DMARD Therapy Research Articles

Changes in physical activity measured by accelerometry following initiation of DMARD therapy in rheumatoid arthritis

The aim of this study was to assess changes in habitual physical activity levels in response to DMARD therapy in RA patients. Eighteen drug-naive RA patients were prospectively assessed at baseline and following 3 months of DMARD therapy for habitual physical activity by accelerometry, disease activity using the clinical disease activity index (CDAI) and functional disability using the modified HAQ (mHAQ). Baseline physical activity was also compared with an equal number of healthy control participants matched for age, sex and BMI. Following 3 months of DMARD therapy, in parallel with significant improvements in CDAI scores (P < 0.001) and HAQ scores (P < 0.001), accelerometry measures in the RA cohort showed that the average activity counts in sedentary thresholds decreased (P = 0.012), while average activity counts within higher-intensity thresholds increased (P = 0.039). Multiple regression analysis showed that the change in moderate activity was associated with a decrease in CRP (β = - 0.922, P = 0.026) while the decrease in sedentary activity and increase in moderate activity were associated with decreased morning stiffness of the joints (β = 0.694, P = 0.035 and β = -0.927, P = 0.024, respectively). At baseline, RA patients were less physically active than control participants in the morning (P = 0.048) and in the late afternoon (P = 0.016), but these diurnal differences were no longer significant after the DMARD intervention. These findings suggest that accelerometry may potentially be a viable objective method of assessing changes in physical disability in response to various disease-modifying drugs.

Treatment of rheumatoid arthritis with marine and botanical oils: an 18-month, randomized, and double-blind trial.

Objective. To determine whether a combination of borage seed oil rich in gamma linolenic acid (GLA) and fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is superior to either oil alone for treatment of rheumatoid arthritis (RA). Methods. Patients were randomized into a double-blind, 18-month trial. Mixed effects models compared trends over time in disease activity measures. Results. No significant differences were observed in changes in disease activity among the three randomized groups. Each group exhibited significant reductions in disease activity (DAS28) at 9 months (fish: −1.56[−2.16, −0.96], borage: −1.33[−1.83, −0.84], combined: −1.18[−1.83, −0.54]) and in CDAI (fish: −16.95[−19.91, −13.98], borage: −11.20[−14.21, −8.19], and combined: −10.31[−13.61, −7.01]). There were no significant differences in change of RA medications among the three groups. Reduced disease activity in study patients was similar to matched patients from an RA registry, and reduction in DMARD use was greater (P < 0.03) in study patients. Conclusion. All 3 treatment groups exhibited similar meaningful clinical responses after 9 months, improvements which persisted for 18 months, and a response similar to matched patients from an RA registry. Study patients were able to reduce DMARD therapy given in combination with TNF antagonists to a greater extent than registry patients. This paper is dedicated to the memory of Dr. John T. Sharp, M.D., a pioneer and innovator in the field of musculoskeletal radiology

Treatment of rheumatoid arthritis with biologic DMARDS (Rituximab and Etanercept).

ABSTRACTGoal:To determine efficacy and safety of treatment with Rituximab and Etanercept plus Methotrexate in patients with active Rheumatoid Arthritis (RA), who had an inadequate response to nonbiologic DMARDS therapies and to explore the pharmacogenetics and pharmacodynamics of Rituximab and Etanercept in our populations. Study was done at Rheumatology Clinic of University Clinical Centre in Prishtina during 2009-2011 years.Methods:We evaluated primary efficacy and safety at 24 weeks in patients enrolled in the study of long term efficacy of Rituximab and Etanercept. Patients with active Rheumatoid Arthritis and an inadequate response to 1 or more non biologic DMARDS were randomized to receive intravenous Rituximab (1 course consisting of 2 infusions of 1.000 mg each –one group, and Etanercept 25 mg twice weekly –second group, but both groups with background MTX. The primary efficacy end point was a response on the ACR 20%, improvement criteria at 24 weeks, Secondary end points were responses on the ACR 50 and ACR 70, improvement criteria, the DAS 28, and EULAR response criteria at 24 weeks.Results:During our investigations we treated 20 patients, 15 females and 5 males, in the treated group with RTX and 13 patients 8 females and 5 males in the treated group with ETN. Patients of group 1 and group 2 were of ages 37-69 years old and 19-69 years old (average 47-44) Most of the patients belong in 2nd and 3 rd functional stage according to Steinbrocker. All ACR response parameters were significantly improved in RTX treated patients who also had clinically meaningful improvement in fatigue, disability and quality of life. Patients showed a trend less progression in radiographic end points. Most adverse events occurred with the first RTX infusion and were mild to moderate severity.Conclusion:At 24 weeks, a single course of RTX and ETN provided significant and clinically meaningful improvements in disease activity in patients with active, longstanding RA who had an inadequate response to 1 or more nonbiologic DMARDS.

PReS-FINAL-2327: Abatacept in the treatment of refractory uveitis

Uveitis is one of the most serious manifestations of Juvenile Idiopathic Arthritis (JIA), with the potential to cause severe sight-threatening ocular complications. The first line treatment consists of topical and oral steroids with DMARDs therapy for more severe cases, including immunosuppressive and anti-TNFα agents. Abatacept (CTLA-4 immunoglobulin) is a soluble, fully human fusion protein that consists of the extracellular domain of CTLA-4, linked to a modified Fc portion of the human immunoglobulin IgG1, which does not activate the complement. The drug is approved for the treatment of polyarticular JIA.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have...

Current Immunotherapy in Rheumatoid Arthritis

Rheumatoid arthritis is a common autoimmune disease primarily manifesting as chronic synovitis, subsequently leading to a change in joint integrity. Progressive disability and systemic complications are strongly associated with a decreased quality of life. To maintain function and health in patients with rheumatoid arthritis, early, aggressive and guided immunosuppressive therapy is required to induce clinical remission. Antirheumatic drugs are capable of controlling synovial inflammation and are therefore named 'disease-modifying antirheumatic drugs' (DMARDs). This article aims to bridge the beginning of DMARD therapy with agents such as methotrexate, leflunomide, sulfasalazine, injectable gold and (hydroxy)chloroquine with biological therapies, and with the new era of kinase inhibitors. Mechanisms of action, as well as advantages and disadvantages of DMARDs, are discussed with respect to the current literature and current recommendations.

Self-Reported Productivity Losses of People with Rheumatoid Arthritis in Alberta, Canada

Objectives: To estimate the annual cost of productivity losses per person with RA by 0.5 increment in HAQscore, and the annual cost of productivity losses for Alberta province. Methods: Using data from the Alberta Biologics Registry - a prospective observational cohort of consecutive patients receiving DMARD or anti-TNF therapies created in 2004, we compared the mean and median costs of productivity losses per patient per year between HAQ-score categories using multiple linear and quantile regressions, respectively. We used a prevalence-based approach to estimate the cost (in 2010 CA$) of productivity losses of RA for Alberta. Results: In total there were 1222 patients with RA interviewed at the baseline. Of this, 358 were the “current employees” and 204 were the “previous employees” totalling 563 patients for analyses. For all HAQ-score categories, the mean (median) of the cost per patient per year was estimated at $18,242 ($3,840). The cost was increasing along with the HAQscore increase. The lowest cost ($6,295) was found in category HAQ&lt;=0.5 and the highest ($31,095) in category HAQ&gt;2.0. The significant differences were found between the worse categories (HAQ&gt;1.5) and the better categories (HAQ&lt;=1.5). The mean costs of productivity losses of RA for the province of Alberta were estimated at $270 million. Conservatively, if median was used for mean, the costs for province would be $57 million. Conclusion: The results suggest that an improvement in the controlling of RA could have a significant economic impact in Alberta and that preventing HAQ-score from the worse categories may be associated with substantial savings in terms of productivity losses.

QuantiFERON testing for cell-mediated immunity to cytomegalovirus in patients with rheumatoid arthritis receiving abatacept and other DMARD therapy

QuantiFERON testing for cell-mediated immunity to cytomegalovirus in patients with rheumatoid arthritis receiving abatacept and other DMARD therapy

THU0146 Clinical analysis of hepatitis B virus reactivation associated with non-biological disease-modifying antirheumatic drug(s) in patients with rheumatoid arthritis

BackgroundHepatitis B virus (HBV) reactivation, which refers to the abrupt rise in HBV replication in patients with inactive or resolved hepatitis B and is triggered typically by immunosuppressive chemotherapy in...

SAT0305 Costs of Best Supportive Care in the Treatment of Moderate-To-Severe Psoriatic Arthritis in the United States

BackgroundPsoriatic arthritis (PsA) is an inflammatory condition of the joints that occurs in up to 30% of patients with psoriasis. While the cost of DMARD therapy has previously been described,...

OP0016 The Influence of Patient and Physician Factors on Decisions to Adjust Therapy for Rheumatoid Arthritis Patients in Moderate to High Disease Activity

BackgroundThe European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recommend that rheumatoid arthritis (RA) patients should be treated to the target of low disease activity or...

FRI0118 Is the metabolic syndrome in rheumatoid arthritis patients influenced by the biologic therapy?

BackgroundMetabolic syndrome (MetS) is a definition encompassing the risk factors for cardiovascular diseases (hypertension, obesity, diabetes mellitus and lipid profile disorders). Recent studies show that MetS frequency is higher in...

OP0284 Impact of a Nurse Led Program of Patient Self-Assessment of Disease Activity on the Management of Rheumatoid Arthritis: Results of a Prospective, Multicentre, Randomized, Controlled Trial (Comedra)

BackgroundThe current T2T and EULAR recommendations (e.g. measures of disease activity must be obtained and documented regularly [1]. Nurses should promote self-management skills in order that patients might achieve a...

AB0455 Disease duration, but not rheumatoid factor status, impacts clinical response in adalimumab-treated rheumatoid arthritis patients with an inadequate response to standard dmard therapy: Subgroup analysis of the DE020 continuation trial

BackgroundRheumatoid factor (RF) is a prognostic marker of aggressive rheumatoid arthritis (RA); effective disease control may be more difficult in RF positive (+) patients (pts). Some biologic DMARDs have differential...

AB0495 Functional outcome in response to treatment with dmards compared to anti-TNF agents in a cohort with rheumatoid arthritis

BackgroundPatient focussed therapy in rheumatoid arthritis should meet the needs of the patients. From the perspective of the patient with rheumatoid arthritis control of symptoms and the prevention of disability...

FRI0089 Early glucocorticosteroid response predicts the effect of dmards after 3 months of therapy

BackgroundThe EULAR treatment guideline recommends rheumatologist to strive, in newly diagnosed rheumatoid arthritis (RA) patients, for remission or at least low disease activity within 3 months in order to obtain...

AB0235 Low vaccination status of patients with ra treated by biological drugs and dmards in czech republic

BackgroundThe risk of infections is increased by patients with RA. There is increasing evidence, that biological agents can contribute to risk of both non serious and serious infections. Vaccination is...

AB0384 Determination of multi-drug resistance activity in the lymphocytes of patients with systemic lupus erythematosus. results of 87 patients from a hungarian single center

BackgroundSystemic lupus erythematosus (SLE) is a prototypic autoimmune disease, where the treatment includes corticosteroids, DMARD-s and newly developed biological agents, but we often face drug resistance and thus inefficiency. One...

FRI0176 Golimumab, a human anti-TNF monoclonal antibody, administered subcutaneously every four weeks as monotherapy in patients with active rheumatoid arthritis despite dmard therapy: 52-week results of clinical, radiographic and pharmacokinetic assessments

ObjectivesTo assess the efficacy and safety of golimumab (GLM) as monotherapy in Japanese patients (pts) with active rheumatoid arthritis (RA) despite DMARD therapy.MethodsGO-MONO is a multicenter, randomized, double-blind, placebo (PBO)-controlled...

OP0083 Comparison of synovial tissue cytokine mrna profiles in very early arthritis patients with divergent outcomes

BackgroundIn the earliest clinically apparent phases of arthritis, it is difficult to distinguish patients who will develop RA from those whose disease will resolve. We hypothesised that synovial tissue cytokine...