Rheumatoid Arthritis Patients In Remission Research Articles

Biologic-free remission by orthopaedic surgery in non-responder to infliximab for rheumatoid arthritis

The aim of this study was to investigate remission and biologic-free remission after orthopaedic surgery and related clinical factors in non-responder to infliximab for rheumatoid arthritis (RA). We analyzed 74 patients who were treated with 3 mg/kg infliximab and methotrexate and underwent orthopaedic surgery after non-responder to infliximab with disease activity score (DAS) 28 (CRP) of ≥3.2. The rates of remission and biologic-free remission at 52 weeks after orthopaedic surgery were investigated and the clinical factors related to remission and biologic-free remission were analyzed by logistic regression and receiver-operating characteristic analyses. The rates of total remission and biologic-free remission were 37/74 (50 %) and 9/74 (12.2 %), respectively. Regarding orthopaedic surgery, the rates of remission and biologic-free remission were 25/38 (65.8 %) and 7/38 (18.4 %) for synovectomy, 7/20 (35 %) and 0/20 (0 %) for arthroplasty, and 5/16 (31.3 %) and 2/16 12.5) for others including spine surgery and foot surgery. DAS28(CRP) at baseline was significantly related to both remission and biologic-free remission. Prednisolone was negatively associated with remission, and DAS28(CRP) was related to biologic-free remission by logistic regression analyses. DAS28(CRP) below 3.7 was cutoff point for acquiring biologic-free remission of non-responder to infliximab after orthopaedic surgery. Therefore orthopaedic surgery may be effective to obtain remission or biologic-free remission in RA patients treated with biologics.

Signs of forefeet joint synovitis have a limited impact on patient's perception of rheumatoid arthritis disease activity and acute-phase reactants

Objectives. To determine the prevalence and distribution of signs of synovitis in the residual joints in remission defined by the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria and the role of their components in preventing misclassification due to reduced joint count.Methods. The cross-sectional observational data of RA patients including full joint counts were analyzed. Definitions of remission used were the ACR/EULAR RA remission criteria and their modifications using full joint counts with the same thresholds of the items and the calculated results.Results. A total of 304 RA patients with 3,149 observations could be analyzed. Patients in remission according to the ACR/EULAR remission criteria can still show residual disease activity in the feet in up to 27% of the population with a 28-joint count remission. Residual disease activity has no impact on patient's global assessment for current disease activity, when signs of concomitant ankle joint synovitis were absent.Conclusions. RA patients in remission according to the ACR/EULAR definitions can still show signs of synovitis mostly in the forefeet joints. Acute-phase reactants and patient's global assessment for current disease activity have little impact in mitigating the limitation of reduced joint count.

Proteinase-activated receptor 2 expression on peripheral blood monocytes and T-cells in patients with rheumatoid arthritis

Aim of the workProteinase-activated receptor 2 (PAR2) is a G protein-coupled receptor activated by serine proteinases with proinflammatory activity. The aim of this work was to evaluate the expression of PAR2 on peripheral blood monocytes and T-cells in rheumatoid arthritis (RA) patients and its correlation with disease activity. Patients and methodsForty RA patients and 16 healthy controls were enrolled in this study. Flow cytometry was performed to detect PAR2 expression. Disease activity score (DAS28) was assessed. ResultsPAR2 expression was significantly higher on monocytes in RA patients with active disease compared with patients in remission and healthy controls (75.4±7.68; 56±13.93 and 46.5±9.8 respectively; p<0.001). It was higher in RA patients in remission compared to healthy control (p=0.01). No significant difference was found between patients with moderate and high disease activity. It significantly correlated with the erythrocyte sedimentation rate (ESR) and DAS28 (p<0.001). It was significantly higher in patients with rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) positivity (p=0.01, p<0.001, respectively). It was not significantly associated with C-reactive protein (CRP) positivity and was not significantly different between early and long standing RA patients. PAR2 expression on CD3+ T-cells was not significantly different between patients with RA disease activity, patients in remission and healthy controls. Also it was not significantly associated with the ESR, DAS28, anti-CCP, RF and CRP positivity. ConclusionPAR2 expression on monocytes is consistent with a pathogenic role for PAR2 in RA and suggests that PAR2 may have utility as a marker for RA disease activity.

CAN SDAI REMISSION BE PREDICTED IN PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS TREATED WITH ANTI-TNF AGENTS?

Objective. To identify predictors for Simplified Disease Activity Index (SDAI) remission in established rheumatoid arthritis (RA) and to develop a predictive score for remission. Methods. Prospective 12-month observational study in ninety active RA receiving their first TNF-α inhibitor. Standard assessments consisted of disease activity scores (DAS28-ESR, SDAI) and immune parameters (total rheumatoid factor, RF; IGA-RF; anti-cyclic citrullinated peptide antibodies, ACPA). The primary outcome measure was SDAI remission (≤ 3.3) at 12 months. Univariate and multivariate logistic regression models were used to estimate association between baseline variables and SDAI remission. Results. 39.7% RA achieved remission, while 56.8% low disease activity. Significant association between SDAI remission and RA-onset before 50 (p = 0.000), history &lt;5 years (p = 0.000), stage (p = 0.000), class I and II Steinbroker functional status (p = 0.022), HAQ-DI≤2 (p = 0.034), CRP ≤ 20mg/l (p = 0.041), IgA-RF ≤ 20 IU/ml (p = 0.002), ACPA ≤ 40 IU/ml (p = 0.047), concomitant DMARDs (p = 0.003) were identified. Four parameters independently predicted 12-month remission (age at onset under 50, RA duration &lt;5 years, ACPA≤40 IU/ml, IgA-RF ≤ 20 IU/ml) as demonstrated by multivariate logistic regression (p&lt;0.05), making correct prediction in 84.4% patients. Furthermore, the remission score correctly classified 90.6% RA, while the transformed simplified version up to 89.4% cases. Gender, clinical parameters and ESR were not predictors for treatment response (p &gt; 0.05). Conclusion. SDAI remission can be predicted in established RA using a score based on age at onset, disease duration, titers of ACPA and RF isotype A. Such a simplified score may help clinicians to manage remission in RA patients according to the current treatment guidelines.

El papel de la ultrasonografía para la evaluación subclínica de la artritis reumatoide en remisión. Revisión sistemática de la literatura

There is an interest in the role of ultrasound (US), particularly the presence of power Doppler (PD) signal and synovial hypertrophy in the evaluation of subclinical activity in rheumatoid arthritis patients (RA) on remission. ObjectiveExamine the evidence to determine the usefulness of US and PD in the evaluation of patients with RA in remission using clinimetric properties. Materials and methodsA systematic literature search was performed using electronic databases PubMed, EMBASE, BioMed Central, Cochrane registry of clinical trials and secondary reference sources of articles published up to 2 March 2014, with the key terms “arthritis, rheumatoid” or “arthritis” and “ultrasonography” or “ultrasonography, Doppler, pulsed” and “remission induction” were used until March 2, of the 2014, without language restriction. Observational cohort studies that assessed the prevalence of subclinical activity by US and PD in adult patients with RA in clinical remission were included. Methodological quality of the articles was verified and relevant information extracted from each one. ResultsA total of 13 studies were identified for analysis. RA activity using these imaging techniques was observed in 14.6 to 95% for US synovial hypertrophy and 1.2 to 64.5% for PD in remission patients using clinimetry. ConclusionsIn RA patients with clinical remission, variable subclinical activity was observed with ultrasound detected by synovial hypertrophy and a positive intra-articular PD signal. The latter enables residual from inflammatory pannus to be differentiated, and to also predict relapse and correlate with disease progression, allowing therapeutic changes. More studies evaluating treatment and prognostic outcomes are required.

Management of Rheumatoid Arthritis Patients with Interstitial Lung Disease: Safety of Biological Antirheumatic Drugs and Assessment of Pulmonary Fibrosis.

Interstitial lung disease (ILD) is one of the major causes of morbidity and mortality of patients with rheumatoid arthritis (RA). Accompanying the increased number of reports on the development or exacerbation of ILD in RA patients following therapy with biological disease-modifying antirheumatic drugs (DMARDs), RA-associated ILD (RA-ILD) has aroused renewed interest. Although such cases have been reported mainly in association with the use of tumor necrosis factor inhibitors, the use of other biological DMARDs has also become a matter of concern. Nevertheless, it is difficult to establish a causative relationship between the use of biological DMARDs and either the development or exacerbation of ILD. Such pulmonary complications may occur in the natural course of RA regardless of the use of biological DMARDs. Since rheumatologists currently aim to achieve remission in RA patients, the administration of biological DMARDs is increasing, even for those with RA-ILD. However, there are no reliable, evidence-based guidelines for deciding whether biological DMARDs can be safely introduced and continued in RA-ILD patients. A standardized staging system for pulmonary conditions of RA-ILD patients is needed when making therapeutic decisions at baseline and monitoring during biological DMARD therapy. Based on the available information regarding the safety of biological DMARDs and the predictive factors for a worse prognosis, this review discusses candidate parameters for risk evaluation of ILD in RA patients who are scheduled to receive biological antirheumatic therapy.

FRI0037 A Comparative Study of Ultrasonography of Interphalangeal Joints in Rheumatoid Arthritis Patients in Remission and in Healthy Subjects

BackgroundMusculoskeletal Ultrasound (US) is now becoming part of the daily practice of rheumatology. In fact, it is a useful tool in rheumatoid arthritis (RA) for detecting persisting infra-clinical synovitis in...

THU0179 Cross-National Comparison of Biological Disease-Modifying Antirheumatic Drug Discontinuation Practice among Rheumatoid Arthritis Patients in Remission: Corrona and Ninja Collaboration

BackgroundSince the introduction of biological disease-modifying antirheumatic drugs (bDMARDs), treatment of rheumatoid arthritis (RA) has changed. Remission is a feasible treatment target for many patients. As a result, there is...

THU0254 Residual Inflammatory Activity Assessed by A Multi-Biomarker Disease Activity Blood Test is Linked to Structural Damage in RA Patients in Low Disease Activity/Remission and Normal C-Reactive Protein Level

BackgroundThe autoantibody positive (AAB+) subset of rheumatoid arthritis (RA) patients is prone to develop bone damage. Since the extent of bone erosion in AAB+ RA shows substantial variation, we hypothesized...

FRI0105 Abcb1and ABCG2 Drug-Efflux Transporters Function and Its Association with Disease Activity in A Cohort of Patients with Rheumatoid Arthritis

BackgroundIs not uncommon to observe that an important number of patients with rheumatoid arthritis (RA) have to withdraw or change treatment because of lack or loss of efficacy. Several mechanisms...

AB0285 Which Score is Better to Assess Remission in Rheumatoid Arthritis?

BackgroundVarious composite outcome measures have been developed in the last decade to evaluate Rheumatoid Arthritis (RA) activity, and the focus was in how to assess remission. The Ultrasonography (US) appears...

FRI0277 Predicting Future Response to Tumor Necrosis Factor Inhibitors by the Distribution of Affected Joints in Rheumatoid Arthritis Patients

BackgroundAchieving remission is essential for avoiding joint destruction and disability in patients with rheumatoid arthritis (RA). Tumor necrosis factor inhibitors (TNFi) therapies represent an important advancement in therapy for RA....

SAT0035 Impact of Corticosteroid Use on Remission Sustainability and Infection Rates among Rheumatoid Arthritis Patients in Remission While on Infliximab: Treatment Implications Based on A Real-World Population

BackgroundAccording to current treatment guidelines short-term treatment with corticosteroids (CS) can be considered in rheumatoid arthritis (RA) patients treated with a traditional and/or biologic DMARD,and should be tapered as rapidly...

THU0181 Short-Lasting Flares and HAQ Impairment in Rheumatoid Arthritis Patients in Remission According to the New Acr/Eular Criteria

BackgroundThe new remission criteria suggested by the ACR/EULAR study group for trials [1] are applied in the clinical practice, although they are considered rather strict [2]. Notwithstanding this criteria, patients...

SAT0060 Best Chance of Achieving Remission in RA Patients with Very Short Disease Duration

BackgroundClinical remission (REM) is the treatment target in rheumatoid arthritis (RA), and there are several composite REM criteria available. Knowledge is limited on how disease duration affects REM in daily...

FRI0286 Clinical Significance of Serum Matrix Metalloproteinase-3 Normalisation in Rheumatoid Arthritis Patients with Anti-TNF Therapy

BackgroundMatrix metalloproteinase-3 (MMP-3) is involved in disruptive events in the cartilage and bone of inflamed joints. In addition, serum MMP-3 is a specific inflammatory marker of the synovium, unlike C-reactive...

A1.13 Ultrasound-guided assessement of axillary lymph nodes in rheumatoid arthritis: cross-sectional and prospective clinico-pathologic significance

Background and ObjectivesJoint-draining lymph nodes (LN) and afferent lymphatics are relevant components of the induction-resolution phases of immune responses, acting through the control of cell efflux from the joint and...

Resting energy expenditure is not associated with disease activity in women with rheumatoid arthritis: cross-sectional study.

Background/AimsIncreased resting energy expenditure (REE) in rheumatoid arthritis (RA) patients is thought to be caused by hypermetabolism associated with production of proinflammatory cytokines. Our aim in the present study was to explore the possible association between REE and disease activity in females with RA.MethodsA total of 499 female RA patients were recruited to this cross-sectional study assessing REE scores on disease activity indices (the routine assessment of patient index data 3 [RAPID3], the disease activity score 28, and the clinical/simplified disease activity index [CDAI/SDAI]) and the levels of RA-associated autoantibodies (rheumatoid factor and anticyclic citrullinated peptide [anti-CCP] antibodies). Age-matched healthy female controls (n = 131) were also enrolled.ResultsREE did not differ between RA patients (all patients, and those in remission or not) and controls, or between RA patients in remission or not (p > 0.05 for all comparisons). Increased REE in total RA patients was associated with younger age and a higher body mass index (BMI) (p < 0.001 and p < 0.001, respectively), but not with disease activity index scores on any of RAPID3, CDAI, or SDAI. BMI was the only clinical parameter exhibiting a significant relationship with REE quartiles (Q1 to Q4; p < 0.001); none of disease duration, functional status, or anti-CCP antibody titer in RA patients was significantly related to REE, based on analysis of covariance.ConclusionsWe found no association between REE and disease activity in RA patients, implying that energy metabolism in RA patients might be independent of RA-associated systemic inflammation.

OP0066 Targeting the Lowest Efficacious Dose for Rheumatoid Arthritis Patients in Remission: Clinical and Structural Impact of a Step-Down Strategy Trial Based on Progressive Spacing of TNF-Blocker Injections (Strass Trial)

BackgroundBiologic tapering has been associated to relapse or structural damage progression in rheumatoid arthritis (RA).ObjectivesTo compare the impact of a DAS28-driven step-down strategy based on TNF-blocker injection spacing (S arm)...

OP0223 M-ficolin, an activator of the complement system, predicts DAS28 remission in early DMARD naïve rheumatoid arthritis

BackgroundM-ficolin is a soluble pattern recognition molecule that activates the complement system. We recently reported a factor 300 difference in the synovial fluid M-ficolin concentration between rheumatoid arthritis (RA) and...