Impact Of Disease-modifying Antirheumatic Drugs Research Articles

Correlation Of Lipid Profile and Das28 Score of Early Rheumatoid Arthritis Patients on Conventional Synthetic Dmards

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and a higher risk of cardiovascular diseases. The relationship between RA disease activity, lipid profiles, and the impact of disease-modifying antirheumatic drugs (DMARDs) on these parameters is an area of ongoing research. Objective: This study aimed to investigate the correlation between lipid profiles and the Disease Activity Score in 28 joints (DAS-28) in patients with early RA who were on conventional synthetic DMARDs. Methods: In this cross-sectional study, 30 RA patients from a rheumatology department were enrolled over six months. The study included adults aged 30-70 years, of both genders, who had been on DMARDs for at least 6 months. Exclusion criteria included fracture of the affected joint, pregnancy, use of steroids or lipid-lowering agents, and heavy smoking. Data on demographics, disease duration, type of DMARDs, and lipid profiles were collected. The DAS-28 score was calculated for each patient. Statistical analysis was performed using SPSS Version 25, with Pearson’s Correlation coefficient used to measure relationships between variables. Results: The cohort consisted of 53.3% males and 46.7% females, with a mean age of 48.23 years. The majority (76.7%) were rheumatoid factor positive. The most commonly used DMARD was Methotrexate (46.7%). The study found strong negative correlations between DAS-28 scores and lipid levels: total cholesterol (Pearson's r = -0.837), triglycerides (r = -0.759), LDL (r = -0.720), and HDL (r = -0.689). BMI showed a significant positive correlation with DAS-28 (r = 0.711). A notable negative correlation was observed between the duration of DMARD use and DAS-28 scores (r = -0.777). Conclusion: The study indicates a significant correlation between lipid profiles and disease activity in RA patients on DMARDs. The findings suggest that effective RA management with DMARDs could influence lipid metabolism and potentially reduce cardiovascular risks. These insights are crucial for developing comprehensive RA treatment strategies that encompass both joint health and cardiovascular considerations.

Considerations for Pharmacologic Management of Rheumatoid Arthritis in the COVID-19 Era: a Narrative Review.

To review the impact of disease-modifying antirheumatic drugs (DMARDs) on COVID-19 severity and vaccine immunogenicity and to discuss COVID-19 outcomes in patients with rheumatoid arthritis (RA). Rituximab is associated with severe COVID-19 and impaired vaccine immunogenicity via its B cell-depleting mechanism. JAK inhibitors and glucocorticoids have been modestly associated with severe COVID-19 and impaired vaccine immunogenicity. TNF inhibitors may have a protective effect against severe COVID-19 and do not appear to affect vaccine immunogenicity. Clinical trials have shown improved seroconversion and antibody titers when methotrexate is held around vaccine doses, but this may yield increased risk of RA flare. Patients with RA are also impacted by DMARD disruption, RA flares, and post-acute sequelae of COVID-19 after COVID-19 infection. Given the risks of COVID-19, rituximab should be used with caution in RA. Holding methotrexate doses around COVID-19 vaccination improves immunogenicity but may increase RA flare risk.

Positive impact on 10-year outcome of the window of opportunity for conventional synthetic DMARDs in rheumatoid arthritis: results from the ESPOIR cohort.

ObjectiveThis study aimed to assess the impact of disease-modifying antirheumatic drugs (DMARDs) on 10-year outcomes in rheumatoid arthritis (RA).MethodsPatients with RA from the ESPOIR cohort with complete data on Disease Activity Score in 28 Joints (DAS28) and Health Assessment Questionnaire (HAQ) at 10 years (n=418) and complete radiographic data at baseline and 10 years (n=343) were included in this study. Outcomes were favourable outcome (FavOut) at 10 years, defined as DAS28 of <2.6 and HAQ score of <0.5 at 10 years, and absence of structural damage progression (AbsSDP) at 10 years, defined as change in Sharp-van der Heijde Score less than the smallest detectable change at 10 years (11.5 points). Three multivariate logistic regression models predicting 10-year outcome were built, considering (1) baseline variables only, (2) baseline variables and DMARD exposure (ever exposed, yes/no) and (3) baseline variables and DMARD exposure as weighted cumulative exposure (WCE) variables.ResultsOverall, 196/418 (46.9%) patients showed FavOut and 252/343 (73.5%) AbsSDP. WCE models had the best predictive performance, with area under the curve=0.80 (95% CI 0.74 to 0.87) for FavOut and 0.87 (95% CI 0.83 to 0.92) for AbsSDP. In the WCE model, the odds of FavOut and AbsSDP were reduced with conventional synthetic disease-modifying antirheumatic drug (csDMARD) initiation at 12 months versus at baseline (OR 0.78, 95% CI 0.65 to 0.94, and OR 0.89, 95% CI 0.76 to 0.98, respectively). Early biologics initiation was not significantly associated with either outcome.ConclusionsWCE models can identify and quantify the long-term benefit of early csDMARD initiation on 10-year functional and structural outcomes in patients with RA.

БАЗИСНЫЕ ПРОТИВОВОСПАЛИТЕЛЬНЫЕ ЛЕКАРСТВЕННЫЕ СРЕДСТВА И ИХ ВОЗДЕЙСТВИЕ НА ДЫХАТЕЛЬНУЮ СИСТЕМУ У ПАЦИЕНТОВ СО СПОНДИЛОАРТРИТАМИ И РЕВМАТОИДНЫМ АРТРИТОМ

At present interaction peculiarities of disease-modifying anti-rheumatic drugs and respiratory system in patients with spondyloarthritеs and rheumatoid arthritis are subject to thorough investigation and reassessment. Objective. To assess the impact of disease-modifying anti-rheumatic drugs (methotrexate) on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis. Material and methods. The research involved 172 patients with spondyloarthritеs and rheumatoid arthritis. The patients were interviewed and examined. The multispiral computer tomography of thorax was performed in order to determine the volume and nature of lung affection. Lung function was tested by means of spirometry and body plethysmography. In order to process the data Statistica 10 software package was used. Results. Lung disorders were found in 77,1% of patients with rheumatoid arthritis who were taking methotrexate while the percentage of patients with lung affection who were not taking disease-modifying anti-rheumatic drugs reached 100%. The patients with spondyloarthritеs or rheumatoid arthritis who were taking methotrexate showed significantly higher parameters of vital capacity and forced vital capacity than the patients with spondyloarthritеs or rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Conclusion. Lung disorders were found more rarely in patients with rheumatoid arthritis who were taking methotrexate as compared to patients with rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Taking into account the assessment of the lung function, we can talk of absence of the negative impact of methotrexate on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis.

Incident diabetes associated with hydroxychloroquine, methotrexate, biologics and glucocorticoids in rheumatoid arthritis: A systematic review and meta-analysis

ObjectivesTo evaluate the impact of disease-modifying antirheumatic drugs on the risk of developing diabetes in rheumatoid arthritis (RA) patients without diabetes. MethodsElectronic database searches of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed from inception to October 2019. The studies assessing the association between diabetes and antirheumatic agents in RA patients in cohort or case-control design were included. Data were pooled using fixed-effects or random-effects meta-analysis according to I2 and pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were used as summary statistic. ResultsA total of 15 studies involving 552,019 patients with RA (11 for hydroxychloroquine, 7 for methotrexate, 6 for tumor necrosis factor inhibitors [TNFi], and 8 for glucocorticoids) were included. In pooled analysis, a reduced risk of diabetes was reported with hydroxychloroquine (meta-HR 0.61, 95% CI 0.56–0.66), methotrexate (meta-HR 0.81, 95% CI 0.75–0.87), TNFi (meta-HR 0.63, 95% CI 0.55–0.71), while glucocorticoids was associated with an increased risk of developing diabetes in a dose-dependent manner (Any dose: meta-HR 1.46, 95% CI 1.39–1.53; <10 mg/day prednisolone or equivalent: meta-HR 1.30, 95% CI 1.13–1.51; ≥10 mg/day prednisolone or equivalent: meta-HR 2.25, 95% CI 1.88–2.70). ConclusionsHydroxychloroquine, methotrexate and TNFi were associated with decreased risk of diabetes, and glucocorticoids with increased risk in RA patients. These important findings may aid clinical decision-making in the management of RA. Large, prospective, well-designed studies are needed in the RA patients with high-risk diabetes.

A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness

A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness