Traditional DMARDs Research Articles

ACP Journal Club. Review: In RA, standard- and high-dose biologic drugs increase serious infection compared with traditional DMARDs.

Source Citation Singh JA, Cameron C, Noorbaloochi S, et al.Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. 2015;386:258-65. 25975452

The impact of concomitant diffuse idiopathic skeletal hyperostosis on the achievement of minimal disease activity in subjects with psoriatic arthritis.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of different entheses. Psoriatic arthritis (PsA) is a seronegative spondyloarthritis associated with psoriasis. Given the possible overlap of the two diseases, we assessed whether DISH presence may affect PsA clinical outcomes. Also, predictors of DISH presence in the cohort were investigated. Consecutive PsA patients from two Italian Rheumatology Research Units were enrolled. Subjects were splitted into two groups, according to the current treatment (TNF-α blockers or traditional DMARDs). All patients underwent a rheumatologic examination, blood sample collections and spine radiographs. Information about traditional vascular risk factors was recorded. In each patient, the presence of minimal disease activity was evaluated and the presence of DISH was established according to the Resnick and Niwayama criteria. Among the 80 enrolled subjects (57.5% men, mean age 56.5±11.1years), the overall prevalence of DISH was 30.0%. Patients with DISH were older, with higher BMI and waist circumference. DISH subjects showed worsen BASMI, HAQ and ESR. In a multivariate regression model, BASMI was a significant predictor of DISH presence (OR 3.027, 95% CI 1.449-6.325, p=0.003). The prevalence of MDA was lower in DISH patients than in no-DISH (16.7 vs 41.1%, p=0.041), and the presence of DISH was a predictor of not achieving MDA (OR 3.485, 95% CI 1.051-11.550, p=0.041). PsA subjects with DISH showed worsen indices of spine mobility and articular function and lower prevalence of minimal disease activity than no-DISH patients.

The role of leptin in the pathophysiology of rheumatoid arthritis.

The past 20 years of research on leptin has provided important insights into its role in rheumatoid arthritis (RA). Leptin is one of the different adipokines produced by the adipose tissue that influences the endocrine system, energy homeostasis and the immune response in several ways. Leptin is known to have predominantly pro-inflammatory effects, especially in the setting of chronic inflammation. Animal models of arthritis have illustrated well the participation of leptin in the inflammatory response within the joints. In patients with RA, numerous studies have evaluated the concentrations of leptin in the bloodstream and/or the joint cavity, showing higher levels compared to control populations. Leptin has also been found to correlate with clinical or biological measurements of disease activity of RA. Conversely, the relationship between serum leptin and joint structural damage is less evident. Leptin may also promote the development of atherosclerosis in RA and may contribute to the cardiovascular consequences of the metabolic syndrome that coexists with RA. Indeed, leptin could be a link between inflammation, metabolic risk factors and cardiovascular diseases in RA. Finally, due to abnormal body composition phenotypes with an increased prevalence of obesity in RA, the therapeutic response to traditional DMARDs and/or biological agents may be attenuated. This review discusses the multiple interplays that have been described between leptin and the clinical, radiographic and therapeutic aspects of RA.

058. The Efficacy and Safety of Subcutaneous Tocilizumab Versus Intravenous Tocilizumab in Combination with Traditional DMARDs in Patients with RA at Week 97: Results from the Summacta Study

058. The Efficacy and Safety of Subcutaneous Tocilizumab Versus Intravenous Tocilizumab in Combination with Traditional DMARDs in Patients with RA at Week 97: Results from the Summacta Study

Tight control of rheumatoid arthritis in a resource-constrained setting: a randomized controlled study comparing the clinical disease activity index and simplified disease activity index.

The aim of this study was to explore the clinical utility of the clinical disease activity index (CDAI). We compared the disease control with protocolized treatment adjustment following a tight control strategy utilizing either the simplified disease activity index (SDAI) or the CDAI. In a prospective 12 month study, DMARD-naive RA patients were randomized to either a CDAI or SDAI arm and were treated with traditional DMARDs, increased on a monthly basis according to a predefined protocol to achieve low disease activity. Of 102 patients (84 females, 96 Black Africans), the mean symptom duration was 3.0 years (s.d. 3.8) and the mean 28-joint DAS (DAS28) at baseline was 6.2 (s.d. 1.2). By 12 months, the proportion of patients in the CDAI and SDAI groups achieving low disease activity (30% and 32%) and remission (33 and 34%) were similar. There were no significant differences in the mean DAS28 or its components or in HAQ Disability Index or health-related quality of life scores. Baseline predictors of low disease activity at 12 months were shorter symptom duration (P = 0.03) and lower HAQ-DI score (P = 0.04). Given that the CDAI performed as well as the SDAI, and considering the cost savings and convenience because no acute phase reactant test is necessary, we suggest the CDAI may be an appropriate tool for monthly disease activity monitoring as part of a tight control strategy in developing countries.

FRI0316 The Efficacy and Safety of Subcutaneous Tocilizumab versus Intravenous Tocilizumab in Combination with Traditional DMARDS in Patients with RA at Week 97 (SUMMACTA)

BackgroundTocilizumab (TCZ) is approved as an intravenous (IV) formulation globally and subcutaneous (SC) formulation in the US for the treatment of adult rheumatoid arthritis (RA). In the SUMMACTA study, efficacy...

THU0133 Results from A Phase 2A, Randomized, Multicenter, Double-Blind, Placebo-Controlled, Parallel-Group Study of Jnj-40346527, an Oral CSF-1R Inhibitor, in Patients with Active Rheumatoid Arthritis despite Disease-Modifying Antirheumatic Drug Therapy

BackgroundJNJ-40346527, an investigational agent, is a selective inhibitor of the colony stimulating factor-1 receptor (CSF-1R) kinase and acts to inhibit macrophage survival, proliferation and differentiation. Based on current understanding of...

FRI0254 Predictive Value of Pretreatment Resistin Levels for Erosive Disease in Early RA Treated with DMARDS and Infliximab

BackgroundResistin is an adipocytokine related to insulin resistance, inflammation and arthritis (1).ObjectivesWe investigated if resistin is associated with the disease activity and inflammation in DMARD-naïve rheumatoid arthritis (RA) patients, if...

THU0438 Is Skin Disease More Important to Patients or Physicians in the Assessment of Disease Activity in Psoriatic Arthritis?

BackgroundPatient (PtGA) and physician (MDGA) global assessment of disease activity are standard outcome measures used in clinical practice and research to ascertain patient and physician subjective perception of disease activity...

THU0395 Adult Onset Still's Disease: A Multicenter Retrospective Cohort Study of 233 Italian Patients

BackgroundAdult onset Still's disease (AOSD) is a rare rheumatic disease with an estimated prevalence of less than 1 case per 100,000 population. The diagnosis is difficult and is often delayed...

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...

THU0098 The Baseline Characteristics of A Canadian Ankylosing Spondylitis Cohort, the Canadian Humira Post Marketing Observational Epidemiological Study: Assessing Effectiviness in Ankylosing Spondylitis (COMPLETE- AS)

BackgroundCOMPLETE-AS is an ongoing, multicenter, observational epidemiological study expected to enroll a total of 1,120 patients with ankylosing spondylitis (AS) from approximately 60 sites across Canada. The main objectives of...

THU0120 Is Early DMARD Use Associated with Less Joint Replacement Surgery? an Analysis of 5,199 Incident Rheumatoid Arthritis (RA) Patients

BackgroundEarly DMARD use in RA may prevent damage and possibly, need for joint replacement.ObjectivesTo assess joint replacements within incident RA patients in Quebec, Canada, and potential associations with early DMARD...

SAT0336 Change over Time in the Profile of Ankylosing Spondylitis Patients Treated with Infliximab in A REAL World Routine Care

ObjectivesThe objective of this study was to describe and compare over time the demographics and disease parameters at infliximab treatment initiation and to assess the effectiveness of treatment at 6...

AB1059 Assessing Treatment Durability of Infliximab in the Management of Psoriatic Arthritis and Rheumatoid Arthritis Patients in A Canadian Setting

BackgroundThe efficacy of anti-TNF in the management of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) has been demonstrated in numerous controlled clinical trials.ObjectivesThe objective of this analysis was to assess...

O22. Efficacy and Safety of Subcutaneous Versus Intravenous Tocilizumab In Combination with Traditional Dmards in Patients with Rheumatoid Arthritis: 49 Week Summacta Data

O22. Efficacy and Safety of Subcutaneous Versus Intravenous Tocilizumab In Combination with Traditional Dmards in Patients with Rheumatoid Arthritis: 49 Week Summacta Data

87. Comparative Efficacy of Novel Disease-Modifying Antirheumatic Drugs as Monotherapy and in Combination with Methotrexate in Rheumatoid Arthritis Patients with an Inadequate Response to Traditional Dmards: A Network Meta-Analysis

87. Comparative Efficacy of Novel Disease-Modifying Antirheumatic Drugs as Monotherapy and in Combination with Methotrexate in Rheumatoid Arthritis Patients with an Inadequate Response to Traditional Dmards: A Network Meta-Analysis

Pharmacogenetics in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic inflammatory arthritis leading to severe joint damage and associated with high morbidity and mortality. Disease-modifying antirheumatic drugs (DMARDs) are the mainstay of treatment in RA. DMARDs not only relieve the clinical signs and symptoms of RA but also inhibit the radiographic progression of disease. In the last decade, a new class of disease-modifying medications, the biologic agents, has been added to the existing spectrum of DMARDs in RA. However, patients' response to these agents is not uniform with considerable variability in both efficacy and toxicity. There are no reliable means of predicting an individual patient's response to a given DMARD prior to initiation of therapy. In this chapter, the current published literature on the pharmacogenetics of traditional DMARDS and the newer biologic DMARDs in RA is highlighted. Pharmacogenetics may help individualize drug therapy in patients with RA in the near future.

Not Better but Quite Good

Not Better but Quite Good

Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial

ObjectiveTo study whether adding initial infliximab to remission-targeted initial combination-DMARD treatment improves the long-term outcomes in patients with early rheumatoid arthritis (RA).MethodsNinety-nine patients with early, DMARD-naïve RA were treated with...