) and medications exposure (sulfasalazine HR = 0.49, p = 0.30; methotrexate HR = 0.52, p = 0.11; leflunomide HR = 0.52, p = 0.37; adalimumab HR = 0.83, p = 0.80; certolizumab HR = 0.05, p = 0.74; etanercept HR = 0.40, p = 0.36; golimumab HR = 0.05, p = 0.32; infliximab HR = 0.05, p = 0.39; secukinumab HR = 1.00, p = 1.00; ustekinumab HR = 0.05, p = 0.78) between patients who had and had not develop CN during the study period. Progression of CIN was independently associated with higher grades of CIN lesion (HR = 6.20; p = 0.05). There was low risk of development and progression of CN in patients with SpA on conventional or biologic DMARD therapy.

EP18 Testicular sarcoidosis: a challenging diagnosis

EP18 Testicular sarcoidosis: a challenging diagnosis

Trabecular and cortical bone involvement in rheumatoid arthritis by DXA and DXA-based 3D modelling.

To evaluate cortical and trabecular bone involvement of the hip in RA patients by dual-energy X-ray absorptiometry (DXA) and 3D analysis. The secondary end-point was to evaluate bone involvement in patients treated with classic (c-DMARD) or biological (b-DMARD) disease-modifying antirheumatic drug therapies and the effect of the duration of the disease and corticosteroid therapy on 3D parameters. A cross-sectional study of 105 RA patients and 100 subjects as a control group (CG) matched by age, sex, and BMI was carried out. BMD was measured by DXA of the bilateral femoral neck (FN) and total hip (TH). The 3D analyses including trabecular and cortical BMD were performed on hip scans with the 3D-Shaper software. FN and TH BMD and trabecular and cortical vBMD were significantly lower in RA patients. The c-DMARD (n = 75) group showed significantly lower trabecular and cortical vBMD than the CG. Despite the lower values, the b-DMARD group (n = 30) showed no significant differences in most parameters compared with the CG. The trabecular and cortical 3D parameters were significantly lower in the group with an RA disease duration of 1 to 5years than in the CG, and the trabecular vBMD was significantly lower in the group with a duration of corticosteroid therapy of 1 to 5years than in the CG, while no significant differences were found by standard DXA in the same period. RA patients had a higher risk of developing low BMD or osteoporosis than controls. RA patients receiving c-DMARD therapy showed significantly lower BMD than controls, while no significant differences in most parameters were found between RA patients receiving b-DMARDs and controls. 3D-DXA allowed us to find changes in trabecular and cortical bone compartments in RA patients.

Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis : A Cohort Study.

Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain. To quantify the risk for hospitalized infection with long-term use of low-dose glucocorticoids in patients with RA receiving stable disease-modifying antirheumatic drug (DMARD) therapy. Retrospective cohort study. Medicare claims data and Optum's deidentified Clinformatics Data Mart database from 2006 to 2015. Adults with RA receiving a stable DMARD regimen for more than 6 months. Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability-weighted analyses, with 1-year cumulative incidence predicted from weighted models. 247297 observations were identified among 172041 patients in Medicare and 58279 observations among 44118 patients in Optum. After 6 months of stable DMARD use, 47.1% of Medicare patients and 39.5% of Optum patients were receiving glucocorticoids. The 1-year cumulative incidence of hospitalized infection in Medicare patients not receiving glucocorticoids was 8.6% versus 11.0% (95% CI, 10.6% to 11.5%) for glucocorticoid dose of 5 mg or less per day, 14.4% (CI, 13.8% to 15.1%) for greater than 5 to 10 mg/d, and 17.7% (CI, 16.5% to 19.1%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids). The 1-year cumulative incidence of hospitalized infection in Optum patients not receiving glucocorticoids was 4.0% versus 5.2% (CI, 4.7% to 5.8%) for glucocorticoid dose of 5 mg or less per day, 8.1% (CI, 7.0% to 9.3%) for greater than 5 to 10 mg/d, and 10.6% (CI, 8.5% to 13.2%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids). Potential for residual confounding and misclassification of glucocorticoid dose. In patients with RA receiving stable DMARD therapy, glucocorticoids were associated with a dose-dependent increase in the risk for serious infection, with small but significant risks even at doses of 5 mg or less per day. Clinicians should balance the benefits of low-dose glucocorticoids with this potential risk. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Incidence of COVID-19 in Patients With Rheumatic Diseases Treated With Targeted Immunosuppressive Drugs: What Can We Learn From Observational Data?

ObjectiveTo describe the incidence and severity of coronavirus disease 2019 (COVID‐19) in patients with rheumatic diseases treated with targeted synthetic or biologic disease‐modifying antirheumatic drugs (DMARDs) compared with that in the general population living in the same Italian region.MethodsPatients followed up at 2 rheumatology referral centers in Lombardy from February 25, 2020 to April 10, 2020 were invited to participate in a survey designed to identify patients who had confirmed COVID‐19, close contact with others with confirmed COVID‐19, or symptoms of the infection, and to detect changes in work, behavior, and disease management made in an attempt to prevent infection. The incidence of COVID‐19 in the Lombardy population was obtained from the National Institute of Statistics. COVID‐19 cases were confirmed by nasopharyngeal swab.ResultsThe survey was given to 955 patients (531 patients with rheumatoid arthritis, 203 patients with psoriatic arthritis, 181 patients with spondyloarthritis, and 40 patients with connective tissue diseases, vasculitides, or autoinflammatory diseases). These patients had a mean age of 53.7 years, and 67.4% were women. The rate of response to the survey was 98.05%, and the incidence of confirmed COVID‐19 cases was consistent with that in the general population (0.62% versus 0.66%; P = 0.92). None of the patients had severe complications or required intensive care treatment, and all of the patients who tested positive for COVID‐19 temporarily discontinued ongoing targeted synthetic drug or biologic DMARD therapy. Almost all patients took precautions to prevent the COVID‐19 infection (90.6%), and almost all continued treatment with targeted synthetic drugs or biologic DMARDs (93.2%). Disease activity remained stable in 89.5% of patients.ConclusionOur results reflected the attitude of patients with rheumatic diseases regarding the prevention of the infection while maintaining their long‐term treatment regimens. The incidence and severity of COVID‐19 in patients treated with targeted synthetic drugs or biologic DMARDs was not significantly different from that in the general population in the same region.

Cardiovascular effects of biological versus conventional synthetic disease-modifying antirheumatic drug therapy in treatment-naïve, early rheumatoid arthritis

ObjectivesTo determine whether patients with early rheumatoid arthritis (ERA) have cardiovascular disease (CVD) that is modifiable with disease-modifying antirheumatic drug (DMARD) therapy, comparing first-line etanercept (ETN) + methotrexate (MTX) with...

Efficacy predictors of a second tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis.

To retrospectively evaluate initial tumor necrosis factor inhibitor (TNFi) failure patients for clinical predictors of response to a 2nd TNFi in our 4282 rheumatoid arthritis (RA) patient database.A cross-sectional retrospective manual chart review of the electronic health record (EHR) was performed on 322 “real world” RA patients who were prescribed 2 TNFis. Response to TNFi was determined by the treating provider who had real time Clinical Disease Activity Index (CDAI) scores to inform treatment decisions. Age, gender, body mass index (BMI), insurance provider, duration of disease, cyclic citrullinated peptide antibody (CCP) and rheumatoid factor (RF) positivity, concomitant disease modifying anti-rheumatic drug therapy, length of time between diagnosis and start of 1st and 2nd TNFi, transient efficacy of 1st TNFi (defined as response to TNFi at 3 months but later lost response), and reason for discontinuation of 1st TNFi were analyzed. A multivariable logistic regression model was used to model response to a 2nd TNFi.Response proportions to the 2nd TNFi were greater in females (161/223, 72.2% response female vs 41/75, 54.7% male, P < .01), those who began their 1st TNFi within 3 months of their RA diagnosis, and in RF+ patients (123/170, 72.4% response seropositive vs 66/110, 60.0% seronegative, P < .03). The higher female response rate was independent of age, BMI, and seropositivity.In RA patients who failed an initial TNFi, female patients and patients with RF+ were more likely to have a clinical response to a 2nd TNFi. In the absence of these predictors, stronger consideration for choosing a biologic with an alternative mechanism of action might be given when the 1st TNFi fails.