DAS28 In Group Research Articles

Evaluation of a non-face to face multidisciplinary health care model in a population with rheumatoid arthritis vulnerable to covid-19 in a health emergency situation

Objectives: The COVID-19 pandemic has impacted everyday practice pattern of health care in rheumatoid arthritis (RA) patients. The objective was to evaluate the implementation of a tele-consultation program in an adult population with RA Methods: Analytical observational study longitudinal cohort (Clinical trials NCT04768413) that evaluated the effectiveness of a tele consultation model compared with a face-to-face consultation model in adult RA patients. Patients were followed 12 weeks (Jul-Oct 2020) at an RA center of excellence in Colombia. Simple random sampling was done. Two groups were included: Group A, patients who were cared for by tele-consultation care and Group B, thosewho wished to continue with the usual face-to-face consultation. Data regarding activity of disease (Week 0,6,12) [Patient Activity Scale (PAS) in both groups and DAS28 in group B], and Quality of life [EQ-5D-3L], disability [Health Assessment Questionnaire (HAQ)], therapeutic adherence [Morisky-Green Adherence Scale (MGLS)] and self-care capacity [Appraisal of Self-care Agency Scale -Revised (ASA-R)] were evaluated (weeks 0-12). Outcomes regarding COVID-19 were evaluated. Bivariate analysis was done (StataV-13;P-value remote>presential (p = 0,0001);the same result was documented in the group presential>remote>presential, with an increase in adherence (p = 0,033). 7 patients developed COVID-19 (one patient hospitalized/group A and one patient died/mixed model) Conclusion: In the tele consultation model patients remained adherent to their RA treatment, without major differences compared to the face-to-face model. It is important to know these results due to the impact they have, given the changes that will follow in the care of RA patients due the current pandemic. Studies with a longer follow-up period are required to corroborate these results.

Foot static disturbances and clinical features in overweight patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, inflammatory, connective tissue disease, leading to foot deformities, impairment of locomotive functions, and reducing patients' quality of life. Obesity prevalence is rising in early RA and is associated with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low Disease Activity Score in 28 joints (DAS28). The aim of the study was to evaluate foot deformities in overweight RA patients according to the severity of the disease. The study was performed on 50 overweight women with RA. The control group consisted of 50 overweight women free of any disorders. Plantography examination was carried out by means of a CQ ST 2K podoscope. Rheumatoid arthritis disease activity was assessed by DAS28. Activity limitation was assessed using the Health Assessment Questionnaire (HAQ) and foot posture by the Foot Posture Index (FPI-6). Body composition analysis was performed using In Body 220. Hallux valgus was the most frequent deformation in RA patients with overweight. Longitudinal flat foot was much more frequent in RA patients than transverse flat foot. A relationship between fat tissue mass and presence of transverse flat foot in RA patients with overweight was found. In this group DAS28, VAS, and Clarke's angle were correlated with increased value of HAQ. Plantar contourography showed a trend of an increase of α angle values and the Sztriter-Godunow index (KY) in overweight RA patients with increasing severity of radiological changes and DAS28, requiring use of proper prevention and therapeutic strategies of destructive changes.

ВЗАИМОСВЯЗЬ МЕЖДУ АНЕМИЕЙ И ПОРАЖЕНИЕМ СЕРДЦА У ПАЦИЕНТОВ С РЕВМАТОИДНЫМ АРТРИТОМ

Objective: To determine the impact of anemia on the structural-geometrical condition of the heart in patients with rheumatoid arthritis (RA). Methods: 154 patients with RA were included in the study: 37 patients with anemia (1st group) and 117 – without systemic manifestations of RA (2nd group). All patients underwent echocardiography. Results: Both groups were comparable in age, sex, ratio of seropositive and seronegative patients. A comparative analysis of both groups revealed that in 1st group DAS28 was higher than in 2nd group (p<0.05). The left ventricular myocardial mass index was higher in 1st group than in the 2nd group (p<0.05). The same applies to the left ventricular end-diastolic diameter: in patients with anemia, it was more than in patients without it (p<0.05). Our results suggest that patients with anemia often have a violation of diastolic myocardial function, which is accompanied by an increase in myocardial mass. The correlation analysis in both groups revealed a direct relationship between age and left ventricular mass index (r=0.62, p<0.0005), inverse relationship between age and E/a parameter of mitral valve (r=-0.71, p<0.00001). In addition, in 1st group we revealed the inverse relationship between DAS28 and E/a parameter of tricuspid valve (r=-0.43, p<0.05). Conclusion: Thus, regardless of the presence of anemia, the patients with RA observed dependence of structural and functional changes in the heart of age: a violation of diastolic function of the left ventricle, an increase of the left ventricular myocardial mass index. However, in patients with anemia, an increase in the activity of the disease is accompanied by diastolic dysfunction of the right ventricle that requires correction in patient management process. Keywords: Rheumatoid arthritis, anemia, echocardiography, diastolic dysfunction.

AB0397 Carotid atherosclerosis and metabolic syndrome in patients with rheumatoid arthritis

BackgroundCardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA) is associated with early atherosclerosis. A possible explanation could be the metabolic syndrome (MetS) and inflammation.ObjectivesTo evaluate MetS prevalence and...

Efficacy and Safety of Leflunomide or Methotrexate plus Subcutaneous Tumour Necrosis Factor-Alpha Blocking Agents in Rheumatoid Arthritis

Several smaller retrospective case series have concluded that leflunomide (LEF) in combination with anti-TNF-alpha blocking agents appears to be effective and safe. Prospective case series and cohort studies have generally confirmed the efficacy of this combination. Overall, there is currently no evidence from controlled trials that an anti-TNF-alpha combination with LEF is as effective as an anti-TNF-alpha combination with methotrexate (MTX). We compared the effectiveness and safety of a therapeutic regimen associating subcutaneous anti-TNF-alpha agents, etanercept (ETN) and adalimumab (ADA), with leflunomide (LEF) or methotrexate (MTX), in a two year open-label study performed in clinical practice. We evaluated 96 patients with active rheumatoid arthritis undergoing therapy with ADA at the dose of 40 mg every other week, or with ETN at the dose of 50 mg/week for two years added to prednisolone (PDN) at the mean dose of 5.2±2.6 mg/day. Fifty-four of these patients were also undergoing therapy with MTX at the mean dose of 11.7±2.6 mg/week, while 42 patients were undergoing therapy with LEF at the daily dose of 20 mg. At 12 months, the analysis of variance showed an improvement of DAS28 in both groups (p<0.001), with a reduction in 33.3% of the patients in treatment with LEF and in 51.8% of the patients in treatment with MTX (p = 0.20). At 18 months, improvement was present in 33.3% of the patients in the LEF group and in 81.5% of the patients in the MTX group (p=0.001). This improvement seems to be independent of the anti-TNF-alpha agent, even if MTX produces the highest DAS28 reduction when used in association with ETN (p<0.078). We found no difference in drug discontinuation rates or in effectiveness measures between anti-TNFalpha+MTX and anti-TNFalpha+LEF. Our data showed a greater reduction of DAS28 in the MTX group and, in combination with ETN, better results after two years of therapy.