Effect of baseline rheumatoid factor (RF) levels on DAS28-response to standard DMARD-combination treatment in patients with rheumatoid arthritis (RA) (original) (raw)
Clinical and experimental rheumatology
To analyze the rate and baseline prognostic factors of clinical remission in a series of patients with early rheumatoid arthritis (RA) after 2 years of therapy based on a structured algorithm using disease-modifying anti-rheumatic drugs (DMARDs) in a clinical setting. To determine whether a good therapeutic response at 6 months of therapy is associated with remission at 2 years. One hundred and five patients (81% female) with early RA (disease duration < 2 years) treated with the same therapeutic protocol using gold salts and methotrexate in a step-up strategy, together with methylprednisolone (4 mg/day), were followed up for 2 years. The outcome variable was clinical remission after 2 years of DMARD therapy using the 28-joint disease activity score (DAS28 < 2.6). Clinical, biological, immunogenetic and radiographic data (Larsen score) were analyzed at study entry and after 6, 12, 18 and 24 months of follow-up. Therapeutic response was analyzed using the ACR and EULAR criteria...
Annals of the Rheumatic Diseases, 2013
Objectives To investigate whether baseline disease activity levels and responses in patients with rheumatoid arthritis (RA) changed during the period 2000-2010. Methods Data were provided by the Norwegian disease-modifying antirheumatic drug (NOR-DMARD) study. Patients with inflammatory joint diseases starting new treatment with disease-modifying antirheumatic drugs (DMARDs) were consecutively included and followed longitudinally. Time trend analyses were performed in methotrexate (MTX)-naïve RA patients starting MTX monotherapy (MTX mono) and biologic DMARD (bDMARD)-naïve RA patients starting tumour necrosis factor inhibitors+MTX (TNFi+MTX). Results A total of 2573 patients were included in the analyses: MTX mono n=1866 (69.9% female, 62.0% RF+, mean (SD) age 56.0 (13.7) years, median (25-75 percentile) time from diagnosis 0.2 (0.01-2.8) years); TNFi+MTX n=707 (70.3% female, 75.0% RF+, mean (SD) age 52.1 (13.2) years, median (25-75 percentile) time from diagnosis 5.7 (2.0-13.7) years). Significant time trends towards lower baseline disease activity score 28 (DAS28) as well as other disease activity measures were found in both groups (DAS28 from 5.17 to 4.75 in MTX mono and from 5.88 to 4.64 in TNFi+MTX), and disease duration became shorter. Six-month DAS28 remission rates increased significantly over the years (from 17.8 to 37.6 in MTX mono and from 16.9 to 46.3 in TNFi+MTX). Conclusions During the last decade, baseline RA disease activity level at the time of starting MTX as well as TNFi+MTX decreased from high to moderate. A more than twofold increase in 6-month remission rates was observed in both groups. Our findings indicate that clinicians have implemented modern, more aggressive treatment strategies, which hopefully will lead to better long-term disease outcomes.
The Korean Journal of Internal Medicine, 2019
Background/Aims: The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was-19.0 in the bDMARD group and-12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.
2012
Objective: This study aimed to evaluate remission in patients with early RA treated by conventional DMARDs and to identify its possible predictor factors. Methods: Patients with early RA (< 12 months) were enrolled in a 2-year follow-up study. Standard evaluation completed at baseline and at 24 months included clinical, laboratory, functional and structural assessment. Clinical remission after 2 years of follow-up was defined when DAS28 was less than 2.6. Possible predictor factors for remission were analyzed. Results: Fifty-one patients (88.2% women, mean age of 46.9 [24-72] years, mean disease duration of 24 [6-48] weeks) were enrolled in this study. The delay in referral for specialist care was 140 [7-420] days. Rheumatoid factor, anti-CCP, HLA-DRB1*01 and DRB1*04 alleles were present respectively in 62.5, 56.6, 11.8, and 45.1% of patients. At 24 months, 77.2% received a median dose of 5 (0-8) mg/day of prednisone and 65.2% was taking methotrexate (MTX). 13.6% of patients had stopped their DMARD because of socioeconomic difficulties. At 24 months, we noted a significant improvement of morning stiffness, pain score, swollen joint count, ESR, CRP, DAS28 and HAQ scores. Remission at 2 years was noted in 34.8% of patients and was significantly associated in univariate but not in multivariate analysis to male sex (P = 0.02) and to short delay in referral for specialist (P = 0.03). Conclusion: In this cohort of early RA patients treated with conventional DMARDs, especially with methotrexate in monotherapy, remission at 2-year of follow-up was obtained in one third of patients. No predictor factors of remission were found out. These results should be verified by further studies.
2020
Background Sustained DMARD-free remission (SDFR) is increasingly achievable. The pathogenesis underlying SDFR development is unknown and patient characteristics at diagnosis poorly explain whether SDFR will be achieved. To increase the understanding, we studied the course of disease activity scores (DAS) over time in relation to SDFR development. Subsequently, we explored whether DAS course could be helpful identifying RA patients likely to achieve SDFR. Methods 772 consecutive RA patients, promptly treated with csDMARDs (mostly methotrexate and treat-to-target treatment adjustments), were studied for SDFR development (absence of synovitis, persisting minimally 12 months after DMARD stop). The course of disease activity scores (DAS) was compared between RA patients with and without SDFR development within 7 years, using linear mixed models, stratified for ACPA. The relation between 4-month DAS and the probability of SDFR development was studied with logistic regression. Cumulative i...
Arthritis Research & Therapy, 2009
Introduction The aim of this study was to determine a low disease activity threshold - a 28-joint disease activity score (DAS28) value - for the decision to maintain unchanged disease-modifying antirheumatic drug (DMARD) treatment in rheumatoid arthritis patients, based on expert opinion. Methods Nine hundred and sixty-seven case scenarios with various levels for each component of the DAS28 (resulting in a disease activity score between 2 and 3.2) were presented to 44 panelists. For each scenario, panelists had to decide whether or not DMARD treatment (excluding steroids) could be maintained unchanged. In each scenario, for decision, the participants were given the DAS28 parameters, without knowledge of the resultant DAS28. The relationship between panelists' decision, DAS28 value, and components of the score were analysed by multiple logistic regression analysis. Each panelist analysed 160 randomised scenarios. Intra-rater and inter-rater reproducibility were assessed. Results Forty-four panelists participated in the study. Inter-panelist agreement was good (κ = 0.63; 95% confidence interval = 0.61 to 0.65). Intra-panelist agreement was excellent (κ = 0.87; 95% confidence interval = 0.82 to 0.92). Quasi-perfect agreement was observed for DAS28 ≤ 2.4, less pronounced between 2.5 and 2.9, and almost no agreement for DAS28 > 3.0. For values below 2.5, panelists agreed to maintain unchanged DMARDs; for values above 2.5, discrepancies occurred more frequently as the DAS28 value increased. Multivariate analysis confirmed the relationship between panelist's decision, DAS28 value and components of the DAS28. Between DAS28 of 2.4 and 3.2, a major determinant for panelists' decision was swollen joint count. Female and public practice physicians decided more often to maintain treatment unchanged. Conclusions As a conclusion, panelists suggested that in clinical practice there is no need to change DMARD treatment in rheumatoid arthritis patients with DAS28 ≤ 2.4.
Clinical Rheumatology, 2002
The aim of the study was to evaluate the efficacy and safety of disease-modifying drugs (DMARDs) in everyday clinical practice in Central European States (the Czech and Slovak republics). This was a retrospective, multicentre study. With the help of a special questionnaire, the medical files of 760 patients in 15 centres were analysed looking for reasons for DMARD discontinuation (e.g. insufficient efficacy, toxicity). The secondary endpoints were duration of therapy with individual DMARDs and the influence of other factors (demographic, disease specific, concomitant therapy) on duration of therapy. In 47.1 % of patients therapy was interrupted because of lack of efficacy, in 43.2 % because of adverse events, and in 9 % for undefined reasons. Toxic reactions leading to withdrawal were most common with gold (62.6 %) and methotrexate (62.5 %). Because of insufficient effect, treatment was most frequently interrupted with antimalarials (62.3 %) and penicillamine (53.2 %), but in only 22% treated with methotrexate. The mean duration of one treatment episode with DMARDs was 28.1 Ô 48.9 months. Surprisingly, it was longest for cyclophosphamide (53.5 + 55.1 months) and shortest for cyclosporin (7.0 Ô 6.7 months). The mean duration of treatment with methotrexate was only 14.9; Ô 16.2 months. The mean duration of treatment with one DMARD was statistically longer in patients with positive rheumatoid factor, extra-articular disease and age lower than 50 years. There was no impact of sex, concomitant steroid treatment and high or low sedimentation rate on treatment duration. Considerable differences in everyday clinical practice with DMARDs between Central European states and published data from the US and western Europe have been found. More education about modern strategies in the treatment of RA is probably necessary for practising rheumatologists.
The Journal of rheumatology, 2003
To determine the proportion of 2 cohorts of patients with rheumatoid arthritis (RA) in Nashville, Tennessee, who met 4 common criteria for inclusion in clinical trials: > or = 6 swollen joints, > or = 6 tender joints, erythrocyte sedimentation rate > or = 28 mm/h, and/or morning stiffness > or = 45 min. Two cohorts of patients with RA, all of whom had met American Rheumatism Association (ARA) [now American College of Rheumatology (ACR)] criteria for RA at some time, were studied. Cohort L (late) included 146 consecutive patients whose mean disease duration was 14.0 years and who had been under care at a weekly academic rheumatology clinic for a mean of 6.2 years when seen in 1998-2001. Cohort E (early) included 232 patients of 5 private practice rheumatologists whose symptoms began in 1998 or later and whose mean disease duration was 1.8 years when seen in 2001. Patients were reviewed for the 4 inclusion criteria as well as 6 ARA remission criteria. In Cohort L, on a 28 ...
Follow-Up Results of Our Patients with Rheumatoid Arthritis
Archives of Rheumatology, 2012
Bu çalışmada romatoid artrit (RA) hastalarının demografik ve klinik özelliklerinin belirlenmesi, başlangıç ve son vizit sırasındaki laboratuvar, klinik, radyografik ve fonksiyonel parametrelerinin karşılaştırılması, hastalık aktivitesi, fonksiyonel durum ve radyografik evredeki değişimlerin gösterilmesi amaçlandı. Hastalar ve yöntemler: Romatoloji Takip Polikliniği'mizde Ocak 2003-Aralık 2009 tarihleri arasında takip edilen 441 RA hastasının dosyası retrospektif olarak incelendi. Demografik ve klinik özellikleri ve başlangıç ve son vizitteki takip parametreleri kaydedildi. Laboratuvar incelemesinde eritrosit sedimentasyon hızı (ESR) ve C-reaktif protein (CRP) değerleri not edildi. Hastalık aktivitesi, fonksiyonel düzey ve radyografik evreleme sırasıyla; 28 eklemi içeren Hastalık Aktivite Skoru (DAS28), Sağlık Değerlendirme Anketi (SDA), ön-arka el radyografisinde Larsen skoru kullanılarak yapıldı. Bulgular: Başlangıç ve son vizit karşılaştırıldığında, DAS28 ve SDA düzeylerinde anlamlı iyileşme saptanırken (p<0.001), Larsen skorlarında anlamlı değişiklik gözlenmedi (p=0.484). Ayrıca son vizite laboratuvar paremetrelerinden yalnızca CRP değerlerinde anlamlı düzelme gözlendi (p<0.001). Eklem dışı tutulumu olmayan ve ilaç uyumu iyi olan hastaların son vizitteki DAS28 skorları, diğerlerine göre düşük bulundu (p=0.043, p<0.001). Sonuç: Bizim sonuçlarımız, RA hastalarında kombine hastalık modifiye edici antiromatizmal ilaç (DMARD) tedavisinin ve düzenli takibin hastalık aktivitesini baskılamak için çok önemli olduğunu gösterdi. İyi ilaç uyumu olan hastaların hastalık aktivite düzeyi daha iyi olduğu için, hastalar ilaçlar konusunda eğitilmelidir. Anahtar sözcükler: Hastalık aktivitesi; takip; romatoid artrit. Objectives: The aims of this study were to evaluate demographic and clinical characteristics of the patients with rheumatoid arthritis (RA), to compare laboratory, clinical, radiographic, and functional parameters at baseline and the last visit and to demonstrate changes in the functional status and radiographic grading. Patients and methods: The files of 441 patients with RA who were followed in our Rheumotology Outpatient Clinic between January 2003-December 2009 were retrospectively analyzed. The demographic and clinical characteristics as well as follow-up parameters at baseline and the last visit were recorded. In laboratory investigations, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were established. Disease activity, functional level and radiographic grading were determined using Disease Activity Score involving 28 joints (DAS28), Health Assessment Questionnaire (HAQ) and Larsen Score with anterior-posterior hand X-rays, respectively. Results: Significant improvements were found in DAS28 and HAQ levels at the last visit, compared to baseline (p<0.001), while no significant change was observed in Larsen scores (p=0.484). Significant improvements were also observed only in CRP values at the last visit, compared to baseline (p<0.001). DAS28 scores of the patients without extra-articular involvement with a good compliance were found to be lower than in the others at the last visit (p=0.043, p<0.001). Conclusion: Our results indicate that disease-modifying antirheumatic drug (DMARD) treatment in combination with regular follow-up is of utmost importance for the suppression of the disease activity in RA patients. Patients should be educated on drugs, as those with good compliance showed a better disease activity level.