Mean Swollen Joint Count Research Articles

Real-Life Data of Secukinumab in Patients with Moderate to Severe Plaque Psoriasis, Psoriatic Arthritis, and Ankylosing Spondylitis: Patient Baseline Characteristics Data from the PROMPT Study.

Secukinumab has proven to be effective and safe in psoriasis (PsO), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in the phase3 studies. However, data on real-world practice is limited. This study is an ongoing, multicenter, 2-year observational study that focuses on patients with moderate to severe plaque PsO, active PsA, or AS receiving secukinumab. The aim of this study is to present baseline data for the entire study population. A total of 127 patients were enrolled, with 101having PsO, 12 with PsA, and 14 with AS. Among the patients, approximately 54.0% were male. The mean body mass index ranged from 25.0 to 27.4kg/m2 across all groups. Patients with PsO had the longest disease duration with an average of 11.0years, followed by AS (3.0years) and PsA (1.0year). Previous biologic therapy was observed in 6.9-8.1% of patients. Baseline disease severity scores revealed moderate to severe disease. In the PsO group, the mean Psoriasis Area and Severity Index score was 16.1. For patients with PsA, the mean Tender Joint Count was 9.1, and the mean Swollen Joint Count was 6.7. In the AS group, the mean Bath Ankylosing Spondylitis Disease Activity Index score was 4.6, and the mean Ankylosing Spondylitis Disease Activity Score was 3.7. The study demonstrates disease durations, disease activity, and treatment history in Thai patients that were generally consistent with previous randomized controlled studies. Long-term data on the efficacy and safety of the treatment will be presented in future publications.

E06 Does GGT level correlate with activity parameters in enthesitis-related arthritis?

Abstract Introduction Enthesitis-related arthritis (ERA) is one of the main subgroups of juvenile idiopathic arthritis. As in the adult population, monitoring of patients with ERA is based on clinical and laboratory evaluation. Some studies showed a correlation between Gamma-glutamyl transferase (GGT) levels and rheumatoid arthritis disease activity markers. Thus, we aimed to evaluate the correlation between GGT levels and ERA activity parameters. Methods This is a cross-sectional monocentric study including patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria for ERA. We collected the demographic and clinical data. We assessed the ERA activity using clinical parameters including Patient Global Assessment (PGA), Visual Analogue Scale (VAS), Morning stiffness (MS), tender joint count (TJC), swollen joint count (SJC), active enthesitis count (AEC), clinical sacroiliitis, back mobility, and ocular involvement. We collected biological parameters such as the C-reactive protein (CRP) and the Erythrocyte sedimentation rate (ESR). We calculated the Juvenile spondyloarthritis disease activity (JSpADA). GGT level was measured on the same day. The correlation was evaluated using Spearman’s rho coefficient (r). r-value <0.3 was considered poor; between 0.3 and 0.39, moderate; between 0.4 and 0.69, strong; and >0.7 very strong. Results Thirty patients with a mean age of 15.1 ± 4.1 years, and a ratio-sex of 2.75 were included. The mean disease duration was 4.3 ± 3.2 years. The mean PGA and the mean VAS were 6.2 ± 7.1 and 8.9 ± 2.9 respectively. Mean TJC, mean SJC, and mean AEC were 1.53 ± 2.8, 0.18 ± 0.47, and 1.2 ± 1.6 respectively. Clinical sacroiliitis was found in eight patients, limited back mobility in six, and uveitis in three patients. The mean CRP and ESR were 15.1 ± 22.7 mg/l and 23.8 ± 21.2 mm, respectively. The mean JSpADA was 2.6 ± 1.7. Mean GGT was 14.3 ± 6.6 mg/l. A strong correlation was noted between the GGT level and both CRP (r = 0.504, P = 0.05) and ESR (r = 0.601, P = 0.01). However, no correlation was noted between GGT level and PGA (r = 0.107, P = 0.6), VAS (r = 0.03, P = 0.9), SJC (r = -0.17, P = 0.368), nor JSpADA (r = 0.323, P = 0.87). Conclusion Our results suggest a strong correlation between GGT level and biological ERA activity parameters, unlike clinical parameters and disease activity scores. More studies are needed to confirm these findings. Ethics The authors have no conflicts of interest to declare.

Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis.

To investigate sex-based sonographic differences in patients with psoriatic arthritis (PsA). The study population included consecutive prospectively recruited patients with PsA, as determined by the CASPAR (Classification for Psoriatic Arthritis) criteria, who underwent clinical and physical examinations, followed by a detailed ultrasound (US) evaluation (greyscale and Doppler). US evaluation included 52 joints, 40 tendons, and 14 points of entheses (Modified Madrid Sonographic Enthesis Index [MASEI] plus lateral epicondyles) performed by an experienced sonographer blinded to the clinical data. The US score was based on the summation of a semiquantitative score for synovitis, tenosynovitis, and enthesitis. The US enthesitis score was categorized into inflammatory lesions (ie, hypoechogenicity, thickening, bursitis, and Doppler) and structural lesions (ie, enthesophytes/calcifications and erosions). The study population of 158 patients included 70 males and 88 females. The males had higher rates of employment (P = 0.01), Psoriasis Area and Severity Index scores (P = 0.04), and mean swollen joint counts (P = 0.04). The total US score and its subcategory scores-the synovitis and tenosynovitis scores-were similar for both sexes, whereas the total enthesitis score and its subcategory score-the inflammatory enthesitis score-were significantly higher for the males compared to the females (P = 0.01 and P = 0.005, respectively). Hypoechogenicity, thickening, and enthesophytes were more prevalent in males compared to females (P < 0.05). Multivariate ordinal logistic regression models showed that male sex was associated with a higher US inflammatory enthesitis score compared to female sex (odds ratio 1.96, P = 0.02). Sonographic enthesitis was more prevalent in males compared to females with PsA. These differences were not reflected by enthesitis disease activity scores derived from clinical assessment.

21 Disease activity and body mass index in juvenile idiopathic arthritis: is the truth revealed?

BackgroundActive disease in chronic rheumatic diseases in adults seems to be associated with overweight and obesity [1]. Juvenile Idiopathic Arthritis (JIA) is the most frequent rheumatic disease in children. The relationship between body mass index (BMI) and disease activity in JIA patients is less studied.ObjectiveTo determine the link between BMI and disease activity in JIA patients.MethodsWe conducted a cross-sectional study including 35 JIA patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria.For each patient, we collected the following data: age, age at the onset of JIA, disease duration, patient global assessment (PGA), visual analogic scale (VAS), tender joint count (TJC), swollen joint count (SJC), disease activity using the Juvenile Arthritis Disease Activity score (JADAS), and therapeutic management.The weight and height were measured for each patient. The BMI was calculated and interpreted according to the World Health Organization classification.We also measured C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) level.ResultsWe included 15 boys and 20 girls. The mean age was 12.2 ± 3.61 years. The mean age at the onset of the disease was 8.65 ± 3.83 years. The mean disease duration was 4.1 ± 3.29 years.The mean PGA and the mean VAS were 3.4 ± 3.02 and 3.37 ± 2.92, respectively.The mean TJC and the mean SJC were 1.48 ± 1.69 and 0.61 ± 0.77, respectively.The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively.The mean JADAS was 7.58 ± 6.3. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 10 patients were under methotrexate (34%), and 5 patients were under TNFα inhibitor (14%).The mean BMI was 19.94 ± 5.46 kg/m². Fourteen patients were underweight (40%), 15 patients had a BMI in the normal range (43%), 4 patients were overweight (11%), and 2 patients were obese (6%).Underweight patients had higher PGA, higher CRP level, higher tender joint count (TJC), and higher JADAS compared with overweight and obese patients, but without significant difference (PGA: 2.97 ± 2.6 vs 2 ± 1.89, p = 0.4; CRP: 7.54 ± 15.09 vs 4.25 ± 4.19 mg/l, p = 0.6; TJC: 1.7 ± 1.56 vs 1 ± 0.8, p = 0.3, and JADAS: 6.3 ± 6.18 vs 2.98 ± 2.24, p = 0.1).No correlations were found between BMI and the following parameters: TJC, SJC, EGP, CRP, ESR, and JADAS.ConclusionData about associations between underweight, obesity, and disease activity in JIA are conflicting. Some authors suggested that active disease is associated with adiposity [2]. Others showed that underweight patients had higher disease activity [3]. Although there was no significant difference, our study is consistent with Neto et al. study. Indeed, active disease seems to affect the child’s appetite and weight gain leading to cachexia [3]. Other studies are needed to confirm these results.

Effects of Combination Therapy of Methotrexate with Sulfasalazine and Hydroxychloroquine: Comparative Clinical Trial

Aims: To study the role of two combination therapies in the treatment of rheumatoid arthritis. Study Design: This an open-label, randomized 180-days clinical trial.&#x0D; Place and Duration of Study: This study was conducted in the Department of Pharmacology and Therapeutics, BMSI and Medical unit ward 6.&#x0D; Methodology: Eighty-nine patients were enrolled (69 women, 20 men; age range 28-62 years). A and B were the groups assigned to the patients. MTX 7.5-20 mg/ week orally and SSZ 10-20 mg / day orally as maximally tolerated were prescribed to the 55 patients of group A. MTX 7.5-20 mg/ week orally and HCQ 200 mg twice daily were prescribed to the 54 patients of group B..&#x0D; Results: When we compared group A with group B, group A showed major progress in mean swollen joint count (1.9 ± 0.97) as compared to group B (2.7 ± 1.78). Group B showed major progress in mean physician’s global assessment (2.7 ± 0.92) as compared to group A (3.8 ± 1.22). For that reason, our study showed that patients receiving both the combinations responded equally in terms of efficacy but the combination of MTX and HCQ is better tolerated than the combination of MTX and SSZ.&#x0D; Conclusion: Both combinations of MTX &amp; SSZ and MTX &amp; HCQ were equally effective but the combination of MTX &amp; HCQ was superior in terms of tolerability than the combination of MTX and SSZ.

Assessing the risk of rapid radiographic progression in Hungarian rheumatoid arthritis patients

BackgroundThe outcome of rheumatoid arthritis (RA) should be determined early. Rapid radiological progression (RRP) is > or = 5 units increase according to the van der Heijde-Sharp score within a year. The risk of RRP can be estimated by a matrix model using non-radiographic indicators, such as C-reactive protein (CRP), rheumatoid factor (RF) and swollen joint count (SJC).Patients and methodsA non-interventional, cross-sectional, retrospective study was conducted in eleven Hungarian arthritis centres. We assessed RRP risk in biologic-naïve RA patients with the prevalence of high RRP risk as primary endpoint. RRP was calculated according to this matrix model. As a secondary endpoint, we compared RRP in methotrexate (MTX) responders vs non-responders.ResultsWe analyzed data from 1356 patients. Mean CRP was 17.7 mg/l, RF was 139.3 IU/ml, mean 28-joint disease activity score (DAS28) was 5.00 and mean SJC was 6.56. Altogether 18.2% of patients had high risk (≥40%) of RRP. RA patients with high RRP risk of RRP (n = 247) had significantly lower age compared to those with RRP < 40% (n = 1109). MTX non-response (OR: 16.84), male gender (OR: 1.67), erosions at baseline (OR: 1.50) and ACPA seropositivity (OR: 2.18) were independent predictors of high-risk RRP. Male gender (OR: 5.20), ACPA seropositivity (OR: 4.67) and erosions (OR: 7.98) were independent predictors of high RRP risk in MTX responders.ConclusionsIn this Hungarian study, high RRP risk occurred in 18% of RA patients. These patients differ from others in various parameters. RRP was associated with non-response to MTX.

Tocilizumab, an anti-interleukin-6 receptor antibody, efficiently ameliorates persistent joint inflammation in rheumatoid arthritis

Objectives To assess the efficacy of tocilizumab (TCZ) in the treatment of persistent arthritis in patients with rheumatoid arthritis (RA). Methods The response to TCZ was evaluated in 304 patients with RA. TCZ treatment was completed after no fewer than 168 consecutive days between 28 May 2008 and 31 July 2019. Efficacy was evaluated using the DAS28-ESR and EULAR response criteria. Results The mean DAS28-ESR decreased from 4.5 at baseline to 2.0 and 1.5, at 2 months and 1 year after treatment initiation, respectively, and was below 1.5 at 10 years. The retention rate within 1 year was 92.3%. TCZ re-administration to 74 patients with relapsed RA after TCZ withdrawal was also effective. The mean DAS28-ESR decreased from 4.4 at baseline to 1.8 and 1.6 at 2 months and 1 year after retreatment initiation, respectively. The mean swollen joint count decreased from 4.1 in initial TCZ administration and 2.8 in re-administration at baseline to 0.8 and 0.4 at 2 months, respectively. In all patients, good or moderate responses were achieved at least once within 12 months in both initial TCZ administration and re-administration. Conclusion TCZ efficiently ameliorated persistent arthritis in RA, regardless of initial administration and re-administration.

Patient global assessment in psoriatic arthritis – what does it mean? An analysis of 223 patients from the Psoriatic arthritis impact of disease (PsAID) study

ObjectivePatient global assessment is a key outcome measure in psoriatic arthritis. To explore the meaning of patient global assessment in psoriatic arthritis by examining associations to domains of health assessed by the Psoriatic arthritis impact of disease score. MethodsPost-hoc analysis of a multicentre cross-sectional study of patients with psoriatic arthritis. Data collection included patient global assessment, specific joint and skin global patient assessments, Psoriatic arthritis impact of disease questions covering physical (including joints and skin), psychological and social impact, and other comparator outcomes. Univariate analyses (Pearson correlation) and multivariate linear regression were performed to explain patient global assessment and the specific joint and skin global patient assessments. ResultsAmong 223 patients (mean age: 51.0 [standard deviation, ±13.3] years; mean disease duration: 9.9 [±10.1] years; mean swollen joint count: 4.1 [±5.1]; 84.3% with current psoriasis [mainly of less than 5% body surface area]), 50.2% were females. Mean patient global assessment was 4.8 (±2.7), mean joint and skin patient assessments were respectively 5.6 (±2.5) and 4.1 (±3.0). Intraclass correlation between patient global assessment and joint or skin patient assessment was respectively 0.71 (95% confidence interval, 0.64–0.77) and 0.52 (95% confidence interval, 0.42–0.60). In multivariate analyses, patient global assessment was explained (R2 of model: 0.754) by coping (β = 0.287); pain (β = 0.240); work and/or leisure activities (β = 0.141); and anxiety (β = 0.109). ConclusionsPatient global assessment in psoriatic arthritis was explained mainly by physical, but also psychological aspects of the disease.

In wealthier countries, patients perceive worse impact of the disease although they have lower objectively assessed disease activity: results from the cross-sectional COMORA study

ObjectivesTo investigate patterns in patient-reported and physician-reported disease outcomes in patients with rheumatoid arthritis (RA) from countries with different level of socioeconomic development.MethodsData from a cross-sectional multinational study (COMOrbidities in...

AB1012 Contribution of Ultrasonography in the Diagnosis of the Very Early Rheumatoid Arthritis

BackgroundImaging in early rheumatoid arthritis (RA) has undergone extraordinary change in recent years and new techniques are now available to help the clinician diagnose and manage patients much more effectively...

SAT0589-HPR Body Mass Index and Its Relationship to Disease Activity in Early Rheumatoid Arthritis

BackgroundObesity rates in Canada have increased 3% (to 25%) over the past 8 years. Obese patients develop more severe forms of many diseases and have more comorbidities develop over time....

OP0151 A Phase 2B, 24-Week Study of VX-509 (DECERNOTINIB), an Oral Selective Janus Kinase 3 Inhibitor, in Combination with Background Methotrexate in Rheumatoid Arthritis

BackgroundVX-509 is an oral selective JAK3 inhibitor being evaluated for the treatment of rheumatoid arthritis (RA). This was a 24-week, randomized, placebo-controlled, double-blind, phase 2 study of four dosing regimens...

FRI0324 Which Factors Influence the Prescription of TOCILIZUMAB (TCZ) Alone or in Combination with DMARDS in Rheumatoid Arthritis Patients in A REAL Life Setting? the Act Solo Study

BackgroundEULAR guidelines1 recommend to use biologics in combination with a DMARD, usually methotrexate (MTX). However, biologics in monotherapy (Mono) represent about 30% of the biologic-treated rheumatoid arthritis (RA) patients (pts)...

OP0149 A Phase 2B Study of an Oral JAK Inhibitor ASP015K Monotherapy in Japanese Patients with Moderate to Severe Rheumatoid Arthritis

BackgroundASP015K is a novel oral Janus kinase (JAK) inhibitor in development for the treatment of rheumatoid arthritis (RA). ASP015K inhibits JAK1/3 with more selectivity over JAK2 and can be dosed...

AB0221 Does Etanercept Maintain Its Efficacy in the Elderly Population. A Single Center Retrospective Analysis

BackgroundBiological drugs have dramatically improved the prognosis of rheumatoid arthritis (RA), especially in those with early disease. These patientsare often in younger age with fewer co-morbidities. Recent Canadian data suggests...

SAT0380 Do Patients Know Best? Reliability of Electronic Patient Self-Evaluation of Swollen and Tender Joints in Psoriatic Arthritis: A Comparison Study with B-Mode Ultrasonography, Physician and Nurse Assessments

Background68 tender (TJC) and 66 swollen joint counts (SJC) are recommended for disease activity assessment in psoriatic arthritis (PsA). However there are time constraints and these counts may not be...

AB0508 Assessment of synovitis using ultrasonography in tocilizumab treated rheumatoid arthritis patients remaining in clinical remission

BackgroundIn rheumatoid arthritis (RA), in order to prevent the progression of joint destruction, it is important to prevent synovitis, primarily in swollen joints. We have already reported that Tocilizumab (TCZ)...

AB0303 Tocilizumab in rheumatoid arthritis – annual interim analysis of the german non-interventional study ichiban

BackgroundThe ICHIBAN study collects routine clinical data to evaluate the effectiveness and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) in real world practice over a period of...

Clinical Characteristics of Korean Rheumatoid Arthritis Patients with Indications for TNF-α Blocker

Objective. The aim of this study was to examine clinical characteristics of Korean rheumatoid arthritis (RA) patients with clinically indications for TNF-α blocker, and to compare their clinical parameters with the Korean National Health Insurance reimbursement criteria. Methods. Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym University affiliated hospitals. Among patients who were previously prescribed DMARDs for more than three months, rheumatologists selected patients clinically indicated for TNF-a blocker. The clinical characteristics at the time TNF-α blocker use was deemed indicated were examined. Radiographic damage was quantified by Modified Sharp van der Heijde score in hand and foot simple AP radiograph. Results. From August 2010 to January 2013, five rheumatologists in four hospitals selected 109 patients clinically indicated for TNF-α blocker. When TNF-α blocker was considered, mean DAS28 was 5.2 (range 2.1∼8.05), mean swollen joint count was 6 (range 0∼22), mean tender joint count was 10.6 (range 0∼28), mean ESR was 43.2 mm/hr (range 1∼140) and mean CRP was 2.5 mg/dL (range 0.1∼ 18.3). The mean total modified Sharp van der Heijde score was 32.72 (range 0∼240). Eighty one percent of subjects did not have enough active joints to satisfy the Korean National Health Insurance reimbursement standard. Conclusion. Our results show that patients with clinically indications for TNF-α blocker had a broad range of disease activity and clinical parameters, and the majority did not meet the Korean National Health Insurance reimbursement criteria

Exaggerated circulating Th-1 cytokine response in early rheumatoid arthritis patients with nodules

BackgroundImmunohistochemical studies of the rheumatoid nodule (RN) suggest it is a Th1 granuloma, with focal vasculitis, yet the pathogenesis remains unclear and little is known about circulating cytokines in these patients. ObjectiveWe studied circulating cytokines in DMARD-naïve RA patients to investigate associations with subcutaneous RN. Methods149 DMARD-naïve adults with early RA (symptom duration ⩽2years) were assessed using the Simplified Disease Activity Index (SDAI), and hand and feet radiographs were scored using the modified Larsen method. Circulating cytokines and growth factors representative of T-helper cell 1(Th1) and Th2 cell, macrophages, and fibroblasts were measured using the Bio-Plex® suspension array system. ResultsOf 149 patients, 34 (22.8%) had subcutaneous RN, and these patients had more severe disease with higher mean swollen joint counts (p=0.02), SDAI (p=0.04) and modified Larsen scores (p=0.004). There were no differences in Rheumatoid Factor or anti-cyclic citrullinated peptide antibody positivity between patients with RN and those without RN. Patients with RN showed significantly higher levels of circulating IL-12 (p=0.02), IL-2 (p=0.048), and VEGF (p=0.033) levels, with a trend towards higher levels of IL-7 (p=0.056), IFN-γ (p=0.059) and IL-8 (p=0.074) compared to those without RN. ConclusionsDMARD-naïve early RA patients with RN had more severe disease than those without RN, and showed an exaggerated circulating Th1 and macrophage cytokine profile.