216 results on '"Moots RJ"'
Search Results
2. Effect of rituximab on a salivary gland ultrasound score in primary Sjögren’s syndrome: results of the TRACTISS randomised double-blind multicentre substudy
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Fisher, BA, Everett, CC, Rout, J, O'Dwyer, JL, Emery, P, Pitzalis, C, Ng, W-F, Carr, A, Pease, CT, Price, EJ, Sutcliffe, N, Makdissi, J, Tappuni, AR, Gendi, NST, Hall, FC, Ruddock, SP, Fernandez, C, Hulme, CT, Davies, KA, Edwards, CJ, Lanyon, PC, Moots, RJ, Roussou, E, Richards, A, Sharples, LD, Bombardieri, M, and Bowman, SJ
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Adult ,Male ,B cells ,Clinical and Epidemiological Research ,Middle Aged ,R1 ,Salivary Glands ,Sjogren's Syndrome ,Treatment Outcome ,sjøgren’s syndrome ,Double-Blind Method ,Humans ,Immunologic Factors ,Female ,Rituximab ,Aged ,Ultrasonography - Abstract
Objectives To compare the effects of rituximab versus placebo on salivary gland ultrasound (SGUS) in primary Sjögren’s syndrome (PSS) in a multicentre, multiobserver phase III trial substudy.\ud \ud \ud \ud Methods Subjects consenting to SGUS were randomised to rituximab or placebo given at weeks 0, 2, 24 and 26, and scanned at baseline and weeks 16 and 48. Sonographers completed a 0–11 total ultrasound score (TUS) comprising domains of echogenicity, homogeneity, glandular definition, glands involved and hypoechoic foci size. Baseline-adjusted TUS values were analysed over time, modelling change from baseline at each time point. For each TUS domain, we fitted a repeated-measures logistic regression model to model the odds of a response in the rituximab arm (≥1-point improvement) as a function of the baseline score, age category, disease duration and time point.\ud \ud \ud \ud Results 52 patients (n=26 rituximab and n=26 placebo) from nine centres completed baseline and one or more follow-up visits. Estimated between-group differences (rituximab-placebo) in baseline-adjusted TUS were −1.2 (95% CI −2.1 to −0.3; P=0.0099) and −1.2 (95% CI −2.0 to −0.5; P=0.0023) at weeks 16 and 48. Glandular definition improved in the rituximab arm with an OR of 6.8 (95% CI 1.1 to 43.0; P=0.043) at week 16 and 10.3 (95% CI 1.0 to 105.9; P=0.050) at week 48.\ud \ud \ud \ud Conclusions We demonstrated statistically significant improvement in TUS after rituximab compared with placebo. This encourages further research into both B cell depletion therapies in PSS and SGUS as an imaging biomarker. \ud \ud Trial registration number 65360827, 2010-021430-64; Results.
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- 2018
3. Randomized Controlled Trial of Rituximab and cost-effectiveness analysis in treating fatigue and oral dryness in primary Sjogren's Syndrome
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Bowman, SJ, Everett, CC, O'Dwyer, JL, Emery, P, Pitzalis, C, Ng, WF, Pease, CT, Price, EJ, Sutcliffe, N, St Gendi, N, Hall, FC, Ruddock, SP, Fernandez, C, Reynolds, C, Hulme, CT, Davies, KA, Edwards, CJ, Lanyon, PC, Moots, RJ, Roussou, E, Giles, IP, Sharples, LD, and Bombardieri, M
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We investigated whether rituximab, an anti-B-cell therapy, improved symptoms of fatigue and oral dryness in patients with Primary Sjögren's Syndrome (PSS). : Multicentre, randomised, double-blind, parallel-group placebo-controlled trial, including Health Economic Analysis. Anti-Ro positive patients with PSS, symptomatic fatigue and oral dryness were recruited from 25 UK rheumatology clinics from August 2011 to January 2014. Patients were centrally-randomised to either placebo IV or rituximab IV (1000mg in 250mL) at weeks 0, 2, 24 and 26, with pre-and post-infusion medication including corticosteroids. Primary endpoint was the proportion of patients achieving 30% reduction in either fatigue or oral dryness at 48 weeks, measured by Visual Analogue Scale. Other outcomes included salivary and lachrymal flow rates, quality of life, ESSDAI and ESSPRI, symptoms of ocular and overall dryness, pain, global disease assessment and cost-effectiveness. ISRCTN 65360827 Results: All patients (n=133) randomised to placebo (n=66) and to rituximab (n=67) were included in the primary analysis. Among complete cases, 21/56 placebo and 24/61 rituximab patients achieved primary endpoint. After multiple imputation of missing outcomes, placebo and rituximab response rates were 36·8% and 39·8%, respectively (adjusted odds ratio 1·13 95% CI 0·50-2·55). There were no significant improvements in any outcome measure, except unstimulated salivary flow. Mean (SD) costs for rituximab and placebo were £10,752 (SD 264·75) and £2,672 (SD 241·71). There were slightly more adverse events reported in total for rituximab, but no difference in serious adverse events (ten in each group). : Rituximab is neither clinically or cost-effective in this patient population. This article is protected by copyright. All rights reserved.
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- 2017
4. VITAL (Vasculitis Integrated Assessment Log) assessment of vasculitis
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Bacon, PA, Moots, RJ, Exley, A, Luqmani, R, and Rasmussen, N
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- 2016
5. Vasculitis integrated total assessment log (VITAL): A system for clinical evaluation of vasculitis
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Luqmani, RA, Talbot, H, Lamb, A, Armstrong, C, Kitas, GD, Exley, A, Moots, RJ, and Bacon, PA
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- 2016
6. AB0444 Effect of rituximab on a salivary gland ultrasound score in primary sjÖgren's syndrome: results of the tractiss multicentre randomised trial sub-study
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Fisher, BA, primary, Everett, CC, additional, Rout, J, additional, O'Dywer, JL, additional, Emery, P, additional, Pitzalis, C, additional, Ng, W-F, additional, Carr, A, additional, Pease, CT, additional, Price, EJ, additional, Sutcliffe, N, additional, Makdissi, J, additional, Gendi, NS, additional, Hall, FC, additional, Ruddock, SP, additional, Fernandez, C, additional, Hulme, CT, additional, Davies, KA, additional, Edwards, CJ, additional, Lanyon, PC, additional, Moots, RJ, additional, Roussou, E, additional, Sharples, LD, additional, Bombardieri, M, additional, and Bowman, SJ, additional
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- 2017
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7. DMARD use in Rheumatoid Arthritis: Can we Predict Treatment Response?
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Genga, EK, Moots, RJ, and Oyoo, GO
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Rheumatoid Arthritis, DMARDS, Determinants of Treatment Response - Abstract
Objective: To review the current and emerging predictors of treatment response by DMARDS in Rheumatoid Arthritis (RA) patients.Data source: Published original research work and reviews were searched in English related to determinants of treatment response in rheumatoid arthritis on DMARDSStudy design: Only articles that emphasis on determinants of rheumatoid arthritis treatment response with DMARDSData extraction: Online and library searches done.Data synthesis: Data added and summarizedConclusions: Treatment of RA has been based on the use of a group of Disease-Modifying Antirheumatic Drugs (DMARDs), of which methotrexate is the most widely used. Although comprehensive clinical experience exists for MTX and synthetic DMARDs, to date it has not been possible to preview correctly whether or not a patient will respond to treatment with these drugs. Predicting response to MTX and other DMARDs would allow the selection of patients based on their likelihood of response, thus enabling individualized therapy and avoiding unnecessary adverse effects and elevated costs. Distinguishing responders from non-responders at treatment start as studies have failed to consistently reproduce similar determinants. Variables possibly influencing drug effectiveness may be related to disease, patient, treatment, clinical or biological (genetic and non-genetic) factors. This study seeks to review the current data regarding biomarkers of treatment response to DMARDS.Keywords: Rheumatoid Arthritis, DMARDS, Determinants of Treatment Response
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- 2015
8. Editorial
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Moots, RJ and Mwachal, SD
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Early arthritis management in Africa: moving on to a reality
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- 2015
9. Prediction of Remission and Low Disease Activity in DMARD-Refractory Patients with RA Treated with Golimumab
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Vastesaeger, N, Durez, P, Dasgupta, B, Combe, B, Schulze-Koops, H, Louw, I, Wollenhaupt, J, Zerbini, C, Beaulieu, A, Pavelka, K, Lazaro, M, Garcia Kutzbach, A, Moots, RJ, Amital, H, Huyck, S, Fu, B, Govoni, M, Vastesaeger, N, Durez, P, Dasgupta, B, Combe, B, Schulze-Koops, H, Louw, I, Wollenhaupt, J, Zerbini, C, Beaulieu, A, Pavelka, K, Lazaro, M, Garcia Kutzbach, A, Moots, RJ, Amital, H, Huyck, S, Fu, B, and Govoni, M
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- 2015
10. Quality indicators in rheumatoid arthritis: results from the METEOR database
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Navarro Compán, V, Smolen, J, Huizinga, Twj, Landewé, R, Ferraccioli, Gianfranco, Da Silva, Jap, Moots, Rj, Kay, J, Van Der Heijde, D., Ferraccioli, Gianfranco (ORCID:0000-0001-6246-2428), Navarro Compán, V, Smolen, J, Huizinga, Twj, Landewé, R, Ferraccioli, Gianfranco, Da Silva, Jap, Moots, Rj, Kay, J, Van Der Heijde, D., and Ferraccioli, Gianfranco (ORCID:0000-0001-6246-2428)
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To test the feasibility of collecting, storing, retrieving and analysing necessary information to fulfil a preliminary set of quality indicators (QIs) that have been proposed by an international task force in a large multinational clinical practice database of patients with RA.
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- 2015
11. Assessment of Global Disease Activity in Rheumatoid Arthritis by Patients and Physicians: Differences Across Countries in the METEOR Database
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Gvozdenović, E, Wolterbeek, R, Allaart, Cf, Brenol, C, Dougados, M, Emery, P, Ferraccioli, Gianfranco, Van Der Heijde, D, Huizinga, Tw, Kay, J, Martin Mola, E, Moots, Rj, Da Silva, Jap, Smolen, J, Veale, D, Landewé, Rb, Ferraccioli, Gianfranco (ORCID:0000-0001-6246-2428), Gvozdenović, E, Wolterbeek, R, Allaart, Cf, Brenol, C, Dougados, M, Emery, P, Ferraccioli, Gianfranco, Van Der Heijde, D, Huizinga, Tw, Kay, J, Martin Mola, E, Moots, Rj, Da Silva, Jap, Smolen, J, Veale, D, Landewé, Rb, and Ferraccioli, Gianfranco (ORCID:0000-0001-6246-2428)
- Abstract
The aim of the study was to compare the differences between patient global disease activity (PtGDA) and physician global disease activity (PhGDA) score within and across 13 countries in the METEOR (Measurement of Efficacy of Treatment in the "Era of Outcome" in Rheumatology) database.
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- 2015
12. Synovial fluid neutrophils transcribe and express class II major histocompatibility complex molecules in rheumatoid arthritis
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Cross, A, Bucknall, Rc, Cassatella, Marco Antonio, Edward, Sw, and Moots, Rj
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- 2003
13. An unusual cause of acute renal failure in systemic sclerosis
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Mpofu, S, Rhodes, JM, Mpofu, CMA, and Moots, RJ
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Health - Abstract
Background: Scleroderma renal crisis is one of the most life threatening complications of scleroderma. Enteric hyperoxaluria complicates extensive disease or resection of the small intestine in the presence of an [...]
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- 2003
14. Bilateral distal fibular and tibial stress fractures associated with heavy smoking. (Letters)
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Mpofu, S, Moots, RJ, and Thompson, RN
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Health - Abstract
An unusual case of simultaneous bilateral stress fractures of the distal tibia and fibula in a 45 year old white woman is described. The onset of symptoms was not associated [...]
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- 2003
15. Congenital heart block associated with undiagnosed maternal Primary Sjögren's Syndrome - a case report and discussion
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Steele, JC, primary, Dawson, LJ, additional, Moots, RJ, additional, and Field, EA, additional
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- 2005
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16. CDP-870 (certolizumab) in rheumatoid arthritis
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Kaushik, V, primary and Moots, RJ, additional
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- 2005
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17. THU0011 Bsm-1 polymorphism and bone mineral density in polymyalgia rheumatica
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Daroszewska, A, primary, Taylor, W, additional, Usher, JL, additional, Bucknall, RC, additional, Moots, RJ, additional, Thompson, RN, additional, Tunn, EJ, additional, and Fraser, WD, additional
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- 2001
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18. A case of multiple sclerosis associated with rheumatoid arthritis and positive anticardiolipin antibodies
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Mpofu, S and Moots, RJ
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Multiple sclerosis -- Case studies -- Diagnosis -- Physiological aspects ,Rheumatoid arthritis -- Diagnosis -- Case studies -- Physiological aspects ,Health ,Diagnosis ,Physiological aspects ,Case studies - Abstract
We describe the case of a 59 year old man with longstanding multiple sclerosis (MS) since his early fifties, who after many years developed the clinical and serological manifestations of [...]
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- 2003
19. Ear, nose and throat manifestations of Behçet's disease: a review.
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Webb CJ, Moots RJ, and Swift AC
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- 2008
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20. The Michael Mason Prize Essay 1998. A fistful of T cells.
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Moots, RJ
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Evidence incriminating T cells in rheumatoid arthritis (RA) is strong but circumstantial - like a smoking gun at the scene of a crime. To investigate this, T lymphocytes were studied in health and disease. The effects of mutations in the groove of HLA-A2 on peptide presentation to T cells was studied to investigate normal T cell function. This allowed a detailed description of the interaction between individual MHC residues and antigens. Subsequently, T cells in the autoimmune disease, multiple sclerosis, were studied, to investigate the mechanisms for breakdown in peripheral tolerance. T-cell clones that recognized both autoantigens and viral proteins were isolated, suggesting that infection may trigger disease. Autoantigens would need to be defined to use this strategy in RA. T-cell responses to type II collagen, a candidate auto-antigen, were therefore studied in RA and an epitope successfully defined. The search for microbial 'mimics' triggering RA, and novel forms of immunotherapy are now possible - with potential rehabilitation of T cells. [ABSTRACT FROM PUBLISHER]
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- 1998
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21. Behcet's syndrome.
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Hart M and Moots RJ
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- 2010
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22. British Association of Dermatologists and British Society for Rheumatology living guideline for managing people with Behçets 2024.
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Murphy R, Moots RJ, Brogan P, Çelik AF, Clement-Jones M, Coulson I, Croft AP, Crozier S, Forrest L, Harrold J, Higgins S, Jawad ASM, Kalra S, Khan SS, McKee H, Pain CE, Petrushkin H, Poveda-Gallego A, Setterfield J, Sharma P, West R, Wlodek C, Hashme M, Manounah L, Mohd Mustapa MF, and Constantin AM
- Abstract
Competing Interests: Conflicts of interest The GDG adhered to BAD’s policy for declaration of interests for guideline authors. Further details may be requested by contacting guidelines@bad.org.uk. The following interests were declared over the duration of the guideline development: RM is member of an advisory board for Janssen (nonspecific). RJM is (i) a member of advisory boards for AbbVie, Chugai, Novartis, Pfizer and Roche (specific); (ii) a speaker at international meetings funded by Chugai/Roche, Eli Lilly and Pfizer (specific); (iii) a director for the National Centre for Behçets Syndrome (specific); (iv) a chief investigator for the BioBehçet’s trial (NIHR EME grant) (specific); and (v) a grant holder and chief investigator for the phase II trial ‘Secukinumab in Behçet’s’, with funding provided to Liverpool University Hospitals NHS Trust (specific). PB (i) receives consultancy or lecturing fees from Sobi, Novartis and Roche (nonspecific); (ii) is a local principal investigator for the EMERALD trial (Sobi) (nonspecific); (iii) is chief investigator of the KDCAAP trial (nonspecific); and (iv) is a trustee of a patient-led charity for Kawasaki disease (nonspecific). AFÇ (i) participates on advisory boards and talks at meetings for irritable bowel disease funded by AbbVie, MSD, UCB Pharma, Takeda, Pfizer, Centurion, Janssen and Mgen (specific); (ii) is head of the Turkish IBD Association, which receives annual funding from MSD, AbbVie, Takeda, UCB Pharma, Centurion, Mgen, Pfizer and Janssen (specific); and (iii) receives funding to their clinic from MSD, AbbVie, Takeda, UCB Pharma, Centurion, Mgen and Janssen, which provides medical equipment used for Behçets (specific). SSK (i) is chairperson for Janssen (nonspecific); (ii) received speaker fees from LEO Pharma, Janssen and L’Oreal (nonspecific); and (iii) has a salary partly funded by a grant awarded by the Women’s Dermatology Society and GLODERM (The International Alliance of Global Health Dermatology) (nonspecific). CEP is the UK’s chief investigator for the apremilast clinical trial in paediatric Behçets funded by Amgen (specific). JS (i) is a shareholder with Welbeck Health Partners in OneWelbeck Skin and Allergy Centre (nonspecific) and (ii) is a subinvestigator for a multicentre open-label phase I study to evaluate the safety, tolerability, pharmacokinetics and early signs of effectiveness of induction of antigen-specific immune tolerance with TPM203 in pemphigus vulgaris (nonspecific). PS (i) is a member of an advisory board for Janssen regarding guselkumab in psoriatic arthritis (nonspecific); (ii) is a member of an advisory board for UCB regarding bimekizumab in psoriatic arthritis (nonspecific); (iii) is a member of an advisory board for Galapagos (nonspecific); (iv) received sponsorship from Amgen for an osteoporosis conference (nonspecific); and (v) received an honorarium from SpA academy (nonspecific). RW is Vice Chair of Behçets UK (specific). MC-J, IC, APC, SC, LF, JH, SH, ASMJ, SK, HM, HP, AP-G, CW, MH, LM, MFMM and AMC have no conflicts of interest to declare.
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- 2024
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23. Patients with High Baseline Neutrophil-to-Lymphocyte Ratio Exhibit Better Response to Filgotinib as Treatment for Rheumatoid Arthritis.
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Taylor PC, Downie B, Han L, Hawtin R, Hertz A, Moots RJ, and Takeuchi T
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Introduction: High baseline neutrophil-to-lymphocyte ratio (NLR) in rheumatoid arthritis (RA) has been associated with positive responses to biologic tumor necrosis factor inhibition and negative responses to conventional synthetic disease-modifying antirheumatic drug (csDMARD) triple therapy. Datasets from three randomized clinical trials in patients with RA were used to test the hypothesis that baseline NLR is associated with improved clinical response to filgotinib in methotrexate (MTX)-naïve or MTX-experienced RA populations., Methods: Patients from FINCH 1 (inadequate response to MTX, MTX-IR; NCT02889796), FINCH 2 (inadequate response to biologic DMARDs; NCT02873936), and FINCH 3 (MTX-naïve; NCT02886728) were classified as baseline NLR-High or baseline NLR-Low based on a previously published cut point of 2.7. In total, 3365 patients were included across the three studies. Differences in clinical outcomes and patient-reported outcomes (PROs) were determined using linear-regression models., Results: Control-arm patients (placebo + MTX/placebo + csDMARD) classified as NLR-High exhibited worse continuous clinical and PRO responses at week 12 across clinical trials compared to NLR-Low patients. In contrast, NLR-High patients who received FIL 200 mg + MTX/csDMARD exhibited consistently better responses after 12 weeks compared to NLR-Low patients across clinical trials, clinical endpoints, and PROs. These trends were most prominent among the MTX-IR population., Conclusion: The 2.7 baseline NLR cut point could be used to enrich for patients most likely to benefit from the addition of filgotinib to background MTX/csDMARD. Use of baseline NLR as part of therapeutic decision-making would not require additional diagnostics and could contribute to improved outcomes for patients with RA., Trial Registration: Clinicaltrials.gov: NCT02889796; NCT02873936; NCT02886728., (© 2024. The Author(s).)
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- 2024
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24. Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.
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Kingsbury SR, Tharmanathan P, Keding A, Watt FE, Scott DL, Roddy E, Birrell F, Arden NK, Bowes M, Arundel C, Watson M, Ronaldson SJ, Hewitt C, Doherty M, Moots RJ, O'Neill TW, Green M, Patel G, Garrood T, Edwards CJ, Walmsley PJ, Sheeran T, Torgerson DJ, and Conaghan PG
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- Humans, Double-Blind Method, Female, Male, Middle Aged, Administration, Oral, Aged, Treatment Outcome, Arthralgia drug therapy, Methotrexate administration & dosage, Methotrexate adverse effects, Methotrexate therapeutic use, Osteoarthritis, Knee drug therapy, Osteoarthritis, Knee complications, Antirheumatic Agents administration & dosage, Antirheumatic Agents adverse effects, Antirheumatic Agents therapeutic use, Pain Measurement
- Abstract
Background: Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain., Objective: To assess symptomatic benefits of methotrexate in knee OA (KOA)., Design: A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41)., Setting: 15 secondary care musculoskeletal clinics in the United Kingdom., Participants: A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion., Intervention: Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia., Measurements: The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs)., Results: A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate ( n = 77) or placebo ( n = 78). Follow-up was 86% ( n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2)., Limitation: Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance., Conclusion: Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months., Primary Funding Source: Versus Arthritis., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0303.
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- 2024
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25. Clotting and bleeding in Behçet's syndrome.
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Nair JR, Syrimi ZJ, Cotton CV, and Moots RJ
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- Humans, Blood Coagulation, Behcet Syndrome complications, Hemorrhage etiology
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Competing Interests: Declaration of interests We declare no competing interests.
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- 2024
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26. Cutaneous signs of rheumatic diseases in skin of colour: are we failing our patients?
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Haddad J, Coulson I, Oyoo GO, and Moots RJ
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- Humans, Skin Pigmentation, Skin, Administration, Cutaneous, Rheumatic Diseases, Skin Diseases
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- 2023
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27. Neutrophil function following treatment of psoriatic arthritis patients with secukinumab: altered cytokine signalling but no impairment of host defence.
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Cross AL, Hawkes J, Frankland H, Mediana A, Wright HL, Goodson NJ, Edwards SW, and Moots RJ
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- Humans, Neutrophils, Interleukin-17, Antibodies, Monoclonal therapeutic use, Treatment Outcome, Arthritis, Psoriatic drug therapy, Arthritis, Psoriatic chemically induced, Psoriasis drug therapy
- Abstract
Objectives: Identifying that dysfunction of the IL-23/17 axis underlies PsA has led to the development of effective targeted therapies such as the IL-17A inhibitor secukinumab. As IL-17A stimulates the secretion of neutrophil chemoattractants, such as CXCL8 (IL-8), we examined the effect of secukinumab on neutrophil function in PsA., Methods: Nineteen patients with active PsA were treated with secukinumab. Clinical response [PsA Response Criteria (PsARC) and Psoriasis Area and Severity Index (PASI)] and peripheral blood neutrophil function (apoptosis, receptor expression, phagocytosis/killing, chemotaxis and RNA expression) were measured at 12 week intervals for 48 weeks and compared with age- and sex-matched healthy controls., Results: At 12 weeks, 12/16 (75%) patients had a PsARC response (100% at 36 weeks) and 10/14 (71%) achieved a 90% PASI response. At baseline, there were no differences in PsA neutrophil reactive oxygen species generation, constitutive or cytokine-delayed apoptosis, chemotaxis or phagocytosis of opsonized Staphylococcus aureus compared with healthy controls. Similarly, there were no differences in these functions from baseline to 12 weeks of therapy. However, surface levels of CD11b/CD18 and CD63 increased and expression of CD16 decreased during therapy. In addition, in a subgroup of early (12 week) responders to secukinumab, RNA sequencing revealed transcriptome changes predicting down-regulation of cytokine signalling and chemotaxis pathways and up-regulation of de novo gene expression pathways, including translation initiation, mRNA catabolism and translation., Conclusion: Complex changes in the properties of circulating neutrophils occur with secukinumab treatment in PsA that may indicate altered responsiveness to changes in both local and systemic levels of pro-inflammatory cytokines. However, host defence processes of neutrophils were unaltered., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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28. The challenge of ocular inflammation in systemic vasculitis: How to address inequalities of care?
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Ghadiri N, Nair J, and Moots RJ
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Competing Interests: Conflict of Interest Robert J Moots is a Co-Editor-in-Chief of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of the editor.
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- 2023
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29. Metabolic Profiling of Rheumatoid Arthritis Neutrophils Reveals Altered Energy Metabolism That Is Not Affected by JAK Inhibition.
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Chokesuwattanaskul S, Fresneda Alarcon M, Mangalakumaran S, Grosman R, Cross AL, Chapman EA, Mason D, Moots RJ, Phelan MM, and Wright HL
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Neutrophils play a key role in the pathophysiology of rheumatoid arthritis (RA) where release of ROS and proteases directly causes damage to joints and tissues. Neutrophil function can be modulated by Janus Kinase (JAK) inhibitor drugs, including tofacitinib and baricitinib, which are clinically effective treatments for RA. However, clinical trials have reported increased infection rates and transient neutropenia during therapy. The subtle differences in the mode of action, efficacy and safety of JAK inhibitors have been the primary research topic of many clinical trials and systematic reviews, to provide a more precise and targeted treatment to patients. The aim of this study was to determine both the differences in the metabolome of neutrophils from healthy controls and people with RA, and the effect of different JAK inhibitors on the metabolome of healthy and RA neutrophils. Isolated neutrophils from healthy controls (HC) (n = 6) and people with RA (n = 7) were incubated with baricitinib, tofacitinib or a pan-JAK inhibitor (all 200 ng/mL) for 2 h. Metabolites were extracted, and 1H nuclear magnetic resonance (NMR) was applied to study the metabolic changes. Multivariate analyses and machine learning models showed a divergent metabolic pattern in RA neutrophils compared to HC at 0 h (F1 score = 86.7%) driven by energy metabolites (ATP, ADP, GTP and glucose). No difference was observed in the neutrophil metabolome when treated with JAK inhibitors. However, JAK inhibitors significantly inhibited ROS production and baricitinib decreased NET production (p < 0.05). Bacterial killing was not impaired by JAK inhibitors, indicating that the effect of JAK inhibitors on neutrophils can inhibit joint damage in RA without impairing host defence. This study highlights altered energy metabolism in RA neutrophils which may explain the cause of their dysregulation in inflammatory disease.
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- 2022
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30. The association between increased body mass index and response to conventional synthetic disease-modifying anti-rheumatic drug treatment in rheumatoid arthritis: results from the METEOR database.
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Dey M, Zhao SS, Moots RJ, Bergstra SA, Landewe RB, and Goodson NJ
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- Antirheumatic Agents administration & dosage, Arthritis, Rheumatoid complications, Databases as Topic, Female, Humans, Linear Models, Logistic Models, Male, Methotrexate administration & dosage, Middle Aged, Obesity complications, Patient Acuity, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Body Mass Index, Methotrexate therapeutic use
- Abstract
Background: Few data exist on the association between increased BMI and response to conventional synthetic DMARDs (csDMARDs) in RA. We aimed to explore the association between increased (overweight or obese) BMI on csDMARD prescribing, MTX dose and disease activity over 12 months., Methods: Participants in an international RA database were stratified into early (<1 year post-diagnosis) and established RA. EULAR response, 28-joint DAS (DAS28) remission and treatments were recorded at baseline, 6 months and 12 months. Increased BMI was explored in early and established RA as predictors of good EULAR response, DAS28 remission, number of csDMARDs and MTX dose, using logistic and linear regression., Results: Data from 1313 patients, 44.3% with early RA, were examined. In early RA, increased BMI was not significantly associated with remission. In established RA, obese patients on monotherapy were significantly less likely to achieve good EULAR response or DAS28 remission at 6 months and more likely to be treated with combination csDMARDs compared with normal BMI. In patients taking MTX, overweight and obese patients with early and established RA were exposed to higher MTX doses (mono- and combination therapy), with a mean dose of 20 mg/week, compared with 15 mg/week in those of normal BMI., Conclusion: We observed that compared with patients with normal BMI, overweight and obese individuals experienced more intensive csDMARD exposures. Similar response rates were observed in early RA but increased BMI was associated with reduced response in established RA. Optimization of targeted RA treatment remains important, particularly in those with increased BMI where response in established disease may be attenuated., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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31. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren's syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial.
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Bowman SJ, Fox R, Dörner T, Mariette X, Papas A, Grader-Beck T, Fisher BA, Barcelos F, De Vita S, Schulze-Koops H, Moots RJ, Junge G, Woznicki JN, Sopala MA, Luo WL, and Hueber W
- Subjects
- Adult, Aged, Antibodies, Monoclonal, Humanized administration & dosage, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Middle Aged, Placebos administration & dosage, Placebos adverse effects, Severity of Illness Index, Sjogren's Syndrome diagnosis, Treatment Outcome, Antibodies, Monoclonal, Humanized adverse effects, Sjogren's Syndrome drug therapy
- Abstract
Background: Sjögren's syndrome is an autoimmune disease characterised by dry eyes and mouth, systemic features, and reduced quality of life. There are no disease-modifying treatments. A new biologic, ianalumab (VAY736), with two modes of suppressing B cells, has previously shown preliminary efficacy. This dose-finding trial aimed to assess the safety and efficacy of different subcutaneous doses of ianalumab in patients with moderate to severe primary Sjögren's syndrome., Methods: VAY736A2201 was a randomised, parallel, double-blind, placebo-controlled, phase 2b dose-finding study done in 56 centres in 19 countries. Patients aged 18-75 years with primary Sjögren's syndrome with moderate to severe disease activity (European Alliance of Associations for Rheumatology [EULAR] Sjögren's Syndrome Disease Activity Index [ESSDAI] score ≥6) and symptom severity (EULAR Sjögren's Syndrome Patient Reported Index score ≥5) were eligible. Participants were randomly assigned (1:1:1:1) to receive subcutaneous placebo or ianalumab (5 mg, 50 mg, or 300 mg) every 4 weeks for 24 weeks using a secure, online randomisation system. Randomisation was stratified by the ESSDAI score at baseline (≥10 or <10). Study personnel and patients were masked to treatment assignment. The primary outcome was the change in ESSDAI score from baseline to 24 weeks in all randomly assigned patients. Dose-related change in disease activity (ESSDAI) from baseline at week 24 was assessed by multiple comparison procedure with modelling analysis. Safety was measured in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT02962895., Findings: Between June 27, 2017, and Dec 06, 2018, 293 patients were screened, 190 of whom were randomly assigned (placebo n=49, ianalumab 5 mg n=47, ianalumab 50 mg n=47, ianalumab 300 mg n=47). Statistically significant dose-responses were seen for overall disease activity (ESSDAI score) in four of the five dose-response models tested (p<0·025 in four models, p=0·060 in one model). The ESSDAI score decreased from baseline in all ianalumab groups, with the maximal ESSDAI score change from baseline observed in the ianalumab 300 mg group: placebo-adjusted least-squares mean change from baseline -1·92 points (95% CI -4·15 to 0·32; p=0·092). There were four serious adverse events in three patients considered treatment-related (pneumonia [n=1] and gastroenteritis [n=1] in the placebo group; appendicitis plus tubo-ovarian abscess in the same patient in the ianalumab 50 mg group)., Interpretation: The study met its primary objective, showing a dose-related decrease in disease activity as measured by ESSDAI at week 24. Overall, ianalumab was well tolerated and safe, with no increase in infections. To our knowledge, this is the first large, randomised, controlled trial in primary Sjögren's syndrome that met its primary endpoint, and its results mean there is potential for more studies of this mechanism in the future., Funding: Novartis., Competing Interests: Declaration of interests SJB and BAF have received support from the National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and the NIHR/Wellcome Trust Birmingham Clinical Research Facility. SJB has received consultancy funding from Abbvie, AstraZeneca, Galapagos, and Novartis in the past 36 months. RF has received consultancy funding from Pfizer and Eli Lilly. TD has received grants and consultancy funding from AbbVie, Celgene, Eli Lilly, EMD MerckSerono, GSK, Janssen, Novartis, and Roche; grants from UCB, Sanofi, Deutsche Forschungsgemeinschaft, and EU Horizon2020 HarmonicSS; and consultancy funding from Gilead/Galapagos. XM received consultancy funding from BMS, Galapagos, GSK, Novartis, and Servier and grants from Servier. AP received grants and consultancy funding from Novartis. TG-B has received consultancy fees from Eli Lilly and Novartis. BAF has received consultancy fees from BMS, Galapagos, Novartis, Roche, and Servier. HS-K received grants and consulting fees from Novartis. RJM received grants from Aintree University Hospital and Novartis. GJ, JNW, MAS, W-LL, and WH are employees of Novartis. All other authors declare no competing interests. The views expressed in this publication are those of the authors and not necessarily those of the institutions they are associated with., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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32. Depression and anxiety symptoms at TNF inhibitor initiation are associated with impaired treatment response in axial spondyloarthritis.
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Zhao SS, Jones GT, Hughes DM, Moots RJ, and Goodson NJ
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- Anxiety physiopathology, Anxiety prevention & control, Axial Spondyloarthritis complications, Cognition physiology, Cross-Sectional Studies, Depression physiopathology, Depression prevention & control, Educational Status, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Anxiety complications, Axial Spondyloarthritis drug therapy, Cognition drug effects, Depression complications, Mental Health, Tumor Necrosis Factor Inhibitors therapeutic use
- Abstract
Objectives: Depression and anxiety are associated with more severe disease in cross-sectional studies of axial spondyloarthritis (axSpA). We examined the association between baseline symptoms of depression or anxiety and response to TNF inhibitors (TNFi) in axSpA., Methods: Biologic naïve participants from a national axSpA register completed the Hospital Anxiety and Depression Scale (HADS) before initiating TNFi. Symptoms of anxiety and depression were each categorized as moderate-severe (≥11), mild (8-10) and 'none' (≤7), and compared against change in disease indices [BASDAI and AS Disease Activity Score (ASDAS)] over time and time to treatment discontinuation using marginal structural models. Inverse-probability weights balanced baseline age, gender, BMI, deprivation, education and baseline values of respective disease indices., Results: Of the 742 participants (67% male, mean age 45 years), 176 (24%) had moderate-severe and 26% mild depression; 295 (40%) had moderate-severe and 23% mild anxiety. Baseline disease activity was higher in higher HADS symptom categories for both depression and anxiety. Participants with moderate-severe depression had significantly poorer response compared with those with 'none' throughout follow-up. At 6 months, the difference was approximately 2.2 BASDAI and 0.8 ASDAS units after balancing their baseline values. Equivalent comparisons for anxiety were 1.7 BASDAI and 0.7 ASDAS units. Treatment discontinuation was 1.59-fold higher (hazard ratio 95% CI: 1.12, 2.26) in participants with moderate-severe anxiety compared with 'none'., Conclusions: Symptoms of depression and anxiety at TNFi initiation are associated with poorer treatment outcomes. Targeted interventions to optimize mental health have potential to substantially improve treatment response and persistence., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
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- 2021
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33. Isolation of Microvesicles from Human Circulating Neutrophils.
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Zhan D, McConachie E, Edwards SW, Wright HL, Moots RJ, and Honsawek S
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Neutrophil-derived microvesicles (NDMVs) are liberated by neutrophils upon cell activation by molecules. Once activated, neutrophils are primarily involved in acute inflammation; however, the microvesicles they produce are largely anti-inflammatory. NDMVs have been shown to protect cartilage during inflammatory arthritis. They exert these effects by inhibiting or affecting the function of target cells, including macrophages. NDMVs have the potential to act as disease-modifying agents, especially for inflammatory diseases. This protocol describes a method using differential centrifugation to separate neutrophils from whole human blood. Subsequently, neutrophils are identified by cytospin and Wright's staining, and then the NDMVs are isolated using differential centrifugation., Competing Interests: Competing interestsThe authors declare no conflict of interest., (Copyright © 2021 The Authors; exclusive licensee Bio-protocol LLC.)
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- 2021
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34. Behçet's syndrome in children and young people in the United Kingdom and the Republic of Ireland: a prospective epidemiological study.
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Pain CE, Beresford MW, Fortune F, Lai ETC, Murphy R, Taylor-Robinson D, Brogan PA, and Moots RJ
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- Adolescent, Behcet Syndrome diagnosis, Behcet Syndrome pathology, Child, Child, Preschool, Delayed Diagnosis statistics & numerical data, Disease Progression, Epidemiologic Studies, Female, Follow-Up Studies, Humans, Incidence, Ireland epidemiology, Male, Patient Acceptance of Health Care statistics & numerical data, Prevalence, Prospective Studies, United Kingdom epidemiology, Behcet Syndrome epidemiology, Population Surveillance
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Objectives: To define the incidence and prevalence of Behçet's syndrome (BS) in children and young people (CYP) up to the age of 16 years in the United Kingdom (UK) and Republic of Ireland (ROI)., Methods: A prospective epidemiological study was undertaken with the support of the British Paediatric Surveillance Unit (BPSU) and the British Society of Paediatric Dermatologists (BSPD). Consultants reported anonymised cases of BS seen. A follow-up study at one year examined progression of disease and treatment., Results: Over a two-year period, 56 cases met the International Criteria for Behçet's Disease. For children under 16 years of age, the two-year period prevalence estimate was 4.2 per million (95% CI: 3.2, 5.4) and the incidence was 0.96 per million person years (95% CI: 0.66, 1.41). Mucocutaneous disease was the most common phenotype (56/100%), with ocular (10/56; 17.9%), neurological (2/56; 3.6%) and vascular involvement (3/56; 5.4%) being less common. Median age at onset was 6.34 years and at diagnosis was 11.72 years. There were slightly more female than male children reported (32/56; 55.6%). The majority of cases (85.7%) were white Caucasian. Apart from genital ulcers, which were more common in females, there were no significant differences in frequency of manifestations between male or females, nor between ethnicities. Over 83% of cases had three or more non-primary care healthcare professionals involved in their care., Conclusion: BS is extremely rare in CYP in the UK and ROI and most have mucocutaneous disease. Healthcare needs are complex, and coordinated care is key., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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35. A Darwinian View of Behçet's Disease.
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Smith R, Moots RJ, Murad M, and Wallace GR
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Behçet's disease (BD) is a multisystem inflammatory disorder of unknown etiology, characterized by oral and genital ulceration, with other complications including eye, skin, joint, and central nervous system (CNS) lesions. Diagnosis is based on clinical findings, which may differ between patients. There is a strong genetic basis for BD; however, only a few genes have been associated with the disease across the geographical spread of BD. In this article, we discuss the history and combination of genes involved in this complex disease in relation to the geographical range and present our view that the disease has developed from a Darwinian perspective, with different gene polymorphisms that affect the same biological pathway. Moreover, these mutations individually are protective mechanisms against the disease relevant to each region, which affected both archaic and modern humans., Competing Interests: Conflict of Interest Robert J. Moots is the Co-Editor-in-Chief of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research groups., (© 2021 Rhodri Smith et al., published by Sciendo.)
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- 2021
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36. Comorbidity and response to TNF inhibitors in axial spondyloarthritis: longitudinal analysis of the BSRBR-AS.
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Zhao SS, Jones GT, Macfarlane GJ, Hughes DM, Moots RJ, and Goodson NJ
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- Adult, Comorbidity, Female, Humans, Male, Middle Aged, Quality of Life, Registries, Severity of Illness Index, Spondylarthritis diagnosis, Spondylarthritis drug therapy, Treatment Outcome, Antirheumatic Agents therapeutic use, Spondylarthritis epidemiology, Tumor Necrosis Factor Inhibitors therapeutic use
- Abstract
Objective: Comorbidities influence disease assessment in axial spondyloarthritis (axSpA), but their association with response to TNF inhibitors (TNFi) is unclear. We examined associations between comorbidity history at TNFi initiation and: (i) change in disease indices over time; (ii) binary response definitions; and (iii) time to treatment discontinuation., Methods: We studied participants starting their first TNFi from a national axSpA register. Comorbidity categories were created from 14 physician-diagnosed conditions and compared against: change in disease indices over time using linear mixed effects models; BASDAI50/2 (50% or 2-unit reduction) and BASDAI < 4 at 6 months using logistic models; and time to treatment discontinuation using Cox models. Models were adjusted for age, gender, BMI, deprivation and education., Results: In total, 994 were eligible for analysis (68% male, mean age 45 years); 21% had one comorbidity and 11% had ≥2. Baseline disease severity was higher in those with comorbidities across all indices, but absolute improvement over time was comparable for BASDAI and spinal pain. Participants with ≥2 comorbidities had smaller absolute improvement in BASFI and quality of life. This group also had numerically reduced odds of achieving BASDAI50/2 [odds ratio (OR) 0.81; 95% CI: 0.45, 1.45] and BASDAI < 4 (OR 0.57; 95% CI: 0.32, 1.04). Treatment discontinuation was increased in those with two comorbidities [hazard ratio (HR) 1.32; 95% CI: 0.88, 2.00] and ≥3 comorbidities (HR 2.18; 95% CI: 1.20, 3.93) compared with none., Conclusions: Participants with multiple comorbidities had poorer treatment outcomes, particularly increased treatment discontinuation and poorer improvements in function and quality of life. These results inform clinicians and educate patients about response to the first TNFi given comorbidity burden., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
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- 2021
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37. Internalization of Neutrophil-Derived Microvesicles Modulates TNFα-Stimulated Proinflammatory Cytokine Production in Human Fibroblast-Like Synoviocytes.
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Zhan D, Cross A, Wright HL, Moots RJ, Edwards SW, and Honsawek S
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- Cell-Derived Microparticles pathology, Cells, Cultured, Fibroblasts drug effects, Fibroblasts immunology, Fibroblasts pathology, Humans, Neutrophils pathology, Osteoarthritis, Knee drug therapy, Osteoarthritis, Knee immunology, Osteoarthritis, Knee pathology, Synoviocytes drug effects, Synoviocytes immunology, Synoviocytes pathology, Cell-Derived Microparticles metabolism, Fibroblasts metabolism, Inflammation Mediators metabolism, Neutrophils metabolism, Osteoarthritis, Knee metabolism, Synoviocytes metabolism, Tumor Necrosis Factor-alpha pharmacology
- Abstract
Neutrophil-derived microvesicles (NDMVs) have the potential to exert anti-inflammatory effects. Our study aimed to explore the effects of NDMVs on proinflammatory cytokines expressed by tumor necrosis factor α (TNFα)-stimulated fibroblast-like synoviocytes (FLS). FLS were isolated from the synovium of knee osteoarthritis (OA) patients undergoing surgery. NDMVs, isolated from TNFα-stimulated healthy neutrophils, were characterized by electron microscopy and nanoparticle tracking analysis. MTT and scratch wound healing assays were used to measure FLS viability and migration after treatment with NDMVs, while internalization of fluorescently labeled NDMVs was appraised by flow cytometry and confocal microscopy. Levels of proinflammatory cytokines in supernatants were quantified by the Bio-Plex system. Incubation of FLS with NDMVs at a vesicle/cell ratio of 100 resulted in a time-dependent uptake, with 35% of synoviocytes containing microvesicles over a 6-24 h time period, with no significant change in cell viability. TNFα stimulated the cytokine expression in FLS, and NDMVs down-regulated TNFα-induced expression of IL-5, IL-6, IL-8, MCP-1, IFNγ and MIP-1β. However, this down-regulation was selective, as NDMVs had no significant effects on TNFα-stimulated expression of IL-2 or IL-4. NDMVs were internalized by FLS to inhibit TNFα-stimulated broad-spectrum proinflammatory cytokine secretion. NDMVs, therefore, may exhibit an anti-inflammatory role in the regulation of the FLS function.
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- 2021
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38. Association between comorbidities and disease activity in axial spondyloarthritis: results from the BSRBR-AS.
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Zhao SS, Jones GT, Macfarlane GJ, Hughes DM, Moots RJ, and Goodson NJ
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- Adult, Aged, Blood Sedimentation, C-Reactive Protein immunology, Comorbidity, Female, Humans, Linear Models, Male, Middle Aged, Severity of Illness Index, Spondylarthropathies epidemiology, Spondylarthropathies immunology, Depressive Disorder epidemiology, Heart Failure epidemiology, Peptic Ulcer epidemiology, Spondylarthropathies physiopathology
- Abstract
Objective: Whether comorbidities influence disease activity assessment in axial SpA (axSpA) is unclear. Comorbidities inflate DAS28 in rheumatoid arthritis through the patient global score. We examined whether axSpA disease activity measures are differentially affected, and whether comorbidities inflate the AS disease activity score (ASDAS) through the patient global component., Methods: We used baseline data from the British Society for Rheumatology Biologics Register for AS, including 14 physician diagnosed comorbidities. Linear models were used to compare disease activity (BASDAI, spinal pain, ASDAS) and ESR/CRP according to comorbidity count, adjusted for age, gender, BMI, smoking, socioeconomic status, and education. The same models were used to examine whether the patient global score was associated with comorbidities, additionally adjusting for other ASDAS components., Results: The number of participants eligible for analysis was 2043 (67% male, mean age 49 years); 44% had at least one comorbidity. Each additional comorbidity was associated with higher BASDAI by 0.40 units (95% CI: 0.27, 0.52) and spinal pain by 0.53 (95% CI: 0.37, 0.68). Effect size for ASDAS (0.09 units; 95% CI: 0.03, 0.15) was not clinically significant. ESR and CRP were not associated with comorbidity count. Depression, heart failure and peptic ulcer were consistently associated with higher disease activity measures, but not CRP/ESR. Patient global was associated with comorbidity count, but not independently of other ASDAS components (P = 0.75)., Conclusion: Comorbidities were associated with higher patient reported disease activity in axSpA. Clinicians should be mindful of the potential impact of comorbidities on patient reported outcome measures and consider additionally collecting ASDAS when comorbidities are present., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
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- 2021
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39. Type I interferon regulates cytokine-delayed neutrophil apoptosis, reactive oxygen species production and chemokine expression.
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Glennon-Alty L, Moots RJ, Edwards SW, and Wright HL
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- Apoptosis, Cells, Cultured, Chemokines genetics, Chemokines metabolism, Gene Expression Regulation, Granulocyte-Macrophage Colony-Stimulating Factor genetics, Healthy Volunteers, Humans, MAP Kinase Signaling System, Myeloid Cell Leukemia Sequence 1 Protein metabolism, Tumor Necrosis Factor-alpha genetics, Arthritis, Rheumatoid immunology, Granulocyte-Macrophage Colony-Stimulating Factor metabolism, Interferon-alpha metabolism, Lupus Erythematosus, Systemic immunology, Neutrophils immunology, Reactive Oxygen Species metabolism, Tumor Necrosis Factor-alpha metabolism
- Abstract
Interferons (IFNs) are key regulators of a number of inflammatory conditions in which neutrophils play an important role in pathology, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), where type I IFNs are implicated in disease pathology. However, IFNs are usually generated in vivo together with other cytokines that also have immunoregulatory functions, but such interactions are poorly defined experimentally. We measured the effects of type I (IFN-α) IFN, elevated in both RA and SLE, on the functions of healthy neutrophils incubated in vitro in the absence and presence of proinflammatory cytokines typically elevated in inflammatory diseases [tumour necrosis factor (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF)]. IFN-α alone had no effect on neutrophil apoptosis; however, it abrogated the anti-apoptotic effect of GM-CSF (18 h, P < 0·01). The enhanced stability of the anti-apoptotic protein myeloid cell leukaemia 1 (Mcl-1) and delayed activation of caspase activation normally regulated by GM-CSF were blocked by IFN-α: this effect was mediated, in part, by activation of p38 mitogen-activated protein kinase (MAPK). IFN-α alone also primed reactive oxygen species (ROS) production and maintained the transient priming effect of TNF-α for up to 4 h: it also down-regulated GM-CSF- and TNF-α-activated expression of chemokine (C-X-C motif) ligand (CXCL)1, CXCL2, CXCL3, CXCL8, CCL3 and CCL4 but, in contrast, increased the expression of CXCL10. These novel data identify complex regulatory signalling networks in which type I IFNs profoundly alter the response of neutrophils to inflammatory cytokines. This is likely to have important consequences in vivo and may explain the complexity and heterogeneity of inflammatory diseases such as RA, in which multiple cytokine cascades have been activated., (© 2020 The Authors. Clinical & Experimental Immunology published by John Wiley & Sons Ltd on behalf of British Society for Immunology.)
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- 2021
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40. Rheumatoid Arthritis Synovial Fluid Neutrophils Drive Inflammation Through Production of Chemokines, Reactive Oxygen Species, and Neutrophil Extracellular Traps.
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Wright HL, Lyon M, Chapman EA, Moots RJ, and Edwards SW
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- Apoptosis immunology, Female, Humans, Joints immunology, Male, Middle Aged, Neutrophil Activation immunology, Peroxidase immunology, Signal Transduction immunology, Synovial Membrane immunology, Arthritis, Rheumatoid immunology, Chemokines immunology, Extracellular Traps immunology, Inflammation immunology, Neutrophils immunology, Reactive Oxygen Species immunology, Synovial Fluid immunology
- Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting synovial joints. Neutrophils are believed to play an important role in both the initiation and progression of RA, and large numbers of activated neutrophils are found within both synovial fluid (SF) and synovial tissue from RA joints. In this study we analyzed paired blood and SF neutrophils from patients with severe, active RA (DAS28>5.1, n=3) using RNA-seq. 772 genes were significantly different between blood and SF neutrophils. IPA analysis predicted that SF neutrophils had increased expression of chemokines and ROS production, delayed apoptosis, and activation of signaling cascades regulating the production of NETs. This activated phenotype was confirmed experimentally by incubating healthy control neutrophils in cell-free RA SF, which was able to delay apoptosis and induce ROS production in both unprimed and TNFα primed neutrophils (p<0.05). RA SF significantly increased neutrophil migration through 3μM transwell chambers (p<0.05) and also increased production of NETs by healthy control neutrophils (p<0.001), including exposure of myeloperoxidase (MPO) and citrullinated histone-H3-positive DNA NETs. IPA analysis predicted NET production was mediated by signaling networks including AKT, RAF1, SRC, and NF-κB. Our results expand the understanding of the molecular changes that take place in the neutrophil transcriptome during migration into inflamed joints in RA, and the altered phenotype in RA SF neutrophils. Specifically, RA SF neutrophils lose their migratory properties, residing within the joint to generate signals that promote joint damage, as well as inflammation via recruitment and activation of both innate and adaptive immune cells. We propose that this activated SF neutrophil phenotype contributes to the chronic inflammation and progressive damage to cartilage and bone observed in patients with RA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wright, Lyon, Chapman, Moots and Edwards.)
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- 2021
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41. Anti-TNF biosimilars in rheumatology: the end of an era?
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Dey M, Zhao SS, and Moots RJ
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- Humans, Treatment Outcome, Antirheumatic Agents therapeutic use, Biosimilar Pharmaceuticals therapeutic use, Rheumatic Diseases drug therapy, Rheumatology, Tumor Necrosis Factor Inhibitors therapeutic use
- Abstract
Introduction: Tumor necrosis factor inhibitors (TNFi) have revolutionized the treatment of rheumatic diseases. Whilst extremely efficacious, the original TNFi also carried a high acquisition cost that limited their use. 'Biosimilar' TNFi's, developed on expiry of the patents for the biooriginators, have comparable efficacy and safety, are less expensive and provide the potential to improve access to these effective therapies in a more cost-effective manner., Areas Covered: The background and development of TNFis, their biosimilars and follow on 'copycat' drugs are discussed, together with their use in both developed and developing countries, focusing on the potential to enhance access to effective targeted therapies., Expert Opinion: Bridging the economic gap to facilitate universal access to anti-TNF biosimilars has been largely unsuccessful, driving the development of copycat mimics in developing countries. Meanwhile, the more recent introduction of targeted synthetic disease-modifying drugs has provided cheaper, equally effective treatments for rheumatic diseases that are conveniently delivered by mouth. We review the TNF biosimilars in rheumatic diseases, their role in a rapidly evolving treatment landscape, and speculate about the future for this iconic therapeutic class.
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- 2021
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42. Biomarkers for Treatment Response in Rheumatoid Arthritis: Where are they?
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Zhao SS and Moots RJ
- Abstract
Competing Interests: Conflict of Interest None declared.
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- 2020
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43. An update on the general management approach to common vasculitides.
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Hng M, Zhao SS, and Moots RJ
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- Adult, Humans, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis diagnosis, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy, Giant Cell Arteritis diagnosis, Giant Cell Arteritis therapy
- Abstract
Primary systemic vasculitides (PSV) are multisystem diseases associated with high morbidity and mortality, particularly if not treated in a timely manner. In recent decades, clinical trials have delivered considerable evidence to underpin optimal diagnostic and therapeutic approaches. This article provides a brief overview of PSV in adults, focusing on the latest updates and recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis and giant cell arteritis., (© Royal College of Physicians 2020. All rights reserved.)
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- 2020
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44. Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis.
- Author
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Zhao SS, Robertson S, Reich T, Harrison NL, Moots RJ, and Goodson NJ
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- Comorbidity, Humans, Hyperlipidemias epidemiology, Hypertension epidemiology, Obesity epidemiology, Prevalence, Spondylarthritis epidemiology
- Abstract
Objectives: Comorbidities are common in people with axial spondyloarthritis (axSpA). In this systematic review and meta-analysis, we aimed to: (i) describe the prevalence of commonly reported comorbidities, (ii) compare comorbidities between axSpA and control populations, and (iii) examine the impact of comorbidity burden on axSpA outcomes., Methods: We systematically searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We excluded studies of only one comorbid condition or a few closely related diseases within one organ system. Where possible, meta-analysis was performed using random-effects models., Results: A total of 40 studies were included for analysis. 36 studies reported prevalence of comorbidities, amounting to a combined sample size of 119 427 patients. The number of comorbidities studied ranged from 3 to 43. The most prevalent individual comorbidities were hypertension (pooled prevalence 23%), hyperlipidaemia (17%) and obesity (14%). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls, particularly large differences were seen for depression [pooled odds ratio (OR) 1.80] and heart failure (OR 1.84). Comorbidities (total number of and individual conditions) were also associated with axSpA disease activity, functional impairment, quality of life, work productivity and mortality., Conclusions: Comorbidities are common in axSpA, particularly cardiovascular diseases and risk factors. Most comorbidities were more prevalent in axSpA patients than in control populations. Overall comorbidity burden, and many individual conditions, were associated with axSpA outcomes including worse disease severity, work productivity and mortality., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
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- 2020
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45. APPA (apocynin and paeonol) modulates pathological aspects of human neutrophil function, without supressing antimicrobial ability, and inhibits TNFα expression and signalling.
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Cross AL, Hawkes J, Wright HL, Moots RJ, and Edwards SW
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- Acetophenones administration & dosage, Anti-Inflammatory Agents administration & dosage, Apoptosis drug effects, Cells, Cultured, Cytokines metabolism, Dose-Response Relationship, Drug, Drug Combinations, Humans, Inflammation drug therapy, Inflammation pathology, Neutrophils pathology, Reactive Oxygen Species metabolism, Signal Transduction drug effects, Tumor Necrosis Factor-alpha metabolism, Acetophenones pharmacology, Anti-Inflammatory Agents pharmacology, Neutrophils drug effects
- Abstract
Neutrophils are key players in the pathophysiological process underlying inflammatory conditions not only by release of tissue-damaging cytotoxic enzymes, reactive oxygen species (ROS) but also by secretion of important immunomodulatory chemokines and cytokines. Here, we report the effects of the novel agent APPA, undergoing formal clinical development for treatment of osteoarthritis, and its constituent components, apocynin (AP) and paeonol (PA) on a number of neutrophil functions, including effects on TNFα- expression and signalling. Neutrophils were treated with APPA (10-1000 µg/mL) prior to the measurement of cell functions, including ROS production, chemotaxis, apoptosis and surface receptor expression. Expression levels of several key genes and proteins were measured after incubation with APPA and the chromatin re-modelling agent, R848. APPA did not significantly affect phagocytosis, bacterial killing or expression of surface receptors, while chemotactic migration was affected only at the highest concentrations. However, APPA down-regulated neutrophil degranulation and ROS levels, and decreased the formation of neutrophil extracellular traps. APPA also decreased cytokine-stimulated gene expression, inhibiting both TNFα- and GM-CSF-induced cell signalling. APPA was as effective as infliximab in down-regulating chemokine and IL-6 expression following incubation with R848. Whilst APPA does not interfere with neutrophil host defence against infections, it does inhibit neutrophil degranulation, and cytokine-driven signalling pathways (e.g. autocrine signalling and NF-κB activation), processes that are associated with inflammation. These observations may explain the mechanisms by which APPA exerts anti-inflammatory effects and suggests a potential therapeutic role in inflammatory diseases in which neutrophils and TNFα signalling are important in pathology, such as rheumatoid arthritis.
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- 2020
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46. Impact of Smoking in Response to Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Methodologic Considerations for Longitudinal Observational Studies.
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Zhao SS, Yoshida K, Jones GT, Hughes DM, Tedeschi SK, Lyu H, Moots RJ, Solomon DH, and Goodson NJ
- Subjects
- Adult, Female, Humans, Longitudinal Studies, Male, Middle Aged, Registries, Severity of Illness Index, Spondylarthritis diagnosis, Treatment Outcome, United Kingdom, Antirheumatic Agents therapeutic use, Smoking, Spondylarthritis drug therapy, Tumor Necrosis Factor Inhibitors therapeutic use
- Abstract
Objective: Observational data facilitate examination of treatment-effect heterogeneity, but the risk of bias is substantial. The present study was undertaken to highlight methodologic considerations through an analysis of whether smoking affects response to tumor necrosis factor inhibitors (TNFi) in axial spondyloarthritis (SpA)., Methods: We used longitudinal data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis. Participants fulfilling the Assessment of SpondyloArthritis international Society criteria for axial SpA who started their first TNFi were eligible for analysis. In comparing the impact of smoking status, weighted generalized estimating equations were used to examine changes in several continuous outcome measures, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Inverse probability weights were used to account for differences in baseline covariates and excluded participants. We separately assessed response in the first 3 months to account for nonrandom dropout., Results: For 840 participants who started on TNFi, 1,641 assessments from 627 individuals were analyzed (69% male, mean age 46 years). A total of 33% were current smokers and 30% ex-smokers. Ex-smokers and current smokers had worse disease than never smokers at baseline. Accounting for these differences, response did not differ according to smoking status. Compared to never smokers, ex-smokers (β = -0.6, 95% confidence interval [95% CI] -1.4, 0.3) and current smokers (β = -0.4, 95% CI -1.1, 0.4) had a similar response according to the BASDAI and ASDAS (ex-smokers β = -0.1, 95% CI -0.5, 0.3; current smokers β = -0.01, 95% CI -0.4, 0.4) at 3 months., Conclusion: TNFi response did not differ according to baseline smoking status in this UK cohort. Conflicting results from previous studies were likely due to methodologic differences. This analysis highlights potential sources of bias that should be addressed in future studies., (© 2019, American College of Rheumatology.)
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- 2020
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47. A novel treatment in the management of genital ulceration in Behçet's disease.
- Author
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Benson RM, Kirwan J, and Moots RJ
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- Female, Genital Diseases, Female, Genital Diseases, Male, Genitalia, Humans, Male, Behcet Syndrome, Ulcer drug therapy
- Published
- 2019
48. Comparison of comorbidities and treatment between ankylosing spondylitis and non-radiographic axial spondyloarthritis in the United States.
- Author
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Zhao SS, Ermann J, Xu C, Lyu H, Tedeschi SK, Liao KP, Yoshida K, Moots RJ, Goodson NJ, and Solomon DH
- Subjects
- Adult, Aged, Chronic Disease drug therapy, Comorbidity, Cross-Sectional Studies, Female, Humans, Inflammation Mediators blood, Male, Middle Aged, Spondylarthritis blood, Spondylarthritis drug therapy, Spondylitis, Ankylosing blood, Spondylitis, Ankylosing drug therapy, United States, Antirheumatic Agents therapeutic use, Biological Products therapeutic use, Chronic Disease epidemiology, Spondylarthritis epidemiology, Spondylitis, Ankylosing epidemiology
- Abstract
Objectives: This study aimed to compare comorbidities and biologic DMARD (bDMARD) use between AS and non-radiographic axial SpA (nr-axSpA) patients, using a large cohort of patients from routine clinical practice in the United States., Methods: We performed a cross-sectional study using electronic medical records from two academic hospitals in the United States. Data were extracted using automated searches (⩾3 ICD codes combined with text searches) and supplemented with manual chart review. Patients were categorized into AS or nr-axSpA according to classification criteria. Disease features, comorbidities (from a list of 39 chronic conditions) and history of bDMARD prescription were compared using descriptive statistics., Results: Among 965 patients identified, 775 (80%) were classified as having axSpA. The cohort was predominantly male (74%) with a mean age of 52.5 years (s.d. 16.8). AS patients were significantly older (54 vs 46 years), more frequently male (77% vs 64%) and had higher serum inflammatory markers than those with nr-axSpA (median CRP 3.4 vs 2.2 mg/dl). Half of all patients had at least one comorbidity. The mean number of comorbidities was 1.5 (s.d. 2.2) and similar between AS and nr-axSpA groups. A history of bDMARD-use was seen in 55% of patients with no difference between groups. The most commonly prescribed bDMARDs were adalimumab (31%) and etanercept (29%). Ever-prescriptions of individual bDMARDs were similar between AS and nr-axSpA., Conclusion: Despite age differences, nr-axSpA patients had similar comorbidity burdens as those with AS. Both groups received comparable bDMARD treatment in this United States clinic-based cohort., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
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49. Patient-reported outcomes for tofacitinib with and without methotrexate, or adalimumab with methotrexate, in rheumatoid arthritis: a phase IIIB/IV trial.
- Author
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Strand V, Mysler E, Moots RJ, Wallenstein GV, DeMasi R, Gruben D, Soma K, Iikuni N, Smolen JS, and Fleischmann R
- Subjects
- Adalimumab administration & dosage, Arthritis, Rheumatoid diagnosis, Drug Therapy, Combination, Humans, Methotrexate administration & dosage, Middle Aged, Piperidines administration & dosage, Pyrimidines administration & dosage, Pyrroles administration & dosage, Severity of Illness Index, Treatment Outcome, Adalimumab therapeutic use, Arthritis, Rheumatoid drug therapy, Methotrexate therapeutic use, Piperidines therapeutic use, Pyrimidines therapeutic use, Pyrroles therapeutic use
- Abstract
Objective: To provide the first direct comparison of patient-reported outcomes (PROs) following treatment with tofacitinib monotherapy versus tofacitinib or adalimumab (ADA) in combination with methotrexate (MTX) in patients with rheumatoid arthritis (RA) with inadequate response to MTX (MTX-IR)., Methods: ORAL Strategy (NCT02187055), a phase IIIB/IV, head-to-head, randomised controlled trial, assessed non-inferiority between tofacitinib 5 mg two times per day monotherapy, tofacitinib 5 mg two times per day+MTX and ADA 40 mg every other week+MTX. PROs assessed included the following: Patient Global Assessment of disease activity (PtGA), Pain, Health Assessment Questionnaire-Disability Index, Functional Assessment of Chronic Illness Therapy-Fatigue and 36-Item Short-Form Health Survey (SF-36) summary and domain scores., Results: Substantial improvements from baseline were reported across all PROs in all treatment arms, which, in the majority, met or exceeded minimum clinically important differences. Compared with tofacitinib monotherapy, tofacitinib+MTX combination treatment conferred significantly greater improvements in PtGA, Pain and SF-36 physical component summary scores at month 6. Statistically or numerically greater improvements were often, but not uniformly, reported for combination treatments compared with tofacitinib monotherapy at other time points., Conclusion: Treatment with tofacitinib+MTX, ADA+MTX and tofacitinib monotherapy resulted in clinically meaningful improvements in PROs in MTX-IR patients with RA. These were comparatively greater with combination treatments versus tofacitinib monotherapy, although differences between treatment arms were small, limiting our ability to confer clinical meaning., Trial Registration Number: NCT02187055., Competing Interests: Competing interests: VS has received consulting fees from AbbVie, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Corrona, Eli Lilly, Genentech/Roche, GSK, Janssen, Merck, Novartis, Pfizer Inc, Regeneron, Samsung, Sandoz, Sanofi and UCB. EM has received research grants, consulting fees or other remuneration from, and is a member of the speakers’ bureau for, AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, MedImmune, Pfizer Inc and Roche. RJM has received research grants and consulting fees from, or is a member of the speakers’ bureau for, AbbVie, AKL Pharma, Biogen, Bristol-Myers Squibb, Chugai, Eli Lilly, Novartis, Pfizer Inc, Roche, Sandoz, Sanofi and UCB. DG, KS and NI are employees and shareholders of Pfizer Inc. GVW and RD were employees and shareholders of Pfizer Inc at the time of the analysis. JSS has received consulting fees, speaking fees and honoraria from AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celltrion, Eli Lilly, GSK, ILTOO, Janssen, MedImmune, MSD, Novartis-Sandoz, Pfizer Inc, Roche, Samsung, Sanofi and UCB Pharma; and has received institutional grants from AbbVie, Eli Lilly, Janssen, MSD, Pfizer Inc and Roche. RF has received research grants or consulting fees from AbbVie, ACEA, Amgen, AstraZeneca, Bristol-Myers Squibb, Celltrion, Eli Lilly, Genentech, GSK, Janssen, Novartis, Pfizer Inc, Samsung, Sanofi-Aventis, Tahio and UCB., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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50. Comorbidity burden in axial spondyloarthritis: a cluster analysis.
- Author
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Zhao SS, Radner H, Siebert S, Duffield SJ, Thong D, Hughes DM, Moots RJ, Solomon DH, and Goodson NJ
- Subjects
- Adult, Anxiety epidemiology, Cluster Analysis, Comorbidity, Coronary Disease epidemiology, Cross-Sectional Studies, Female, Fibromyalgia epidemiology, Humans, Irritable Bowel Syndrome epidemiology, Linear Models, Male, Middle Aged, Patient Reported Outcome Measures, Quality of Life, Spondylarthritis psychology, United Kingdom epidemiology, Cost of Illness, Depression epidemiology, Hypertension epidemiology, Severity of Illness Index, Spondylarthritis epidemiology
- Abstract
Objectives: To examine how comorbidities cluster in axial spondyloarthritis (axSpA) and whether these clusters are associated with quality of life, global health and other outcome measures., Methods: We conducted a cross-sectional study of consecutive patients meeting ASAS criteria for axSpA in Liverpool, UK. Outcome measures included quality of life (EQ5D), global health and disease activity (BASDAI). We used hierarchical cluster analysis to group patients according to 38 pre-specified comorbidities. In multivariable linear models, the associations between distinct comorbidity clusters and each outcome measure were compared, using axSpA patients with no comorbidities as the reference group. Analyses were adjusted for age, gender, symptom duration, BMI, deprivation, NSAID-use and smoking., Results: We studied 419 patients (69% male, mean age 46 years). 255 patients (61%) had at least one comorbidity, among whom the median number was 1 (range 1-6). Common comorbidities were hypertension (19%) and depression (16%). Of 15 clusters identified, the most prevalent clusters were hypertension-coronary heart disease and depression-anxiety. Compared with patients with no comorbidities, the fibromyalgia-irritable bowel syndrome cluster was associated with adverse patient-reported outcome measures; these patients reported 1.5-unit poorer global health (95%CI 0.01, 2.9), reduced quality of life (0.25-unit lower EQ5D; 95%CI -0.37, -0.12) and 1.8-unit higher BASDAI (95% CI 0.4, 3.3). Similar effect estimates were found for patients in the depression-anxiety cluster., Conclusion: Comorbidity is common among axSpA patients. The two most common comorbidities were hypertension and depression. Patients in the depression-anxiety and fibromyalgia-IBS clusters reported poorer health and increased axSpA severity., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF
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