125 results on '"Simplified Disease Activity Index"'
Search Results
2. MCT-Induced Ketosis and Fiber in Rheumatoid Arthritis (MIKARA)—Study Protocol and Primary Endpoint Results of the Double-Blind Randomized Controlled Intervention Study Indicating Effects on Disease Activity in RA Patients
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Christina Heidt, Jörn Pons-Kühnemann, Ulrike Kämmerer, Thorsten Marquardt, and Monika Reuss-Borst
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rheumatoid arthritis ,medium-chain triglycerides ,fiber ,Simplified Disease Activity Index ,β-hydroxybutyrate ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Fatty acids, such as medium-chain fatty acids (MCFAs) and short-chain fatty acids (SCFAs), both important components of a normal diet, have been reported to play a role in bone-related diseases such as rheumatoid arthritis (RA). However, the role of medium-chain triglycerides (MCTs) has not been investigated in RA to date. The aim of this study was to investigate the effect of supplementation of regular diet with MCT with and without fiber on disease activity as measured with the SDAI (Simplified Disease Activity Index) in RA patients. A total of 61 RA patients on stable drug treatment were randomly assigned to a twice-daily control regimen or to a twice-daily regimen of a formulation containing medium-chain triglycerides (MCTs) 30 g/day for 8 weeks followed by a second twice-daily regimen of combining MCT (30 g/day) plus fiber (30 g/day) for an additional 8 weeks. The control group received a formulation containing long-chain triglycerides (LCTs) instead of MCTs. The preliminary results showed a significant reduction in SDAI from baseline to week 16 in the test group and a significant increase in β-hydroxybutyrate (BHB) levels, while no improvement in SDAI was observed in the control group.
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- 2023
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3. Consideration of differences in drug usage between young-onset and elderly-onset rheumatoid arthritis with target of low disease activity.
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Kosuke Kumagai, Noriaki Okumura, Yasutaka Amano, Takafumi Yayama, Tomohiro Mimura, Tsutomu Maeda, Mitsuhiko Kubo, Kanji Mori, Barrett-Jolley, Richard, and Shinji Imai
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DRUG utilization , *RHEUMATOID arthritis treatment , *RHEUMATOID factor , *PREDNISOLONE , *METHOTREXATE , *BIOLOGICALS - Abstract
Objectives: Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital. Methods: Demographics, clinical history, and treatments were compared between patients with EORA (n=70) and YORA (n=190). Results: There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p=.011) and overall biologics use (32.9% vs. 56.3%, p=.0012) were significantly lower in patients with EORA than in those with YORA. Conclusion: Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA. [ABSTRACT FROM AUTHOR]
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- 2021
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4. Preferences of inflammatory arthritis patients for biological disease-modifying antirheumatic drugs in the first 100 days of the COVID-19 pandemic
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Orhan Küçükşahin, Servet Akar, Emel Gönüllü, Duygu Ersözlü, Sedat Kiraz, Gezmiş Kimyon, Hakan Emmungil, Umut Kalyoncu, Ali İhsan Ertenli, Nihan Coşkun, Emre Bilgin, Rıdvan Mercan, Yavuz Pehlivan, Omer Karadag, Hüseyin Dalkiliç, Cemal Bes, Süleyman Serdar Koca, Burcu Yağız, Nilüfer Alpay Kanıtez, Timuçin Kaşifoğlu, Seda Colak, Elif Durak Ediboglu, Levent Kilic, İç Hastalıkları, Kanıtez, Nilüfer Alpay (ORCID 0000-0003-1185-5816 & YÖK ID 239432), Kalyoncu, Umut, Pehlivan, Yavuz, Akar, Servet, Kaşifoğlu, Timuçin, Kimyon, Gezmiş, Karadağ, Ömer, Dalkılıç, Ediz, Ertenli, Ali İhsan, Kılıç, Levent, Ersözlü, Duygu, Beş, Cemal, Emmungil, Hakan, Mercan, Rıdvan, Ediboğlu, Elif Durak, Bilgin, Emre, Çolak, Seda, Koca, Süleyman Serdar, Gönüllü, Emel, Küçükşahin, Orhan, Coşkun, Nihan, Yağız, Burcu, Kiraz, Sedat, Koç University Hospital, and School of Medicine
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rheumatoid arthritis ,Male ,Bath ankylosing spondylitis disease activity index ,Inflammatory arthritis ,polymerase chain reaction ,very elderly ,health status ,Disease ,Arthritis, Rheumatoid ,Cohort Studies ,rituximab ,adalimumab ,Pandemic ,middle aged ,disease modifying antirheumatic drug ,Health Assessment Questionnaire ,Prospective Studies ,Registries ,golimumab ,Aged, 80 and over ,register ,Ankylosing Spondylitis Disease Activity Score ,secukinumab ,adult ,medication compliance ,Simplified Disease Activity Index ,Biologic DMARDs ,General Medicine ,spondyloarthritis ,Middle Aged ,cohort analysis ,aged ,female ,spondylarthritis ,Rheumatoid arthritis ,drug withdrawal ,Antirheumatic Agents ,young adult ,Rituximab ,Female ,biologic DMARDs ,medicine.drug ,prospective study ,Adult ,medicine.medical_specialty ,abatacept ,hydroxychloroquine ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Visual analogue scale ,COVID-19 ,Spondyloarthritis ,salazosulfapyridine ,methotrexate ,Article ,Medication Adherence ,tocilizumab ,coronavirus disease 2019 ,Young Adult ,remission ,Internal medicine ,medicine ,DAS28 ,Humans ,human ,Pandemics ,Aged ,leflunomide ,business.industry ,SARS-CoV-2 ,pandemic ,questionnaire ,General and internal medicine ,visual analog scale ,medicine.disease ,major clinical study ,Discontinuation ,certolizumab pegol ,Bath ankylosing spondylitis functional index ,antirheumatic agent ,observational study ,erythrocyte sedimentation rate ,business ,infliximab ,Crohn Disease Activity Index ,etanercept ,disease activity - Abstract
Background/aim: to evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic. Materials and methods: a total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6-9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients' data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results: a total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21-73] vs. 44 years [20-79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion: although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored., Hacettepe Rheumatology Society
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- 2021
5. A Deep Insight on Rheumatoid Arthritis, Indexes (Disease Activity Score 28 (DAS28), ESR, CRP, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Global Health) and Correlation with the Level of Disease Activity
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Syed Faaez Ul Hassan Naqvi and Gul Shehnaz
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medicine.medical_specialty ,business.industry ,Simplified disease activity index ,Activity index ,medicine.disease ,Clinical disease ,Das28 esr ,Disease activity ,Correlation ,Rheumatoid arthritis ,Internal medicine ,Global health ,Medicine ,business - Abstract
Rheumatoid arthritis as one of the autoimmune diseases is more prevalent now than ever before. Being more common in women than men, RA has been focused by researchers to invent a therapeutic agent for effective clinical response. Various Diagnostic biomarkers are being used for early diagnosis of RA depending upon their selectivity and specificity. Certain indexes for RA disease activity evaluation are used for assessment of disease on a continuous scale. Disease activity Score combined with laboratory data result and imaging technologies makes the decision of treatment strategies easier than before. Traditionally, TNFi are the most used agents since a decade and first choice of treatment by clinicians, however, combination therapy with DMARD is used in inadequate responders. Despite all the advancements in treatment of RA and proved remission possibility using latest biological agents, studies are needed to ensure quick clinical outcomes and remission probability in larger fraction of people.
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- 2020
6. How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort
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Zhuoli Zhang, Wenhui Xie, Guangtao Li, and Hong Huang
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medicine.medical_specialty ,business.industry ,Swollen joint count ,Simplified disease activity index ,medicine.disease ,Rheumatology ,humanities ,Agreement ,Disease activity ,Clinical Practice ,Rheumatoid arthritis ,Internal medicine ,Cohort ,Low disease activity ,Immunology and Allergy ,Medicine ,Cutoff ,Boolean ,business ,Original Research - Abstract
Introduction The aim of this work is to propose Boolean-defined low disease activity (LDA) and to test its utility in rheumatoid arthritis (RA). Methods We used data from a longitudinal academic clinical database of RA in Peking University First Hospital over a decade. The initial proposal of Boolean-defined LDA was proposed with ascending thresholds from 2 to 5 in steps of 1 (referred to as Boolean-LDA2/3/4/5). Agreement and residual swollen joint count (SJC) pattern with the index-based [Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)] LDA was analyzed. To confirm discovery, we randomly classified RA patients in a 3:2 ratio into either analysis cohort or validation cohort. Results In total, 4881 visits of 672 patients were included in the analysis cohort. Of these visits, the frequencies of achieving LDA were 71.9% (SDAI), 73.6% (CDAI), 52.8% (Boolean-LDA2), 65.2% (Boolean-LDA3), 73.5% (Boolean-LDA4), and 80.7% (Boolean-LDA5). High consistency and similar SJC pattern with SDAI-LDA or CDAI-LDA were observed in Boolean-LDA3 (kappa = 0.796, 0.771). Further analysis found meeting SDAI-LDA but not Boolean-LDA3 was largely attributable to higher patient’s global assessment (PGA) scores (62.9%). In further modification of Boolean-LDA3, better agreement with SDAI-LDA or CDAI-LDA was reached when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by evaluator’s global assessment (EGA) with cutoff to 3.0. These findings were further replicated in randomly generated validation cohort of 449 patients with 3306 clinic visits. Conclusions Using cutoff of 3 to Boolean-LDA provides great clinical utility with index-based LDA, especially when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by EGA with cutoffs to 3.0. This may deserve being considered in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00270-z.
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- 2020
7. Serum Levels of Beta-2 Microglobulin in Rheumatoid Arthritis Patients and its Relationship with Disease Activity: Can it be used as a Disease Activity Marker?
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Murat Turgay, İlyas Ercan Okatan, Gülay Kinikli, Emine Gözde Aydemir Gülöksüz, Ayşe Bahar Keleşoğlu Dinçer, Emine Uslu Yurteri, Serdar Sezer, Aşkın Ateş, Murat Torgutalp, and Müçteba Enes Yayla
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musculoskeletal diseases ,030203 arthritis & rheumatology ,030213 general clinical medicine ,medicine.medical_specialty ,Ankylosing spondylitis ,Beta-2 microglobulin ,business.industry ,Simplified disease activity index ,Activity index ,medicine.disease ,Clinical disease ,Gastroenterology ,Disease activity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Rheumatoid arthritis ,medicine ,business ,Rheumatoide arthritis - Abstract
Background Beta-2 microglobulin (β2M) is mainly released from activated lymphocytes. Increased serum β2M levels have been shown in autoimmune diseases. The aim of this study was to analyse the serum levels of β2M in rheumatoid arthritis (RA) patients and to evaluate its relationship with disease activity measures. Material and Methods This cross-sectional study included 137 RA patients, 102 ankylosing spondylitis patients (AS) and 50 healthy controls (HC). To assess the disease activity of RA patients, the 28-joint Disease Activity Score-Erythrocyte Sedimentation Rate (DAS28-ESR), the 28-joint Disease Activity Score-C-Reactive Protein (DAS28-CRP), the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) were used. A p value of Results Serum β2M levels were significantly higher in RA patients (2.95±1.19 mg/L) compared with HC (2.21±0.54 mg/L) and AS patients (2.200.58 mg/L) (p Conclusion Our study revealed that serum β2M levels were higher in RA patients than in healthy controls, and, in contrast to other studies, we found positive correlations between β2M levels and RA disease activity measures.
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- 2020
8. Clinical conditions needed to acquire sustained functional remission in rheumatoid arthritis patients
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Yoshihiro Takayama, Masanori Wako, Kensuke Koyama, Hirotaka Haro, Tetsuro Ohba, and Ryousuke Koizumi
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medicine.medical_specialty ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disease activity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Remission criteria ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,030203 arthritis & rheumatology ,business.industry ,Remission Induction ,General Medicine ,Simplified disease activity index ,medicine.disease ,C-Reactive Protein ,Treatment Outcome ,Antirheumatic Agents ,Rheumatoid arthritis ,Usual care ,Functional status ,business - Abstract
Treatments aimed at maintaining sustained clinical remission in rheumatoid arthritis (RA) patients have been recommended by several groups. Improvement and maintenance of functional status are also important for RA patients. The purpose of this study was to investigate the factors for maintaining long-term functional remission.RA patients with usual care without specific protocols were included. Disease activity score using 28-joint count C-reactive protein (DAS28-CRP), simplified disease activity index (SDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score was calculated every 3 months for 1 year. Patients were divided into the HAQ-DI remission (REM) group and the HAQ-DI non-remission (NO-REM) group; time-averaged values of these parameters were compared between groups.Of the 205 patients, 154 fulfilled the remission criteria. Time-averaged DAS28-CRP and SDAI score were significantly lower in the REM group than in the NO-REM group (1.66 vs 2.59, 3.54 vs 10.68, respectively; p0.001). Subsequent receiver-operating characteristic (ROC) analysis for estimation of remission indicated a cut-off value of 1.65 for time-averaged DAS28-CRP and 2.85 for time-averaged SDAI score.Previous reports showed that fulfillment of clinical remission increases the possibility of functional remission; the probability of which is higher in patients with sustained clinical remission. Sustained clinical remission is required to achieve sustained functional remission; the criteria for clinical remission may be more stringent. Key Points • Sustained deep clinical remission was required to achieve sustained functional remission.
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- 2020
9. Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy.
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Fumio Hirano, Waka Yokoyama, Hayato Yamazaki, Koichi Amano, Atsushi Kawakami, Taichi Hayashi, Naoto Tamura, Shinsuke Yasuda, Hiroaki Dobashi, Takao Fujii, Satoshi Ito, Yuko Kaneko, Toshihiro Matsui, Yasuaki Okuda, Kazuyoshi Saito, Fumihito Suzuki, Ryusuke Yoshimi, Ryoko Sakai, Ryuji Koike, and Hitoshi Kohsaka
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Objective: To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T). Methods: In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (-3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI)-0.5 or with the delta van der Heijde-modified total Sharp score (DvdH-mTSS)
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- 2017
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10. A Proposal to Standardize Low Disease Activity Criteria in Rheumatoid Arthritis Based on the Outcome Measures in Rheumatology Minimal Disease Activity Definition
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Toshihiro Matsui, Naoto Yokogawa, Jinju Nishino, Akiko Komiya, Shoji Sugii, Kota Shimada, and Shigeto Tohma
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musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,medicine.diagnostic_test ,business.industry ,Brief Report ,Minimal disease ,Outcome measures ,Simplified disease activity index ,medicine.disease ,Rheumatology ,Disease activity ,Erythrocyte sedimentation rate ,Internal medicine ,Rheumatoid arthritis ,medicine ,Cutoff ,lcsh:RC925-935 ,business - Abstract
Objective We aimed to standardize the definition of low disease activity in rheumatoid arthritis (RA) using the Outcome Measures in Rheumatology (OMERACT) group's proposed definition of minimal disease activity. Method Based on a nationwide RA database, we proposed new Boolean low disease activity criteria using OMERACT's core set definition of minimal disease activity that requires the fulfillment of at least five of the following seven core set measures: a pain score of 2 or less, a swollen joint count (SJC28) of 1 or fewer, a tender joint count of 1 or fewer, a Health Assessment Questionnaire score of 0.5 or less, a Physician's Global Assessment score of 1.5 or less, a Patient's Global Assessment score of 2 or less, and an erythrocyte sedimentation rate (ESR) of 20 mm/h or less. Using receiver operating characteristic analysis, we determined the cutoffs for the Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Routine Assessment of Patient Index Data 3 (RAPID3), and the Disease Activity Score in 28 joints (DAS28)-ESR. Results Of 8298 patients, 56.2% met the proposed Boolean low disease activity criteria. We determined an SDAI score of 5.5 or less and a CDAI score of 5 or less to be the new cutoffs, and we chose a DAS28 of 2.85 or less (the original cutoff for DAS-based minimal disease activity) and a RAPID3 score of 6 or less (the original cutoff for RAPID3-based low disease activity) with or without a swollen joint count (SJC) (SJC of 2 or fewer) as the cutoffs for DAS28 and RAPID3. The agreement between the new cutoffs for DAS28 of 2.85 or less vs. CDAI score of 5 or less, CDAI score of 5 or less vs. RAPID3 score of 6 or less (with SJC of 2 or fewer), and DAS28 of 2.85 or less vs. RAPID3 score of 6 or less (with SJC of 2 or fewer), was 0.619, 0.612 (0.702), and 0.474 (0.531), respectively. Conclusion OMERACT's minimal disease activity definition may be used to standardize the criteria for low disease activity.
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- 2020
11. Differences in disease activity measures in patients with rheumatoid arthritis who achieved DAS, SDAI, or CDAI remission but not Boolean remission
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Sheng Zhong, Josef S Smolen, Xin Wang, Daniel Aletaha, Kelly Monastiriakos, and Stefan Florentinus
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musculoskeletal diseases ,medicine.medical_specialty ,4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ,Activity index ,Arthritis, Rheumatoid ,Disease activity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Remission criteria ,Internal medicine ,Early ra ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,030203 arthritis & rheumatology ,business.industry ,Simplified disease activity index ,Clinical disease ,medicine.disease ,humanities ,Anesthesiology and Pain Medicine ,Antirheumatic Agents ,Rheumatoid arthritis ,business - Abstract
Objectives In patients with rheumatoid arthritis (RA), remission may be assessed by various composite measures. We assessed achievement of remission as defined by Boolean criteria, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and 28-joint Disease Activity Score using C-reactive protein (DAS28[CRP]) and determined the components that limit patients in SDAI, CDAI, or DAS28(CRP) remission from achieving Boolean remission. Methods The proportions of patients achieving Boolean, SDAI, CDAI, or DAS28(CRP) remission were calculated for 3 trials: PREMIER and OPTIMA in patients with early RA and DE019 in patients with established RA. At the first visit that remission was recorded during the first 52 weeks of the trial, the following were assessed: swollen/tender joint count at 28 and 66/68 joints, CRP, Patient's/Physician's Global Assessment (PGA/PhGA), SDAI, DAS28(CRP), and Health Assessment Questionnaire-Disability Index. Results The majority of patients (61–66%) who achieved SDAI or CDAI remission also attained Boolean remission. Although DAS28(CRP) remission was most frequently attained, 74–77% of patients in DAS28(CRP) remission did not achieve Boolean remission. Compared with patients in Boolean remission, patients in SDAI or CDAI remission but not Boolean remission had higher PGA scores, while patients with DAS28(CRP) remission but not Boolean remission had higher joint counts, and PGA and PhGA scores. Conclusions Differences in PGA limit patients in SDAI/CDAI remission from meeting the Boolean remission criteria, suggesting that these criteria otherwise can be used interchangeably. In contrast, patients in DAS28(CRP) remission are limited by differences in multiple disease activity measures from achieving Boolean remission.
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- 2020
12. Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal?
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Farideh Alasti, David T. Felson, Josef S Smolen, Tanja Stamm, Daniel Aletaha, Maarten de Wit, and Paul Studenic
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medicine.medical_specialty ,Visual Analog Scale ,Immunology ,Recursive partitioning ,Severity of Illness Index ,General Biochemistry, Genetics and Molecular Biology ,Arthritis, Rheumatoid ,Rheumatology ,Internal medicine ,Outcome Assessment, Health Care ,Early ra ,medicine ,Humans ,Immunology and Allergy ,Randomized Controlled Trials as Topic ,Receiver operating characteristic ,business.industry ,Remission Induction ,Adalimumab ,Antibodies, Monoclonal ,Simplified disease activity index ,medicine.disease ,Infliximab ,Rheumatoid arthritis ,Tumor Necrosis Factor Inhibitors ,business ,Kappa ,Rheumatism - Abstract
ObjectivesThis study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA).MethodsWe used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0–10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored.ResultsData from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions.ConclusionIncreasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.
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- 2020
13. Serum Reactive Oxygen Metabolites as a Predictor of Clinical Disease Activity Index, Simplified Disease Activity Index, and Boolean Remissions in Rheumatoid Arthritis Patients Treated With Biologic Agents
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Keiichiro Terayama, Masato Sonobe, Shinji Taniguchi, Koichi Nakagawa, Ayako Kubota, Masaki Norimoto, Yorikazu Akatsu, Yasuchika Aoki, Arata Nakajima, and Junya Saito
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musculoskeletal diseases ,rheumatoid arthritis ,medicine.medical_specialty ,reactive oxygen metabolites ,biologic agents ,business.industry ,General Engineering ,predictor ,Simplified disease activity index ,Activity index ,medicine.disease ,Clinical disease ,Gastroenterology ,digestive system diseases ,humanities ,Biologic Agents ,remission ,Rheumatology ,Rheumatoid arthritis ,Internal medicine ,medicine ,business - Abstract
Introduction Reactive oxygen metabolites (ROMs) are metabolite hydroperoxides in the blood, and their serum levels were associated with the disease activity score 28 (DAS28) in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether ROMs would be predictive of the clinical disease activity index (CDAI) remission, simplified disease activity index (SDAI) remission, or Boolean remission. Materials and methods Fifty-one biologic agents (BA)-naïve RA patients were included in this observational study. Associations between ROMs, C-reactive protein, matrix metalloproteinase-3, DAS28-erythrocyte sedimentation rate (ESR), CDAI, SDAI, and health assessment questionnaire (HAQ) at 12 weeks and the DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were investigated. Results The DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were 66.7, 52.9, 54.9, and 54.9%, respectively. A multivariate logistic regression analysis revealed that ROMs and HAQ at 12 weeks were associated with the CDAI, SDAI, and Boolean remission at 52 weeks. Receiver operating characteristic analyses demonstrated that the cut-off value for CDAI, SDAI, and Boolean remission was 389.5 U.Carr. Conclusion Reactive oxygen metabolites at 12 weeks of initial treatment with BAs was a predictor for CDAI, SDAI, and Boolean remission at 52 weeks. Serum levels of ROMs may be a useful biomarker in the current treatment strategy aiming at early remission of RA.
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- 2021
14. Patient global assessment to define remission in rheumatoid arthritis:quo vadis?
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Maarten Boers
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0301 basic medicine ,medicine.medical_specialty ,Immunology ,Arthritis ,Severity of Illness Index ,General Biochemistry, Genetics and Molecular Biology ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,In patient ,030203 arthritis & rheumatology ,Tender joint count ,business.industry ,Remission Induction ,Simplified disease activity index ,Guideline ,medicine.disease ,Treatment Outcome ,030104 developmental biology ,Antirheumatic Agents ,Rheumatoid arthritis ,Physical therapy ,business ,Rheumatism - Abstract
The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) preliminary criteria for remission in rheumatoid arthritis (RA) have found widespread endorsement and adoption since their publication in 2011 (box 1).1 Patients that fulfil the criteria are almost indistinguishable from healthy persons and live a normal life.2 Nevertheless, the criteria are also seen as too strict,3 as not including enough patient-important outcomes4; and their application in patient care, as advised by guideline committees, has problems. Most of the criticism focuses on the inclusion of patient global assessment (PGA) and its threshold. Box 1 ### American College of Rheumatology–European League Against Rheumatism remission criteria.1 #### Boolean-based definition At any time point, patient must satisfy all of the following: Tender joint count ≤l* Swollen joint count ≤l* C reactive protein ≤1 mg/dL Patient global assessment (PGA) ≤1 (on a 0–10 scale)† #### Index-based definition At any time point, patient must have a Simplified Disease Activity Index Score of ≤3.3‡
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- 2020
15. New approaches to the assessment of rheumatoid arthritis activity: Simplified Disease Activity Index (SDAI) TOC \o '1-5' \h \z in early arthritis
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N A ChemeriS, D E Karateev, and E L Nassonov
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rheumatoid arthritis ,undifferentiated arthritis ,simplified disease activity index ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Objective. To assess significance of Simplified Disease Activity Index (SDAI) in early arthritis. Material and methods . 76 pts with suspicion of rheumatoid arthritis (RA), duration of the disease less than 6 months (3,6±1,7 months), meanage48,5±14years(17-76years)and male/female ratio 1/5 were examined. DAS 28 and SDAI were calculated for complex assessment of arthritis activity. Results. Mean SDAI value was 28,9±14,9 (1,37-67,64). In 40 (52,1%) of pts it corresponded to moderate, in 20 (26,6%) - to low and in 16 (21,3%) - to high activity of RA. Mean DAS 28 value was 4,86+1,23 (2,31-6,92). 12,5% of pts had low, 40,3% - moderate and 47,2% - high activity. SDAI significantly correlated with DAS 28 (p
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- 2005
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16. Tofacitinib for the treatment of rheumatoid arthritis: a real-world study in China
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Guangfeng Zhang, Yuan Feng, Yunzhen Shi, and Yuesheng Xie
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Pain score ,medicine.medical_specialty ,China ,Tofacitinib ,business.industry ,Visual analogue scale ,Simplified disease activity index ,Disease ,Activity index ,medicine.disease ,Clinical disease ,Arthritis, Rheumatoid ,Pyrimidines ,Treatment Outcome ,Piperidines ,Rheumatoid arthritis ,Internal medicine ,Antirheumatic Agents ,Emergency Medicine ,Internal Medicine ,Medicine ,Humans ,Pyrroles ,business ,Retrospective Studies - Abstract
Tofacitinib has only been available in China for 2 years to treat rheumatoid arthritis (RA). Our purpose was to compare real-world effectiveness of tofacitinib with that of disease-modifying anti-rheumatic drugs (DMARDs) in Chinese patients with RA. The records of patients with RA treated at Guangdong Provincial People’s Hospital between July 2017 and September 2019 were retrospectively reviewed. Patients were divided into those treated with tofacitinib, biological DMARDs (bDMARDs), and conventional synthetic DMARDs (csDMARDs). Clinical disease activity index (CDAI), simplified disease activity index (SDAI), health assessment questionnaire-disability index (HAQ-DI), visual analog scale (VAS) pain score, patient global assessment of disease activity (PtGA), physician global assessment of disease activity (PhGA), and swollen joint and tender joint count were compared among the groups up to 12 months of treatment. A total of 150 patients were included: 63 were treated with tofacitinib, 48 with bDMARDs, and 39 with csDMARDs. Tofacitinib was first-line treatment in 26.98% of patients, second-line treatment in 49.21%, and third-line treatment in 26.98%. Patients in the tofacitinib group had significantly higher disease duration (6.11 ± 6.97 years) than those in the other groups. All disease indices in the three groups decreased with time, indicating improvement of symptoms, with no differences among the groups at 12 months. Tofacitinib appeared to improve symptoms more rapidly than other treatments; however, differences in disease indices were not significant. This real-world study suggests that tofacitinib is rapidly effective and that the effects are sustained after 12 months in Chinese patients with RA.
- Published
- 2021
17. Simplified disease activity changes in real-world practice: a nationwide observational study of seropositive rheumatoid arthritis patients with moderate-to-high disease activity
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Kichul Shin, Sung Jae Choi, Dae Hyun Yoo, Seung Won Choi, Jin Wuk Hur, Sang-Heon Lee, Seung Jae Hong, Min Wook So, Hoon Suk Cha, Wan Hee Ryu, Dong Hyuk Sheen, Seong-Ho Kim, Shin-Seok Lee, Jung Yoon Choe, Hye Soon Lee, Jinseok Kim, Seung-Geun Lee, Jung Soo Song, Sung Hwan Park, Sung Soo Na, Chang Hee Suh, Won Park, Sung-Soo Kim, and Eun Young Lee
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musculoskeletal diseases ,medicine.medical_specialty ,Arthritis ,Logistic regression ,Severity of Illness Index ,Disease activity ,Arthritis, Rheumatoid ,Rheumatology ,Internal medicine ,Medicine ,Blood test ,Humans ,Biological therapy ,skin and connective tissue diseases ,Exercise ,medicine.diagnostic_test ,business.industry ,Remission Induction ,Simplified disease activity index ,medicine.disease ,Seropositive rheumatoid arthritis ,Treatment Outcome ,Antirheumatic Agents ,Observational study ,Original Article ,business ,Antirheumatic drugs ,Biomarkers - Abstract
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 rheu matoid 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. Se rial 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%, re spectively. 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.
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- 2019
18. Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis
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Sonia Farah, Fausto Salaffi, Marina Carotti, and Marco Di Carlo
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Adult ,Male ,medicine.medical_specialty ,Hand Joints ,Immunology ,Arthritis ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disease activity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Surveys and Questionnaires ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,Aged ,Interpretability ,030203 arthritis & rheumatology ,business.industry ,Reproducibility of Results ,Construct validity ,Simplified disease activity index ,Middle Aged ,Physical Functional Performance ,medicine.disease ,Disease control ,Rheumatoid arthritis ,Female ,business - Abstract
Objective of this study is to evaluate the construct validity and the interpretability of the shortened Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) in the assessment of rheumatoid arthritis (RA) hand disability. Consecutive RA patients were assessed through the QuickDASH and other function and disease activity indices, respectively, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Recent-Onset Arthritis Disability questionnaire (ROAD). For each patient were evaluated the tender and swollen 28-joints counts. Interpretability was defined determining cut-off points of impairment in accordance to the Simplified Disease Activity Index (SDAI) definition of disease activity states. A total of 440 patients (89 men and 351 women, mean age of 57.0 ± 12.7 years) were enrolled. Following the SDAI definition, 98 patients (22.3%) resulted in REM, 115 subjects (26.1%) in LDA, 74 patients (16.8%) in MDA, and 153 subjects (34.8%) in HDA. Mean QuickDASH differed significantly between patients classified as remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) (p 0.001). High correlations were found comparing QuickDASH to composite indices of disease activity and of physical health function: of special interest are the correlations between the comparable dimension of the QuickDASH and the ROAD Upper Extremity Function (rho = 0.876; p 0.001). The cut-off points for functional categories (SDAI categories as external criterion) resulted: no impairment ≤ 13, 13 low impairment ≤ 18.5, 18.5 moderate impairment ≤ 31.5, and high impairment 31.5. QuickDASH is useful in clinical practice, for its ease of administration, and positively correlates with the disease activity. It may be a surrogate for evaluating upper extremity impairment, disability index and disease control in RA patients.
- Published
- 2018
19. Joint index vector: a novel assessment measure for stratified medicine in patients with rheumatoid arthritis
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Susumu Nishiyama, Tetsuji Sawada, Shigeto Tohma, and Jinju Nishino
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Information Systems and Management ,Index (economics) ,lcsh:Computer engineering. Computer hardware ,Computer Networks and Communications ,Computer science ,lcsh:TK7885-7895 ,02 engineering and technology ,Decision analysis ,Data management ,lcsh:QA75.5-76.95 ,03 medical and health sciences ,0302 clinical medicine ,Stratified medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Mean vector ,In patient ,Vector (molecular biology) ,Rheumatoid arthritis ,Joint (geology) ,030203 arthritis & rheumatology ,lcsh:T58.5-58.64 ,business.industry ,lcsh:Information technology ,Simplified disease activity index ,medicine.disease ,Hardware and Architecture ,020201 artificial intelligence & image processing ,lcsh:Electronic computers. Computer science ,Nuclear medicine ,business ,Information Systems - Abstract
Objective To predict the next-year status in patients with rheumatoid arthritis using big data. Methods Joint index (JI) of upper/large (UL), upper/small (US), lower/large (LL), and lower/small (LS) was calculated as the sum of tender and swollen joint counts divided by the number of evaluable joints in each region of interest. Joint index vector V (x, y, z) was defined as x = JIUL + JIUS, y = JILL + JILS, and z = JIUL + JILL − JIUS − JILS. Low disease activity was defined as |Vxy| (= √x2 + y2) ≤ 0.1. Patients with |Vxy| > 0.1 were further classified into three groups: evenly affected (EVN): |z| ≤ 0.2, small joint dominant (SML): z 0.2. To predict the next-year V (x, y, z) of each patient, a transformation matrix was computed from the mean vectors of the EVN, SML, and LAR groups and their translation vectors. Results |Vxy| was correlated with Simplified Disease Activity Index (SDAI) (r = 0.82). Z of mean vector increased as the disability index of the Health Assessment Questionnaire (HAQ-DI) and the Steinbrocker class worsened. The LAR group had the worst HAQ-DI and the second highest SDAI after those in the SML group. Positive predictive value and likelihood ratio in predicting the LAR group were 58.7% and 5.9, respectively. Likelihood ratio was greater with treatment, at 7.2, 7.4, and 8.6 when targeted patients were treated with methotrexate, biologics, and both drugs, respectively. Conclusions Patients with high disease activity and poor functional state were predicted with high probability using joint index vectors.
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- 2018
20. Consideration of differences in drug usage between young-onset and elderly-onset rheumatoid arthritis with target of low disease activity
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Kanji Mori, Yasutaka Amano, Mitsuhiko Kubo, Takafumi Yayama, Tomohiro Mimura, N. Okumura, Tsutomu Maeda, Shinji Imai, Kosuke Kumagai, and Richard Barrett-Jolley
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musculoskeletal diseases ,Drug ,Male ,medicine.medical_specialty ,elderly-onset rheumatoid arthritis ,young-onset rheumatoid arthritis ,media_common.quotation_subject ,Young onset ,Disease activity score 28-CRP ,Drug usage ,Disease activity ,Arthritis, Rheumatoid ,03 medical and health sciences ,Drug treatment ,0302 clinical medicine ,simplified disease activity index ,Rheumatology ,Rheumatoid Factor ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Age of Onset ,skin and connective tissue diseases ,media_common ,Aged ,030203 arthritis & rheumatology ,business.industry ,Simplified disease activity index ,Middle Aged ,medicine.disease ,low disease activity ,Methotrexate ,Rheumatoid arthritis ,Antirheumatic Agents ,Elderly onset ,Female ,business - Abstract
Objectives:Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital., Methods:Demographics, clinical history, and treatments were compared between patients with EORA (n = 70) and YORA (n = 190)., Results:There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p = .011) and overall biologics use (32.9% vs. 56.3%, p = .0012) were significantly lower in patients with EORA than in those with YORA., Conclusion:Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA.
- Published
- 2021
21. Reliability and validity of CDAI and SDAI indices in comparison to DAS-28 index in Moroccan patients with rheumatoid arthritis.
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Slama, Imane Ben, Allali, Fadoua, Lakhdar, Touria, El kabbaj, Sarra, Medrare, Lamyae, Ngeuleu, Ange, Rkain, Hanan, and Hajjaj - Hassouni, Najia
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- *
RHEUMATOID arthritis diagnosis , *COMPARATIVE studies , *RHEUMATOID arthritis , *CROSS-sectional method , *SEVERITY of illness index ,RESEARCH evaluation - Abstract
Background: Clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are useful tools for the evaluation of disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Moroccan population. Therefore, this study was designed to assess validity and reliability of CDAI and SDAI in comparison to disease activity score-28 joints (DAS-28) in Moroccan patients with RA.Methods: Patients with RA were included in a cross-sectional study. Patient characteristics and RA were collected. The disease activity was assessed by DAS-28, CDAI and SDAI. Patients were splitted into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28, CDAI, and SDAI. A Spearman correlation between composite indexes and inter-group comparison of the indexes were performed. Using DAS-28 as a gold standard, the Receiver operator characteristic (ROC) curve was used to assess the performance of a screening test at different levels.Results: The study was conducted with 103 patients of female predominance (87.4%). Mean age was 49.7 ± 11.4 years. Median disease duration was in the order of 8 years [3-14]. There was an excellent correlation between DAS-28 and CDAI (r = 0.95, p <0.001), CDAI and SDAI (r = 0.90, p <0.001), and DAS-28 and SDAI (r = 0.92, p <0.001). There was a good inter-rater alignment between the DAS-28 and CDAI (Weighted kappa =0.743) and there was a moderate inter-rater alignment between the DAS-28 and SDAI (Weighted kappa =0.60), and also between the SDAI and CDAI (Weighted kappa = 0.589). There was no statistically significant difference between AUROC of CDAI and SDAI as both were performed equally well.Discussion: This study is the first Moroccan case study to compare the performance of both CDAI and SDAI in evaluation of disease activity in patients with RA. Our study showed that there was a direct and excellent correlation between DAS-28 and CDAI, and SDAI and DAS-28.Conclusion: Our study shows a strong positive correlation between DAS-28, CDAI and SDAI. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Moroccan scenario. [ABSTRACT FROM AUTHOR]- Published
- 2015
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22. A new laboratory surrogate (Monocyte Chemotactic Protein-1) for Disease Activity Score28: a favourable indicator for remission in rheumatoid arthritis
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Ting-chih Yeh, Lieh-bang Liou, Chih Feng Tan, Ping-Han Tsai, Shr-shian Jang, Yao-Fan Fang, and Jenn-Haung Lai
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0301 basic medicine ,musculoskeletal diseases ,Male ,medicine.medical_specialty ,lcsh:Medicine ,CCL2 ,Predictive markers ,Bone erosion ,Article ,Disease activity ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,Internal medicine ,Medicine ,Humans ,Prospective Studies ,Rheumatoid arthritis ,lcsh:Science ,skin and connective tissue diseases ,Chemokine CCL2 ,030203 arthritis & rheumatology ,Multidisciplinary ,business.industry ,lcsh:R ,Remission Induction ,Simplified disease activity index ,Odds ratio ,Middle Aged ,medicine.disease ,Rheumatology ,030104 developmental biology ,Antirheumatic Agents ,lcsh:Q ,Female ,business ,Rheumatism - Abstract
This prospective one-year follow-up study was conducted from 835 visits in 178 rheumatoid arthritis (RA) patients. Tender-/swollen-joint count, Health Assessment Questionnaire Disability Index (HAQ-DI), Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI) and DAS28-monocyte chemotactic protein-1 (DAS28-MCP-1) scores were obtained every 3 months. Radiographs of hands and feet were acquired at baseline and one year. We evaluated the correlation and accuracy of activity scores in predicting remission, HAQ-DI changes and radiographic changes. DAS28-MCP-1 correlated strongly with DAS28-ESR, DAS28-CRP and SDAI scores (0.830, 0.899 and 0.931, respectively, with all P P P = 0.002) and 0.98, respectively (and DAS28-MCP-1 with DAS28-CRP
- Published
- 2020
23. Simplified disease activity index and clinical disease activity index before and during pregnancy correlate with those at postpartum in patients with rheumatoid arthritis
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Daisuke Fujita, Tohru Takeuchi, Yumiko Wada, Takuya Kotani, Eri Nakamura, Ayaka Yoshikawa, Yuri Hiramatsu, Yoko Matsumura, Kenichiro Hata, and Nao Tokai
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Adult ,Male ,medicine.medical_specialty ,Prednisolone ,Activity index ,Severity of Illness Index ,Arthritis, Rheumatoid ,Biological Factors ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Pregnancy ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Postpartum Period ,Remission Induction ,Simplified disease activity index ,medicine.disease ,Clinical disease ,C-Reactive Protein ,Research Design ,Antirheumatic Agents ,Rheumatoid arthritis ,Female ,business ,Postpartum period ,medicine.drug - Abstract
Objectives We explored rheumatoid arthritis (RA) disease activity before, during, and after pregnancy in patients treated with tight control and investigated the association between disease activity in the postpartum period and those before and during pregnancy. Methods We retrospectively reviewed disease activity and medications of 27 patients before pregnancy, at every trimester, and in the postpartum period. Results Prednisolone was administered to 33% of patients with a median dose of 0 (0-2.5) mg/day and biologic agents was 78% in the third trimester. The median remission rates during all periods were the Disease Activity Score-28-C-reactive Protein assessed with three variables (DAS28-CRP-3) 85%, Simplified Disease Activity Index (SDAI) 55%, and Clinical Disease Activity Index (CDAI) 54%. Although SDAI and CDAI decreased significantly from before pregnancy to the first trimester and increased from the third trimester to the postpartum period, DAS28-CRP-3 did not change during all periods. Although SDAI and CDAI before and during pregnancy were significantly correlated with those in the postpartum period, DAS28-CRP-3 was not. Conclusions Tight control before pregnancy suppressed RA disease activity during pregnancy and in the postpartum period. SDAI/CDAI before and during pregnancy were predictive for disease activity in the postpartum period.
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- 2020
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24. The relationship between bristol rheumatoid arthritis fatigue scales and disease activity of patients with rheumatoid arthritis
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Sevinc Can Sandikci, Seda Colak, Derya Gökmen, and Ahmet Omma
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Adult ,Male ,medicine.medical_specialty ,Turkey ,Activity index ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disease activity ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Rating scale ,Surveys and Questionnaires ,Internal medicine ,Adaptation, Psychological ,medicine ,Humans ,030212 general & internal medicine ,skin and connective tissue diseases ,Fatigue ,Aged ,Aged, 80 and over ,030203 arthritis & rheumatology ,business.industry ,General Medicine ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Clinical disease ,Rheumatoid arthritis ,Multivariate Analysis ,Linear Models ,Quality of Life ,Female ,business - Abstract
Fatigue is a symptom that affects the 40-80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3 ± 1.24, 9.51 ± 7.96, and 10.5 ± 8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.
- Published
- 2018
25. Origins of Discordant Responses among 3 Rheumatoid Arthritis Improvement Criteria
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Michael M. Ward, Lori C. Guthrie, Maria I. Alba, and Abhijit Dasgupta
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Longitudinal study ,Immunology ,Blood Sedimentation ,Sensitivity and Specificity ,Article ,050105 experimental psychology ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Immunology and Allergy ,0501 psychology and cognitive sciences ,Longitudinal Studies ,Prospective Studies ,skin and connective tissue diseases ,Response criteria ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,Remission Induction ,05 social sciences ,Simplified disease activity index ,Middle Aged ,medicine.disease ,C-Reactive Protein ,Treatment Outcome ,Antirheumatic Agents ,Rheumatoid arthritis ,Baseline characteristics ,Erythrocyte sedimentation rate ,Female ,business ,Rheumatism - Abstract
Objective.We examined agreement between the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR), and Simplified Disease Activity Index (SDAI) response criteria in rheumatoid arthritis (RA) and tested whether discordant responses were associated with patients’ baseline characteristics or changes in RA activity encapsulated by the different criteria.Methods.In a prospective longitudinal study, we examined responses of 243 patients with active RA to escalation of antirheumatic treatment. We computed agreement between pairs of response criteria using κ coefficients and identified patient characteristics associated with unique responses to individual criteria.Results.We found that 110 patients (45.3%) had an ACR 20% improvement (ACR20) response, 135 (55.5%) had a EULAR moderate/good response, and 83 (34.1%) had an SDAI50 response. Agreement was moderate to good (ACR20/EULAR κ 0.57; ACR20/SDAI50 κ 0.64; EULAR/SDAI50 κ 0.59). All who had SDAI50 response also had a EULAR response. Patient characteristics at baseline generally did not distinguish those who responded to both, 1, or neither criterion. Discordance was most often because of improvements in the erythrocyte sedimentation rate or C-reactive protein level among EULAR and SDAI50 responders, which were not as common among ACR20 responders. Based on receiver-operating characteristic curves, SDAI35 response had a better balance of sensitivity and specificity relative to ACR20 and EULAR moderate/good responses than SDAI50.Conclusion.Discordant responses to RA improvement criteria are most often because of differences in responses of acute-phase reactants. SDAI35 response had higher sensitivity for improvement, as reflected by other response criteria, than SDAI50 response.
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- 2018
26. Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region
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Yu Lu, Rudy Hidayat, Nguyen Van Hung, Adeeba Al-Herz, Pongthorn Narongroeknawin, Ru Li, Buddhi Paudyal, Keshav Raj Sigdel, Minhaj Rahim Choudhury, Keishi Fujio, Zhanguo Li, Yuko Kaneko, Sapan Pandya, Swan Sim Yeap, Feng Sun, Carmen Ho, Leong Khai Pang, Wanruchada Katchamart, Bagus Putu Putra Suryana, Parawee Chevaisrakul, Yueming Cai, Manjari Lahiri, and Xing Sun
- Subjects
medicine.medical_specialty ,Younger age ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Simplified disease activity index ,Logistic regression ,Asia pacific region ,medicine.disease ,Unmet needs ,Psychiatry and Mental health ,Infectious Diseases ,Internal medicine ,Rheumatoid arthritis ,Pediatrics, Perinatology and Child Health ,Internal Medicine ,Medicine ,Public aspects of medicine ,RA1-1270 ,Geriatrics and Gerontology ,Medical prescription ,Antirheumatic drugs ,business ,Research Paper - Abstract
Background Clinical remission is an attainable goal for Rheumatoid Arthritis (RA). However, data on RA remission rates from multinational studies in the Asia-Pacific region are limited. We conducted a cross-sectional multicentric study to evaluate the clinical remission status and the related factors in RA patients in the Asia-Pacific region. Methods RA patients receiving standard care were enrolled consecutively from 17 sites in 11 countries from APLAR RA SIG group. Data were collected on-site by rheumatologists with a standardized case-report form. Remission was analyzed by different definitions including disease activity score using 28 joints (DAS28) based on ESR and CRP, clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean remission definition, and clinical deep remission (CliDR). Logistic regression was used to determine related factors of remission. Findings A total of 2010 RA patients was included in the study, the overall remission rates were 62•3% (DAS28-CRP), 35•5% (DAS28-ESR), 30•8% (CDAI), 26•5% (SDAI), 24•7% (Boolean), and 17•1% (CliDR), respectively, and varied from countries to countries in the Asia-Pacific region. Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prescription rate was low (17•9%). Compared to patients in non-remission, patients in remission had higher rates of b/tsDMARDs usage and lower rates of GC usage. The favorable related factors were male sex, younger age, fewer comorbidities, fewer extra-articular manifestations (EAM), and use of b/tsDMARDs, while treatment with GC was negatively related to remission. Interpretation Remission rates were low and varied in the Asia-Pacific region. Treatment with b/tsDMARDs and less GC usage were related to higher remission rate. There is an unmet need for RA remission in the Asia-Pacific region. Funding Macao science and technology development fund (0094/2018/A3) (partial).
- Published
- 2021
27. Global assessments of disease activity are age-dependent determinant factors of clinical remission in rheumatoid arthritis
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S. Takenaka, Takehisa Ogura, Y Fujisawa, H. Ito, Hideto Kameda, Takaharu Katagiri, K. Mizushina, A. Hirata, and N. Hayashi
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Male ,medicine.medical_specialty ,Disease duration ,Age dependent ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disease activity ,Diagnostic Self Evaluation ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Physical Examination ,Aged ,Pain Measurement ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Remission Induction ,Age Factors ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Radiography ,Clinical Practice ,C-Reactive Protein ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Functional disability ,Antirheumatic Agents ,Case-Control Studies ,Rheumatoid arthritis ,Multivariate Analysis ,Physical therapy ,Female ,Joints ,Remission rate ,business - Abstract
The aim of the study is to assess the factors associated with clinical remission of patients with rheumatoid arthritis (RA) in daily clinical practice.This analysis was based on the data of 304 RA patients in our center between May 2014 and March 2015. The following information was included: tender, swollen, and symptomatic joint counts, patient's and physician's global assessments, functional disability, laboratory and radiographic data, and RA treatments received.The patients were predominantly female (77.6%), with a median age of 71 years and a median disease duration of 5.8 years. Clinical remission rate, determined using the simplified disease activity index (SDAI), was 49.7%. Patient's and physician's global assessments (/10cm) showed a higher score among patients who did not achieve SDAI remission than among those who did (median: 3.2 versus 0.3, p0.0001; and median: 1.8 versus 0.3, p0.0001, respectively). The contribution of serum C-reactive protein values (mg/dL) to SDAI was limited (median: 0.19 versus 0.06; p0.0001), as well as tender or swollen joint counts (median = 0 or 1). On multivariate analysis of factors not directly related to the disease activity, age was an independent risk factor for non-remission, and global assessment scores by patients and physicians showed an age-dependent increase, while counts of tender, swollen and symptomatic joints were comparable among elderly and non-elderly patients.Global assessment of disease activity was age-dependent and independent of joint counts, and it provides a critical determinant of clinical non-remission.
- Published
- 2017
28. Comparison of composite indices with global synovitis score on ultrasound for detecting remission
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Merve Ozata Olmez, Sibel Zehra Aydin, Gokce Yeter, Esen Kasapoglu Gunal, Ayşe Bilge Öztürk, Havva Keskin, Erim Çobanoğlu, and Sibel Bakirci Ureyen
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Adult ,Male ,medicine.medical_specialty ,Activity index ,Severity of Illness Index ,Gastroenterology ,Arthritis, Rheumatoid ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Synovitis ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Ultrasonography ,030203 arthritis & rheumatology ,business.industry ,Remission Induction ,Ultrasound ,General Medicine ,Simplified disease activity index ,Middle Aged ,Clinical disease ,medicine.disease ,Antirheumatic Agents ,Rheumatoid arthritis ,Female ,Joints ,business - Abstract
We aimed to compare composite indices with Ultrasound Global Synovitis Score (GLOESS) for remission in rheumatoid arthritis (RA). RA patients in remission according to the clinician were investigated with Disease Activity Score28 (DAS28), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and RAPID-3 (Routine Assessment of Patient Index Data 3). Ultrasonography was performed using the GLOESS scores. Patients in CDAI-remission had lower GLOESS (median (IQR), 5(3-9.75) vs 7(4-11.75), p = 0.048) with a similar trend in SDAI (5(3-9.25) vs 7(4-11.25), p = 0.064). This was not observed with DAS28-CRP and RAPID3. Our results show that CDAI is superior to other indices to assess remission in RA.
- Published
- 2017
29. Etanercept or Methotrexate Withdrawal in Rheumatoid Arthritis Patients Receiving Combination Therapy: Comment on the Article by Curtis et al
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Sumantro Mondal, Rashmi Roongta, and Alakendu Ghosh
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musculoskeletal diseases ,medicine.medical_specialty ,Combination therapy ,business.industry ,Immunology ,Simplified disease activity index ,medicine.disease ,Etanercept ,Arthritis, Rheumatoid ,Regimen ,Methotrexate ,Rheumatology ,Antirheumatic Agents ,Internal medicine ,Rheumatoid arthritis ,medicine ,Humans ,Immunology and Allergy ,skin and connective tissue diseases ,business ,medicine.drug - Abstract
We read with great interest the article by Curtis et al on etanercept or methotrexate withdrawal in rheumatoid arthritis. They have taken patients in sustained and deep remission- fulfilling the stringent Simplified Disease Activity Index (SDAI) criteria and simulated near-ideal conditions, before withdrawing either methotrexate or etanercept from the regimen. They have then observed the proportion of patients who maintained SDAI remission at week 48.
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- 2021
30. Levels of plasma fibrinogen are elevated in well-controlled rheumatoid arthritis.
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Rooney, Terence, Scherzer, Rebecca, Shigenaga, Judy K., Graf, Jonathan, Imboden, John B., and Grunfeld, Carl
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RHEUMATOID arthritis , *ANALYSIS of variance , *AUTOANTIBODIES , *BLOOD testing , *CARDIOVASCULAR diseases , *COMPUTER software , *FIBRINOGEN , *FISHER exact test , *MULTIVARIATE analysis , *REGRESSION analysis , *STATISTICS , *U-statistics , *DATA analysis , *VISUAL analog scale , *SEVERITY of illness index , *PROGNOSIS - Abstract
Objective. Patients with RA have systemic inflammation and increased risk of cardiovascular (CV) events, including thrombosis. Levels of fibrinogen, a pro-thrombotic protein with predictive value for CV disease (CVD), are elevated during systemic inflammation. We compared circulating fibrinogen levels in patients with RA with healthy controls and evaluated the relationship with measures of disease activity.Methods. Patients with RA and controls were recruited at the University of California, San Francisco (UCSF). Disease activity was evaluated using standard composite indices. Fibrinogen, ESR, serum CRP, acute-phase serum amyloid A and levels of selected cytokines were quantified.Results. A total of 105 RA patients and 62 controls were studied. Among patients with RA, disease activity ranged from quiescent to highly active disease. Circulating fibrinogen levels were significantly higher in RA than in controls [median (interquartile range) 466 (391–575) vs 367 (309–419) mg/dl, respectively, P < 0.0001]. This difference remained highly statistically significant after adjustment for demographic variables and BMI. Although fibrinogen correlated significantly with clinical measures of disease activity, significantly elevated levels were observed at low levels of activity, even in RA patients with no detectable swollen or tender joints. In multivariable models, ∼80% of the increased fibrinogen in RA was accounted for by increases in CRP and ESR.Conclusion. Circulating levels of fibrinogen are elevated in RA and correlated with markers of inflammation, but only modestly correlate with clinical assessments of disease activity. Even RA patients with excellent clinical disease control exhibit elevated levels compared with controls. [ABSTRACT FROM PUBLISHER]
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- 2011
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31. Assessment of the validity of the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) as a disease activity index of rheumatoid arthritis in the efficacy evaluation of 24-week treatment with tocilizumab: subanalysis of the SATORI study
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Nishimoto, Norihiro and Takagi, Nobuhiro
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JOINT diseases , *BLOOD sedimentation , *RHEUMATOID arthritis , *MONOCLONAL antibodies , *DRUG efficacy , *ACUTE phase proteins , *BIOMARKERS , *INTERLEUKIN-6 - Abstract
tocilizumab (TCZ) greatly inhibits inflammatory markers, methods of evaluating rheumatoid arthritis (RA) disease activity that include inflammatory markers may overestimate the effect of TCZ treatment. We have evaluated the impact of inflammatory markers on the efficacy of TCZ by comparing the efficacy indicated by the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) with that indicated by the clinical and simplified disease activity indexes (CDAI and SDAI, respectively) and the American College of Rheumatology (ACR) core set criteria in a double-blind study of TCZ-the SATORI study. The Spearman correlation coefficient between DAS28-ESR and CDAI was comparable between that at week 24 and that at baseline [correlation coefficient at baseline and week 24 was 0.823 ( p < 0.0001) and 0.818 ( p < 0.0001), respectively]. A large difference between the DAS28 remission rate and CDAI remission rate was observed at week 24. However, these results are comparable to those of a previous study conducted with non-TCZ-treated patients. Moreover, the same results were obtained in the comparison between the DAS28-ESR and SDAI, even though the SDAI includes an inflammatory parameter as a component. These results confirm that the DAS28-ESR has a validity comparable to that of other methods in terms of evaluating the RA treatment efficacy of TCZ, despite its strong inflammatory marker-inhibiting effects. [ABSTRACT FROM AUTHOR]
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- 2010
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32. POS0453 VALIDATION OF THE SIMPLIFIED DISEASE ACTIVITY INDEX (SDAI) WITH A QUICK QUANTITATIVE C-REACTIVE PROTEIN ASSAY (SDAI-Q) IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONAL, MULTICENTER STUDY
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G.-R. Burmester, B. Muche, H. C. Brandt, M. Verba, S. Lüders, Denis Poddubnyy, H. Käding, J. Brandt-Juergens, Murat Torgutalp, Hildrun Haibel, K. Karberg, Fabian Proft, Mikhail Protopopov, V. Rios Rodriguez, S. Zinke, and J. Schally
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Contingency table ,medicine.medical_specialty ,biology ,Intraclass correlation ,business.industry ,Immunology ,C-reactive protein ,Simplified disease activity index ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Clinical trial ,Rheumatology ,Internal medicine ,Rheumatoid arthritis ,medicine ,Prednisolone ,biology.protein ,Immunology and Allergy ,business ,Kappa ,medicine.drug - Abstract
Background:Therapeutic decisions in RA patients should be based on regular disease activity assessment using scores like the Simplified Disease Activity Index (SDAI) or the Clinical Disease Activity Index (CDAI) [1]. The CDAI has the benefit of being immediately available, while the SDAI encompasses with the C-reactive protein (CRP) an acute phase reactant and therefore is the recommended score for the use in clinical trials. However, CRP determination takes hours to days, thus hindering the treat-to-target concept using the SDAI. Quick quantitative CRP (qCRP) tests allow CRP measurement within a few minutes. Therefore, qCRP based SDAI (SDAI-Q) could combine the advantages of both scores.Objectives:To validate the SDAI-Q in a prospective, multicenter study of RA patients.Methods:The study was conducted in five centers in Berlin, Germany. Consecutive adult (≥ 18 years) RA patients were included. In addition to a rheumatological assessment, including patient reported outcomes, routine CRP was measured in the local labs. Additionally, a qCRP testing with the „QuikRead go instrument“ (Aidian Oy, Finland) was performed locally (measurement range 0.5 - 200 mg/l). Statistical analysis included descriptive statistics, cross tabulation and weighted Cohen´s kappa comparing disease activity categories, Bland-Altman plots and intraclass correlation coefficient (ICC) for CRP, qCRP, SDAI, SDAI-Q and CDAI.Results:In this study 100 RA patients were included (mean age: 60.9 years, mean disease duration: 11.4 years, 73.0% were female, 63.0% RF positive, 57.0% ACPA positive, 49.0% positive and 29% negative for both parameters). 75.0% were treated with csDMARD, 15% with tsDMARDs, 39.0% with bDMARDs and 40% with glucocorticoids (mean prednisolone equivalent: 5.4 mg prednisolone/d). Mean CRP and qCRP-levels were 6.97 and 7.89 mg/l, respectively (ICC 0.992; 95%CI: 0.987; 0.995). Comparing SDAI-Q and SDAI, all patients (100%) achieved the same disease activity status (Table 1A); weighted Cohen´s kappa was 1.000 (95%CI: 1.000; 1.000). ICC for SDAI-Q- and SDAI-values was 1.000 (95%CI: 1.000; 1.000). The agreement of SDAI-Q and SDAI is shown in a Bland-Altman plot (Figure 1). When comparing the CDAI with the SDAI-Q 93 patients (93%) were assigned to the same disease activity category (Table 1B); weighted Cohen´s kappa was 0.929 (95%CI: 0.878; 0.981). ICC for numerical values of SDAI-Q and CDAI was 0.989 (95%CI: 0.978; 0.994).Conclusion:SDAI-Q showed an absolute agreement with SDAI on the assignment to disease activity categories with the important advantage of time. With SDAI-Q, rheumatologists could base their clinical decision-making immediately on an index-based disease activity measurement by using a composite score considering acute phase reactants. Consequently, SDAI-Q can be integrated in clinical routine and clinical trials and could be implemented into the treat-to-target concept in RA patients.References:[1]Smolen JS, et al. Ann Rheum Dis. 2016 Jan; 75(1):3-15.Table 1.A) Disease activity categories by SDAI-Q vs. SDAI; B) Disease activity categories by SDAI-Q vs. CDAIASDAI-Q (n = 100)Remission (≤ 3.3)Low Disease Activity (> 3.3 and ≤ 11)Moderate Disease Activity (> 11 and ≤ 26)High Disease Activity (> 26)SDAIRemission (≤ 3.3)28 (28.0%)Low Disease Activity (> 3.3 and ≤ 11)31 (31.0%)Moderate Disease Activity (> 11 and ≤ 26)35 (35.0%)High Disease Activity (> 26)6 (6.0%)BSDAI-Q (n = 100)Remission (≤ 3.3)Low Disease Activity (> 3.3 and ≤ 11)Moderate Disease Activity (> 11 and ≤ 26)High Disease Activity (> 26)CDAIRemission (≤ 2.8)26 (26.0%)Low Disease Activity (> 2.8 and ≤ 10)2 (2.0%)28 (28.0%)2 (2.0%)Moderate Disease Activity (> 10 and ≤ 22)3 (3.0%)33 (33.0%)High Disease Activity (> 22)6 (6.0%)Fields highlighted in red indicate that disease activity categories do not match.SDAI = Simplified Disease Activity Index;SDAI-Q = SDAI calculated with a quick quantitative CRP assay;CDAI = Clinical Disease Activity Index.Figure 1.Bland-Altman plot for SDAI and SDAI-Q AcknowledgementsThe authors would like to deeply thank Braun T, Doerwald C, Deter N, Höppner C, Lackinger J, Lorenz C, Lunkwitz K, Mandt B, Sron S and Zernicke J for their practical support and coordinating the study.Funding statement:The AQUA study was supported by an unrestricted research grant from Novartis. Testing kits were provided free of charge from Aidian Oy, Finland.Disclosure of Interests:None declared
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- 2021
33. POS0670 ROUTINE ASSESSMENT OF PATIENT INDEX DATA 3 (RAPID3) IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH LONG-TERM UPADACITINIB THERAPY
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E. Wong, Yoshiya Tanaka, Namita Tundia, G. Citera, Vibeke Strand, J. Suboticki, Maya H Buch, Martin J. Bergman, Sami Bahlas, and Y. Song
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Immunology ,Population ,Simplified disease activity index ,Physical function ,medicine.disease ,Clinical disease ,General Biochemistry, Genetics and Molecular Biology ,Rheumatology ,Rheumatoid arthritis ,Internal medicine ,Adalimumab ,Immunology and Allergy ,Medicine ,In patient ,business ,Antirheumatic drugs ,education ,medicine.drug - Abstract
Background:Routine Assessment of Patient Index Data 3 (RAPID3) is a pooled index of 3 patient-reported measures: patient global assessment, pain, and physical function. RAPID3 was shown to correlate with other composite measures of disease activity1 and is recommended by the American College of Rheumatology for use in clinical practice.2Objectives:To evaluate the impact of upadacitinib (UPA) versus comparators on RAPID3 over 60 weeks, as well as the correlation of RAPID3 scores with other disease measures in the UPA phase 3 SELECT clinical program.Methods:This post hoc analysis included placebo-controlled (SELECT-NEXT, -BEYOND, and -COMPARE) and active comparator-controlled (SELECT-EARLY, -MONOTHERAPY, and -COMPARE) trials. Patients received UPA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Mean change from baseline in RAPID3 and the proportion of patients reporting RAPID3 remission (≤3), low (LDA, >3 to ≤6), moderate (MDA, >6 to ≤12), and high disease activity (HDA, >12) were assessed. Correlations between absolute scores for RAPID3 and Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and 28-joint Disease Activity Score with C-reactive protein (DAS28[CRP]) were assessed using Spearman correlation coefficients. All data are as observed.Results:A total of 661, 498, 648, 1629, and 945 patients were included from SELECT-NEXT, -BEYOND, -MONOTHERAPY, -COMPARE, and -EARLY. At baseline, the majority of patients across all studies were in RAPID3 HDA (mean baseline RAPID3 [across all studies], 17.2–19.2) (Table 1 and Figure 1). Improvements from baseline in RAPID3 were observed with UPA 15 mg and 30 mg through Week 60, with numerically greater improvements observed with UPA compared with active comparators (Table 1). Across studies, mean improvements in RAPID3 exceeded the minimal clinically important difference (MCID) with UPA and adalimumab (ADA) treatment (MCID=3.83). By Week 60, approximately one-half of UPA-treated patients were in RAPID3 remission or LDA, with only 10–25% remaining in HDA, except for the more refractory population in SELECT-BEYOND, in which ~38% of patients remained in HDA (Figure 1). RAPID3 scores moderately to strongly correlated with CDAI (ρ=0.69–0.83), SDAI (ρ=0.69–0.82), and DAS28(CRP) (ρ=0.58–0.77), across all studies, at Week 60 (all pConclusion:UPA, as monotherapy or in combination with csDMARDs, was associated with improvements in patient-reported disease activity, pain, and physical function, as assessed by RAPID3 over 60 weeks in the phase 3 SELECT clinical program. RAPID3 continues to be an important tool in clinical practice to assess disease activity, as it was shown to correlate to other disease activity measures and allows for rapid scoring.References:[1]Pincus T, et al. Arthritis Care Res (Hoboken) 2010;62:181–9.[2]England BR, et al. Arthritis Care Res (Hoboken) 2019;71:1540–55.[3]Ward MM, et al. J Rheumatol 2019;46:27–30.Table 1.Change from BL in RAPID3 at Week 60 (as observed)Phase 3 studyGroupnaMean (SD) BL scoreMean (SD) change from BLbSELECT-EARLYc(MTX-naïve)MTX23618.5 (5.6)−9.6 (7.5)UPA 15 mg QD26918.9 (5.6)−12.0 (7.6)UPA 30 mg QD25318.2 (5.6)−13.4 (7.2)SELECT-NEXT(csDMARD-IR)UPA 15 mg QD17217.7 (5.1)−11.1 (7.3)UPA 30 mg QD17217.6 (5.3)−10.4 (6.8)SELECT-MONOTHERAPY(MTX-IR)UPA 15 mg QD17217.4 (5.8)−9.6 (7.4)UPA 30 mg QD18017.2 (5.9)−10.6 (7.2)SELECT-COMPAREc(MTX-IR)UPA 15 mg QD55218.5 (5.5)−10.2 (7.1)ADA 40 mg EOW26418.7 (5.4)−8.8 (6.7)SELECT-BEYOND(bDMARD-IR)UPA 15 mg QD13319.2 (5.1)−8.6 (6.8)UPA 30 mg QD11818.5 (5.3)−9.3 (7.3)b, biologic; BL, baseline; EOW, every other week; IR, inadequate response; MTX, methotrexate; QD, once daily; SD, standard deviationaNumber of patients with RAPID3 values at both BL and Week 60. bNegative values indicate improvement from BL. cObserved data include patients rescued to UPA and/or ADA; treatment effect may include both the randomized and switch treatments in these patientsAcknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Grant Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Martin Bergman Shareholder of: Johnson & Johnson, Speakers bureau: AbbVie, Celgene, GSK, MSD, Novartis, Pfizer, and Sanofi/Regeneron, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Genentech/Roche, Gilead, Horizon, Janssen, MSD, Novartis, Pfizer, Sandoz, Sanofi/Regeneron, and Scipher, Maya H Buch Consultant of: AbbVie, Eli Lilly, Merck-Serono, Pfizer, Sandoz, and Sanofi, Grant/research support from: Pfizer, Roche, and UCB, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, Sanofi, Takeda, UCB, and YL Biologics, Grant/research support from: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, MSD, Ono, Taisho Toyama, and Takeda, Gustavo Citera Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Genzyme, Pfizer, and Roche, Sami Bahlas: None declared, Ernest Wong Consultant of: AbbVie, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Chugai, Novartis, and UCB, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Namita Tundia Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jessica Suboticki Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Vibeke Strand Consultant of: AbbVie, Amgen, Arena, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Gilead, Ichnos, Inmedix, Janssen, Kiniksa, MSD, Myriad Genetics, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, Scipher, Setpoint, and UCB.
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- 2021
34. POS0574 RELATIONSHIP BETWEEN INVOLVED JOINT FOR REGION AND MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE SCORE IN JAPANESE PATIENT WITH RHEUMATOID ARTHRITIS
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I. Yoshii
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medicine.medical_specialty ,Pain score ,Visual analogue scale ,business.industry ,Immunology ,Simplified disease activity index ,medicine.disease ,Chronic inflammatory disease ,General Biochemistry, Genetics and Molecular Biology ,Rheumatology ,Health assessment ,Internal medicine ,Rheumatoid arthritis ,Large joint ,medicine ,Immunology and Allergy ,Rheumatoid factor ,business - Abstract
Objectives:Rheumatoid arthritis (RA) is a chronic inflammatory disease that involves various joints in whole body. For evaluation of daily life activities (ADL), modified Health Assessment Questionnaire (mHAQ) is usually used. This index configures eight ADL functions these are separated by predominant extremities. This study aimed to evaluate how involved joint affect ADL predominantly in real world setting.Methods:A total of 24,450 times of consultation with RA patient were visited in the institute. Here, patient with RA was interviewed every another visit, and involved joint in whole body, pain score with visual analog scale (PS-VAS), and mHAQ were recorded. Involved joints were divided by four regions in accordance with joint size and part; small joint in upper extremities (US), large joint in upper extremities (UL), small joint in lower extremities (LS), and large joint in lower extremities (LL). mHAQ was also separately evaluated in accordance with predominant regions; upper extremities predominant mHAQ (mHAQ_UE), and lower extremities predominant mHAQ (mHAQ_LE). Adding to these parameters, as an index for disease activity monitoring, components of the simplified disease activity index score (SDAI) was also recorded. Relationship between mHAQ for each predominant extremities, and these parameters and sex, age, disease duration of RA, anti-cyclic citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), and Sharp/van der Heijde score (SHS), were statistically evaluated using linear regression analysis.Results:mHAQ_UE significantly correlated with age, ACPA and RF titre, SHS, tenderness joint count (TJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), US, UL, LL, and PS-vas, whereas mHAQ-LE significantly correlated with all parameters that demonstrated significant correlation with mHAQ-UE and disease duration. mHAQ also correlated with all parameters those that demonstrated significant correlation with mHAQ-LE. Interestingly, all of mHAQ-UE, mHAQ-LE, and mHAQ did not correlated significantly with swollen joint count (SJC) and LS.Conclusion:mHAQ is influenced by various factors, however, SJC and involvement of small joint in lower extremities did not affect mHAQ.Disclosure of Interests:None declared
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- 2021
35. Residual minimal disease activity in rheumatoid arthritis: a simple definition through an in-depth statistical analysis of the major outcome.
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Pietrapertosa, Donatello, Salaffi, Fausto, Peluso, Giusy, Bosello, Silvia L., Fedele, Anna L., Cuoghi, Ilaria, Michelutti, Alessandro, Gremese, Elisa, and Ferraccioli, Gianfranco F.
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MEDICAL research , *RHEUMATOID arthritis , *MEDICAL statistics , *HEALTH status indicators , *CLINICAL trials - Abstract
Objective. To obtain the simplest definition of minimal disease activity (MDA) and to compare it with published proposed definitions of MDA in patients with RA.Methods. Two hundred and fourteen patients with long-standing RA (LSRA) were evaluated for clinical and laboratory parameters. Factor analysis was performed to remove redundant variables included in the core set measure for MDA definition stated by the OMERACT. Receiver operating characteristic (ROC) curves analysis allowed to obtain optimal cut-off predictors of a 28-joint disease activity score (DAS28) ⩽2.85. These were tested in 112 LSRA and 95 early-onset RA (ERA) patients.Results. Factor and ROC curve analysis showed that the best predictors of a DAS28 ⩽ 2.85 in LSRA cohort were: (i) ESR <20 mm/h (sensitivity: 80%, specificity: 54%); (ii) swollen joint count (out of 28) ⩽2 (sensitivity: 95%, specificity: 74%); (iii) patient global assessment (0–100) ⩽15 (sensitivity: 78%, specificity: 78%); and (iv) HAQ (0–3) ⩽0.5 (sensitivity: 91%, specificity: 61%). To each of these four criteria we assigned a value of 1 when it was satisfied (score ranging: 0–4). The cut-off with the highest overall accuracy for identifying RA patients with DAS28 ⩽ 2.85 was a score ⩾3. We adopted these four parameters in order to define the residual MDA (RMDA). Comparing RMDA criteria, in distinct 112 LSRA and 95 ERA patients, with OMERACT, Simplified Disease Activity Index and Clinical Disease Activity Index definitions of MDA, we found a good agreement in the LSRA cohort and moderate agreement in the ERA cohort.Conclusions. HAQ, PaGA, SJC28 and ESR allow identification of RA patients with an RMDA. The RMDA criteria behaves similarly to OMERACT definitions, but appears more simple and feasible. [ABSTRACT FROM PUBLISHER]
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- 2009
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36. Performances of Clinical Disease Activity Index ( <scp>CDAI</scp> ) and Simplified Disease Activity Index ( <scp>SDAI</scp> ) appear to be better than the gold standard Disease Assessment Score ( <scp>DAS</scp> ‐28‐ <scp>CRP</scp> ) to assess rheumatoid arthritis patients
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Siddharth Kumar Das, Urmila Dhakad, Pooja Dhaon, and Ragini Srivastava
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musculoskeletal diseases ,030203 arthritis & rheumatology ,medicine.medical_specialty ,business.industry ,Gold standard ,Simplified disease activity index ,Clinical disease ,medicine.disease ,digestive system diseases ,Rheumatology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Rheumatoid arthritis ,medicine ,Physical therapy ,030212 general & internal medicine ,Disease assessment ,skin and connective tissue diseases ,Prospective cohort study ,business ,Rheumatism - Abstract
Background/Purpose To compare the performance of Disease Assessment Score of 28 joints – C-reactive protein (DAS-28-CRP), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) composite measures to assess status of patients with rheumatoid arthritis (RA) on methotrexate, versus DAS-28 CRP as the gold standard. Methods One hundred and thirty-five patients with RA as per the 2010 American College of Rheumatology/European League Against Rheumatism criteria were included in the prospective study. The disease activity was assessed at baseline and at every 6 weeks for 24 weeks, by DAS-28-CRP, CDAI and SDAI. Patients were divided into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28-CRP, CDAI and SDAI. A Spearman correlation between composite measures and inter-group comparison of the measures was performed. Results There was an excellent positive correlation between DAS-28-CRP and CDAI (linear weighted κ baseline – 0.545), DAS-28 CRP and SDAI (linear weighted κ – 0.689) at baseline. There was moderate agreement between DAS-28-CRP and CDAI (linear weighted κ final visit – 0.458) at final visit. There was moderate correlation between SDAI and DAS-28-CRP at final visit (linear weighted κ – 0.470). However, correlation between CDAI versus SDAI remained excellent at baseline and final visit. Patients in remission as per DAS-28-CRP had significantly more residual disease activity compared to SDAI and CDAI remission criteria. Conclusion The study shows an excellent strong positive correlation between DAS-28-CRP, CDAI and SDAI at initial evaluation but not at final visit. SDAI- and CDAI-based remission criteria seem to be better than DAS-28-CRP-based remission criteria.
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- 2017
37. Mizoribine Synchronized Methotrexate Therapy should be Considered when Treating Rheumatoid Arthritis Patients with an Inadequate Response to Various Combination Therapies
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Shihoko Nakajima, Kenji Takamori, Kana Tanji, Takuya Hirai, Keigo Ikeda, Kaori Uomori, Shinji Morimoto, Tomoko Miyashita, Yoshinari Takasaki, Hideoki Ogawa, Kozo Watanabe, and Iwao Sekigawa
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musculoskeletal diseases ,rheumatoid arthritis ,Male ,medicine.medical_specialty ,Observation period ,Pilot Projects ,Gastroenterology ,DMARDs ,methotrexate ,Disease activity ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,remission ,IMP dehydrogenase ,immune system diseases ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,skin and connective tissue diseases ,Aged ,030203 arthritis & rheumatology ,Mizoribine ,Dose-Response Relationship, Drug ,business.industry ,General Medicine ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Treatment Outcome ,Rheumatoid arthritis ,Antirheumatic Agents ,Methotrexate ,Original Article ,Drug Therapy, Combination ,Female ,Matrix Metalloproteinase 3 ,Ribonucleosides ,business ,mizoribine ,medicine.drug - Abstract
Objective The objective of this study was to confirm the efficacy of low-dose mizoribine (MZR), an inhibitor of inosine monophosphate dehydrogenase, as part of synchronized methotrexate (MTX) therapy for rheumatoid arthritis (RA) patients with an inadequate response to various combination therapies of MTX, other synthetic disease-modifying anti-rheumatic drugs (DMARDs) and biological DMARDs. Methods Low-dose MZR was administered to 56 uncontrolled RA patients being treated with MTX and various biological DMARDs. The observation period was 12 months, and the disease activity was evaluated based on the Disease Activity Score in 28 joints (DAS28)-ESR, Simplified Disease Activity Index (SDAI) and serum MMP-3 level. Results All of the disease activity indices were significantly improved within three months, and the serum MMP-3 levels were also significantly decreased around four months after starting low-dose MZR therapy. No patients experienced any adverse effects. Conclusion The present preliminary findings suggest that low-dose MZR therapy with MTX should be considered for the treatment of RA patients with an inadequate response to various combination therapies including MTX, other synthetic DMARDs and biological DMARDs or in whom increasing the dose of MTX is difficult for reasons such as adverse effects and complications.
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- 2017
38. AB0353 COMPARATIVE STUDY OF PATIENT BACKGROUND AND TREATMENT OUTCOME BY BARICITINIB DOSE UNDER REAL CLINICAL CONDITIONS
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Kenya Terabe, Tsuyoshi Nishiume, Nobunori Takahashi, Naoko Ishiguro, Toshihisa Kojima, and Shuji Asai
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medicine.medical_specialty ,business.industry ,Baricitinib ,Immunology ,Treatment outcome ,Significant difference ,Patient characteristics ,Simplified disease activity index ,General Biochemistry, Genetics and Molecular Biology ,Discontinuation ,Rheumatology ,Multicenter study ,Internal medicine ,Statistical significance ,medicine ,Immunology and Allergy ,business - Abstract
Background:Balicitinib (BAR) is one of the Janus kinase (JAK) inhibitors, which mainly inhibits JAK1 and JAK2 and has an anti-inflammatory effect on rheumatoid arthritis(RA). In Japan, it is necessary to use different doses of BAR depending on the RA patient’s estimated glomerular filtration rate (eGFR). The RA-BEACOM and RA-BUILD trials reported the treatment effects by BAR dose at 24 weeks and concluded that there was no difference in DAS(disease activity score)28CRP between BAR 2mg and 4mg. The patient background treated in these double-blind RCTs is uniform even at different BAR doses.There is uncertainty about the difference in the therapeutic effects of BAR dose under the real clinical setting where the patient background differs from that of the trial patients.Objectives:To compare patient backgrounds and treatment outcome by Baricitinib dose under real clinical setting.Methods:113 RA patients taking BAR who were registered in the Nagoya University Orthopedic Surgery Multicenter Study (TBCR) were included in this study. Patient characteristics (such as age, illness duration, combined anti-rheumatic drugs, eGFR) and DAS28CRP, clinical and simplified disease activity index(CDAI, SDAI respectively) up to 24 weeks were compared between BAR 2mg and 4mg groups. The continuation rates, including the discontinuation due to ineffectiveness and adverse events (AEs), were also compared between the two groups. For these comparisons, Student’s t-test and Pearson’s chi-square test, Kaplan-Meier survival curve were used. Missing data due to discontinuation of BAR was complemented by LOCF method and analyzed statistically. The significance level was set to less than 0.05.Results:There were 39 subjects (8 males and 31 females) in BAR2mg group and 74 patients (17 males and 57 females) in BAR4mg group. There was a significant difference in mean age (73.5 vs. 62.3 years old,p2,pppppConclusion:BAR2mg group under real clinical setting was older and had lower eGFR than BAR4mg group. Although the treatment effect for 24 weeks was similar, safety management was considered more important because the discontinuation rate due to AEs tended to be higher in BAR2mg group.References:[1]Taylor PC, (2017) The New England journal of medicine. 376(7), 652.[2]Takeuchi T, Ann Rheum Dis 2019;78:171–178.[3]Keystone EC, Ann Rheum Dis 2015;74:333–340Table 1.ITT outcomes at week 13BAR2mg (n=39)BAR4mg (n=74)pvalueAge, years old73.5±9.762.3±12.6Female31(79)57(77)0.767Disease duration, year13.7±11.314.2±15.40.857Stage(1/2/3/4)6/17/8/815/24/14/210.473ACPA >4.5U/ml29(74.4)59(79.7)0.629eGFR, ml/min/1.73m265.1±27.784.8±23.2MTX dose, mg/week3.03±4.835.54±5.480.018MTX use11(28.2)41(55.4)0.003GC dose, mg/day1.91±2.361.32±2.200.191GC use20(51.3)25(33.8)0.007DAS28CRP3.42±1.043.52±13.00.689CDAI12.6±7.615.1±10.90.222SDAI14.7±9.716.2±11.40.279Values are the mean±SD or the number (%).Disclosure of Interests:Tsuyoshi Nishiume: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Kenya Terabe: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama
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- 2020
39. AB0260 TREATMENT WITH BIOTECHNOLOGICAL DRUGS ACCORDING TO PRE-DEFINED SELECTION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A SINGLE COHORT
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Daniela Iacono, Francesco Ciccia, Serena Fasano, Ilenia Pantano, and Giuseppe Scalise
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030203 arthritis & rheumatology ,0301 basic medicine ,medicine.medical_specialty ,Tailored therapy ,business.industry ,Significant difference ,Simplified disease activity index ,medicine.disease ,Rheumatology ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Background current ,Internal medicine ,Rheumatoid arthritis ,Cohort ,medicine ,In patient ,business - Abstract
Background Current recommendations on the treatment of Rheumatoid Arthritis (RA) are based on a treat to target approach, nevertheless which biologic drug should be used in an unresponsive patient is not clarified (1). Such a strategy is essentially justified by the fact that no biotechnological drug has proved to be superior to any other (2). Recent studies have reported some disease or patient features that are associated with a greater or lesser likelihood of response (3). Nevertheless, an adapted therapy to the single patient and based on physiopathological mechanisms has not been acquired yet. Objectives Aim of this study was to evaluate if the choice of a tailored therapy, based on patient and disease features, would be an effective strategy. Methods From April 1st 2017, at our Department of Rheumatology of the University of Campania, each patient with RA has been characterized, at enrolment, for demographic and disease features, and started a biological Disease-modifying antirheumatic drug based on an established algorithm (Figure 1). Attainment of the targeted end point i.e. remission (R) as assessed by Simplified Disease Activity Index (SDAI) Results Forty-nine patients were admitted to our centre from April 1st2017 to December 31st2018. Out of them, 36 patients have been followed up at least for 3 months and were included in the study (algorithm+ patients). Out of them, 26 (72.2%) reached 6 months of treatment, while 16 (44.4%) 12 months of treatment. Among the 26 patients evaluated at 6 months, 23(88.5%) achieved the targeted end point. At 12 months, 16/16 patients (100%) preserved a status of remission or at least low disease activity. We compared our results to those registered, from January 2015 to September 2016, in a RA cohort of 79 patients (RA general cohort). We found a significant difference in regard to attainment of the target at 6 months (23/26 patients, 88.5% algorithm+ vs 45/67 patients, 67.2% RA general cohort; p=0.04) and at 12 months (16/16 patients, 100% algorithm+ vs 40/57 patients, 70.2% RA general cohort; p=0.01) (Table 1). Notably, 32 out of the 79 patients had undergone a biological drug which didn’t follow the predefined algorithm. These patients (algorithm- patients) presented a further lower incidence of response with regard to those enrolled according to the algorithm: 22/32 patients (68.7%) at 3 months; p=0.4; 17/29 (58.6%) at 6 months; p=0.001; 17/24 (70.8%) at 12 months; p=0.03). Conclusion The choice of a personalized approach toward treatment of RA might be an effective strategy to achieve the targeted end point of remission or at least low disease activity in every patient. References [1] Smolen JS et al. Ann Rheum Dis 2017;76:960–77 [2] Pierreisnard A et al. Joint Bone Spine. 2013;80:386-92. [3] Daien CI et al. Mediators of Inflammation 2014;2014:386148 Disclosure of Interests DANIELA IACONO Speakers bureau: PFIZER company, Ilenia Pantano: None declared, SERENA FASANO: None declared, GIUSEPPE SCALISE: None declared, Francesco Ciccia Grant/research support from: CELGENE, PFIZER, Consultant for: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, Paid instructor for: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, JANSSEN, Speakers bureau: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, JANSSEN, MSD, ROCHE, AMGEN
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- 2019
40. Is CDAI comparable to DAS 28 and SDAI regarding inter-observer agreement and correlation to MHAQ in Egyptian RA patients?
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Sherif M. Gamal, N Y Elsaid, S Saad, and Khaled T. El-Hadidi
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rheumatoid arthritis ,Male ,lcsh:Internal medicine ,medicine.medical_specialty ,Inter observer agreement ,lcsh:Medicine ,Positive correlation ,Severity of Illness Index ,Statistics, Nonparametric ,Correlation ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Rheumatology ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,lcsh:RC31-1245 ,030203 arthritis & rheumatology ,Observer Variation ,DAS 28 ,MHAQ ,Chi-Square Distribution ,CDAI ,business.industry ,lcsh:R ,Reproducibility of Results ,Simplified disease activity index ,Middle Aged ,Clinical disease ,medicine.disease ,humanities ,Rheumatoid arthritis ,Cohort ,interobserver agreement ,Egypt ,Female ,SDAI ,business - Abstract
Choosing between the different disease activity indices used for rheumatoid arthritis RA evaluation in clinical practice and research is often difficult. The aim of the current study was to compare clinical disease activity index (CDAI) to simplified disease activity index (SDAI), and disease activity score 28 (DAS28) regarding inter-observer reliability and correlation to the modified health assessment questionnaire (MHAQ) in a cohort of Egyptian RA patients. This study included one hundred RA patients. Every patient had an independent clinical evaluation made by two rheumatologists (professor and candidate) to evaluate disease activity using DAS28 with its 4 types, CDAI and SDAI. We used Cohen’s weighted kappa coefficient to measure the inter-observer agreement between the professor and candidate in different disease activity measures. Correlation between MHAQ and disease activity measures was made with Spearman’s rho test. Inter-observer agreement in CDAI and DAS28 values was almost perfect. A strong positive correlation was found between professor and candidate regarding the tested activity indices (p
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- 2019
41. Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis
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Eri Kato, Kota Shimada, Shigeto Tohma, Mayu Tago, Haeru Hayashi, Tetsuji Sawada, Hiroaki Mori, Koichiro Tahara, Susumu Nishiyama, and Toshihiro Matsui
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Databases, Factual ,Epidemiology ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disease activity ,03 medical and health sciences ,0302 clinical medicine ,Animal science ,Japan ,Rheumatology ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Rheumatoid arthritis ,Aged ,030203 arthritis & rheumatology ,030222 orthopedics ,business.industry ,Significant difference ,Seasonality ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Clinical disease ,Large joint ,Disease Progression ,Female ,Joints ,Seasons ,lcsh:RC925-935 ,business ,Research Article - Abstract
Background Previous studies suggest that RA activity is sensitive to seasonal changes. This study explored the influence of season on RA activity, particularly the distribution of affected joints, using a nationwide database in Japan. Methods We investigated 12,839 patients whose RA activity was recorded in spring (n = 3250), summer (n = 916), fall (n = 1021), and winter (n = 7652). Disease activity score (DAS) 28-CRP, simplified disease activity index (SDAI), and clinical disease activity index (CDAI) were used as indices of disease activity. Disease activity was also assessed according to DAS28-CRP scores (remission, low, moderate, or high). The affected joint distribution was investigated using novel joint indices (x, y, z), where x and y are indices for the upper and lower joints, respectively, and z is the index for large joint predominance. Results Mean DAS28-CRP and median SDAI and CDAI scores were highest in spring and lowest in fall. There was a significant difference in the DAS28-CRP for fall versus spring and winter. Fall was associated with a higher remission rate, and spring and winter with high and moderate RA activity, respectively. Significant differences in x, y, SDAI, and CDAI scores were found for spring versus summer, fall, and winter, in addition to fall versus winter (except in y). There was no seasonal difference in the z index. Conclusions RA activity in the upper and lower extremities may be highest in spring, followed by winter. Seasonal changes should be considered in patients with RA to better understand their symptoms.
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- 2019
42. Estimates of minimal clinically important improvments vary with the responsiveness of the sample.
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Ward MM and Alba MI
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- Humans, Longitudinal Studies, Prednisone therapeutic use, Prospective Studies, Severity of Illness Index, Surveys and Questionnaires, Arthritis, Rheumatoid drug therapy
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Objective: Minimal clinically important improvements (MCII) are known to vary with the baseline level in the sample. We examined if MCIIs are also larger in samples with higher responsiveness., Study Design and Setting: In a prospective longitudinal study of patients with active rheumatoid arthritis, we assessed arthritis activity before and after new treatments. We estimated anchor-based MCIIs for three outcomes (pain severity, physical functioning by the Health Assessment Questionnaire, and Simplified Disease Activity Index, a composite measure) using receiver operating characteristic curves. We compared MCIIs among patients treated with three interventions of different impact (dose escalation, new disease-modifying medication, or prednisone). Separately, we used simulations to estimate MCIIs in five groups of responsiveness., Results: Among 250 patients, standardized response means (SRMs) increased across the dose escalation, disease-modifying treatment, and prednisone treatment groups (-0.74, -1.00, and -1.53, respectively). MCIIs were also highest in the prednisone group. For example, corresponding MCIIs were -5.5, -8.9, and -13.8 for the composite measure. In the simulations, MCIIs (range -4.6 to -11.9) varied directly with SRMs (range -0.40 to -1.33). Results were similar for pain and the Health Assessment Questionnaire., Conclusion: The MCII is not an intrinsic measurement property but varies directly with sample responsiveness., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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43. Sustained Remission Improves Physical Function in Patients with Established Rheumatoid Arthritis, and Should Be a Treatment Goal: A Prospective Observational Cohort Study from Southern Sweden
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Lars Erik Kristensen, Meliha C Kapetanovic, Jon Thorkell Einarsson, Pierre Geborek, and Tore Saxne
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Health Status ,Immunology ,Arthritis ,Treatment goals ,Physical function ,Severity of Illness Index ,Arthritis, Rheumatoid ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,In patient ,Prospective Studies ,030212 general & internal medicine ,Sweden ,030203 arthritis & rheumatology ,Tumor Necrosis Factor-alpha ,business.industry ,Remission Induction ,Recovery of Function ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Treatment Outcome ,Antirheumatic Agents ,Rheumatoid arthritis ,Physical therapy ,Female ,Sustained remission ,business ,Goals ,Cohort study - Abstract
Objective.It has been proposed that remission should be maintained throughout the course of rheumatoid arthritis (RA); however, the evidence supporting this is limited. Physical function measured by the Health Assessment Questionnaire (HAQ) is a major outcome in RA, and HAQ is shown to be one of the strongest predictors of longterm outcomes. The purpose of this study was to investigate the physical function over a long time in patients with RA who achieved sustained remission (SR) compared with that of patients occasionally achieving remission [non-sustained remission (NSR)].Methods.Patients with RA treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) < 2.6 or Simplified Disease Activity Index (SDAI) ≤ 3.3 at some point and those who achieved SR, i.e., remission during consecutive visits for at least 6 months. The course of functional status was assessed using the HAQ at each visit.Results.Of the 2416 patients, 1177 (48.7%) reached DAS28 remission at some point. SR was achieved by 382 (15.8%) for the DAS28 and 186 (7.7%) for the SDAI criteria. Comparing the SR and NSR groups, HAQ improved during the first 12 months in the DAS28 remission. HAQ continued to improve relatively as long as SR was maintained. A higher proportion of patients in SR reached full physical function.Conclusion.In patients with established RA, physical function measured by the HAQ improves in patients reaching SR compared with patients who only occasionally reach remission. The improvement continues while in remission, which supports that maintaining remission should be a treatment goal.
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- 2016
44. Evaluation of switching from intravenous to subcutaneous formulation of tocilizumab in patients with rheumatoid arthritis
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Kunihiro Ichinose, Akitomo Okada, Kaoru Terada, Naoki Iwamoto, Akinari Mizokami, Fumiaki Nonaka, Tomohiro Koga, Takahisa Suzuki, Keita Fujikawa, Katsumi Eguchi, Toshiyuki Aramaki, Tomoki Origuchi, Hideki Nakamura, Ayako Nishino, Shoichi Fukui, Yoshiro Horai, Atsushi Kawakami, Mami Tamai, Yukitaka Ueki, Shin-ya Kawashiri, Yoshikazu Nakashima, Masataka Umeda, Yasuko Hirai, and Munetoshi Nakashima
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Injections, Subcutaneous ,Antibodies, Monoclonal, Humanized ,Body weight ,Gastroenterology ,Arthritis, Rheumatoid ,03 medical and health sciences ,chemistry.chemical_compound ,Subcutaneous injection ,0302 clinical medicine ,Tocilizumab ,Rheumatology ,Internal medicine ,Humans ,Medicine ,In patient ,Infusions, Intravenous ,Aged ,030203 arthritis & rheumatology ,business.industry ,Simplified disease activity index ,Middle Aged ,medicine.disease ,Clinical disease ,Surgery ,Treatment Outcome ,030104 developmental biology ,chemistry ,Antirheumatic Agents ,Rheumatoid arthritis ,Female ,business ,Body mass index - Abstract
To evaluate the efficacy of switching the route from intravenous tocilizumab (TCZ) infusion (TCZ-IV) to subcutaneous TCZ injection (TCZ-SC) in a real-world setting through a comparison of the clinical response.Fifty-eight rheumatoid arthritis (RA) patients, for whom TCZ-SC was initiated following TCZ-IV between June 2013 and August 2014, were consecutively enrolled. Disease activity score (DAS)28-ESR, simplified disease activity index (SDAI), and clinical disease activity index (CDAI) were examined at baseline and after switching from TCZ-IV to TCZ-SC for 3 months. We investigated whether body weight and body mass index (BMI) affected the efficacy of TCZ-SC.Most of the patients had achieved remission or low disease activity at baseline (77.6% examined by DAS28). Fifty-seven patients (98%) continued the TCZ-SC treatment, and the disease activity was well controlled after 3 months. ΔDAS28 tended to be worsened after switching to TCZ-SC in the high-body-weight groups (≥60 kg) as compared with the groups with body weight 60 kg, although no statistical significance was found. BMI did not affect the efficacy of TCZ-SC.Caution should be exercised in the high-body-weight subjects, but these data indicate that TCZ-SC maintains the favorable RA disease activity established using TCZ-IV.
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- 2016
45. Consideration of differences in drug usage between young-onset and elderly-onset rheumatoid arthritis with target of low disease activity.
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Kumagai K, Okumura N, Amano Y, Yayama T, Mimura T, Maeda T, Kubo M, Mori K, Barrett-Jolley R, and Imai S
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- Age of Onset, Aged, Female, Humans, Male, Methotrexate therapeutic use, Middle Aged, Rheumatoid Factor, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid drug therapy
- Abstract
Objectives: Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital., Methods: Demographics, clinical history, and treatments were compared between patients with EORA ( n = 70) and YORA ( n = 190)., Results: There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p = .011) and overall biologics use (32.9% vs. 56.3%, p = .0012) were significantly lower in patients with EORA than in those with YORA., Conclusion: Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA.
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- 2021
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46. FRI0083 GLUCOCORTICOID USE IS ASSOCIATED WITH DETERIORATION OF MUSCLE QUALITY AND FUNCTION: FROM THE CHIKARA STUDY
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K. Mandai, Kentaro Inui, Hiroaki Nakamura, Masahiro Tada, Y. Yamada, and Noriaki Hidaka
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medicine.medical_specialty ,business.industry ,Immunology ,Simplified disease activity index ,Physical function ,medicine.disease ,Muscle mass ,General Biochemistry, Genetics and Molecular Biology ,Rheumatology ,Sarcopenia ,Internal medicine ,Rheumatoid arthritis ,medicine ,Immunology and Allergy ,In patient ,Risk factor ,business ,Glucocorticoid ,medicine.drug - Abstract
Background:We previously reported that glucocorticoid (GC) use was an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis (RA)1. On the other hand, sarcopenia was not associated with deterioration of muscle function (dynapenia)2.Objectives:Factors associated with deterioration of muscle quality and function were prospectively investigated.Methods:Muscle quality and function were examined by measuring power, speed, and balance in standing-up motion using an exercise functional analysis device (BM-220, Tanita, Japan) at baseline and at 2-year follow-up in the prospective, observational CHIKARA study. Associations between changes in these parameters (Δ muscle quality, Δ muscle function) and body composition, disease activity, treatment, physical function, and history of falls and fractures were investigated by univariate and multivariate analyses.Results:Eighty-one RA patients completed the survey. Their average age was 66 years, disease duration was 5.3 years, the simplified disease activity index (SDAI) was 5.3, and the modified Health Assessment Questionnaire (mHAQ) was 0.25 at baseline. Of the patients, 12.3% used GCs at an average dose of 3.08 mg/day over 2 years. The average GC dose was negatively correlated with changes in muscle quality (r=-0.25, p=0.03), power (r=-0.23, p=0.04), and speed (r=-0.24, p=0.03). The SDAI at baseline was negatively correlated with power (r=-0.23, p=0.04) and speed (r=-0.22, p=0.05) (Table 1). No factor was associated with the mHAQ and a history of falls. No independent factor was identified on multiple regression analysis.Table 1.Associations between changes in muscle quality and function and body composition, disease activity, treatment, physical function, and history of falls and fracturesΔ muscle qualityΔ muscle functionpowerspeedbalancerprprprpage, years-0.210.063-0.110.337-0.230.0410.180.105GC dose, mg/day-0.250.025-0.230.041-0.240.032-0.020.883CRP, mg/dl0.010.9100.030.7810.030.7990.200.067MMP-3, ng/ml-0.250.022-0.130.249-0.170.1340.020.847DAS28ESR-0.090.441-0.050.665-0.090.4350.010.961SDAI-0.140.216-0.230.041-0.220.0480.010.917mHAQ-0.130.248-0.040.728-0.060.578-0.060.585SMI, kg/m20.030.7640.9980.030.7610.240.034BMR, kcal/day0.050.2780.010.960.110.3220.180.111fall0.070.5310.120.2860.020.871-0.020.852fracture0.9730.989-0.050.677-0.190.097Δ, changes from baseline; GC, glucocorticoid; CRP, C-reactive protein; MMP-3, matrix metalloproteinase 3; DAS, Disease Activity Score; ESR, erythrocyte sedimentation rate; SDAI, simplified disease activity index; mHAQ, modified Health Assessment Questionnaire; SMI, skeletal muscle index; BMR, basal metabolic rate.Conclusion:GC use was associated with deterioration in muscle quality and function, as well as sarcopenia development. GC use adversely affected muscle mass, quality, and function. In addition, since high disease activity led to low exercise function, disease activity control is important to prevent deterioration of exercise function.References:[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jan 14. Epub ahead of print.[2]M Tada, Y Yamada, K Mandai et al. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr. Gerontol. Int. 2019;19:1220-25.Disclosure of Interests:Yutaro Yamada: None declared, Masahiro Tada: None declared, Koji Mandai: None declared, Noriaki Hidaka: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.
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- 2020
47. Comorbidities in rheumatic arthritis
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Małgorzata Wisłowska and Łukasz Kłodziński
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musculoskeletal diseases ,030203 arthritis & rheumatology ,medicine.medical_specialty ,business.industry ,Immunology ,Osteoporosis ,02 engineering and technology ,Simplified disease activity index ,Disease ,021001 nanoscience & nanotechnology ,medicine.disease ,Osteopenia ,03 medical and health sciences ,0302 clinical medicine ,Rheumatic Arthritis ,Rheumatology ,Internal medicine ,Rheumatoid arthritis ,medicine ,Etiology ,Immunology and Allergy ,In patient ,0210 nano-technology ,business - Abstract
ObjectivesRheumatoid arthritis (RA) is one of the most common systemic inflammatory diseases, but its etiology is still not fully known. The aim of this preliminary study was to assess what particular comorbidities are involved in the progression of RA and determine the influence that the aforementioned diseases have on each other.Material and methodsForty patients with diagnosed RA according to EULAR/ACR criteria from 2010 were included in the study. The majority of the group was female (n = 35; 87.5%). Patients were tested using routine laboratory and imaging methods allowing diagnosis and assessment of disease activity. Dual energy X-ray absorptiometry was also evaluated for mineral density. The activity of the disease was assessed using the disease activity score DAS28 (ESR) and SDAI (Simplified Disease Activity Index).ResultsAmong studied patients, based on the DAS28 index, 9 patients were in the remission phase (22.5%) and 12 (30%) had high disease activity. Increased values of CRP were observed in the majority of patients (65%). The group analysis demonstrated the most common comorbidities in patients with RA, as follows: hypertension (n = 14; 35%) and osteoporosis or osteopenia (n = 13; 32.6%).ConclusionsPatients with rheumatoid arthritis (RA) are more susceptible to developing hypertension and osteoporosis. We did not observe a significant association between other comorbidities and activity of RA. The next study will assess a larger number of patients.
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- 2018
48. AB0281 Reduction rate of rheumatoid factor reflects disease activity of rheumatoid arthritis
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Taku Kawasaki, Takafumi Yayama, Shinji Imai, Kousuke Kumagai, and N. Okumura
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medicine.medical_specialty ,business.industry ,Disease duration ,Reduction rate ,Simplified disease activity index ,medicine.disease ,Gastroenterology ,Biological drugs ,Disease activity ,Titer ,Rheumatoid arthritis ,Internal medicine ,medicine ,Rheumatoid factor ,business - Abstract
Background Rheumatoid factor (RF) is involved in the pathology of rheumatoid arthritis (RA) and its titer varies during the course of treatment with biological or synthetic DMARD. Objectives In this study, we examined the relationship between RF change rate and disease activity. Methods We analysed 287 RA patients (mean age 62.3 years; mean disease duration 13.1 years) in our hospital between 2015 and 2017, who were able to confirm the RF, and 3 groups were classified according to the change rate of RF for 1 year (92 in decreasing less than 80%, 114 in unchanged 80% or more, less than 120% and 81 in increasing 120% or more). We evaluated disease activity by simplified disease activity index(SDAI). Results The drugs used are: MTX usage rate 63.1%, mean amount 3.81 mg, PSL usage rate 37.3%, mean amount 1.47 mg, biological drugs usage rate 48.8%. Disease activity change amount in 1 year (delta SDAI) was −0.88 (from 6.90 to 6.02). The median RF titer at baseline was 76 (27.5–178.5), the median RF change rate was 96% (71.5–125) and delta SDAI was significantly improved in the decreasing group (−1.97, 0.005,–0.04, p=0.0011). The swollen joint counts, tender joint counts, global assessment of evaluator and CRP were similarly improved significantly in this group. Conclusions Although RF dose not decrease in all cases, it suggested that reduction rate of RF reflects disease activity. Disclosure of Interest None declared
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- 2018
49. FRI0669 Physician global assessments for disease activity in rheumatoid arthritis are all over the map!
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M. A. Turk and Janet E. Pope
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Response rate (survey) ,medicine.medical_specialty ,business.industry ,Simplified disease activity index ,Disease ,medicine.disease ,Rheumatology ,Disease activity ,Clinical Practice ,Internal medicine ,Rheumatoid arthritis ,Physical therapy ,medicine ,business ,Kappa - Abstract
Background: Assessments of disease activity in rheumatoid arthritis (RA) determine the course of treatment. Physician global assessments of disease activity (MD globals) are important outcomes in trials as they are part of the CDAI and SDAI composite scores. MD globals may vary between physicians based on their age, sex, practice setting, experience, and years in practice. Objectives: Our research goal was to determine which factors contribute to the variability of MD globals. We expected assessments to be lower as physician experience increased. Methods: After obtaining ethics approval, we surveyed rheumatologists who were members of the Canadian Rheumatology Association with RA patient scenarios where each was rated as a MD global for disease activity from 0 – 10. The cases covered a range of disease activity; to determine extreme cases and cases in between. There were some scenarios where a change in status was given (i.e. a rating with one disease state and then the patient returned and another rating was given by each participant when the patient was obviously better or worse). Kappa, Intra-class correlation (ICC) coefficients, and linear mixed models were used to analyze the data Results: We received 145 responses from eligible physicians spanning the above categories (approximately 40% response rate). Contrary to our original hypothesis, MD global assessments were not significantly different between physicians in any category (number of RA patients seen per year, years of experience, age, sex, type of practice [community vs. university], and self-reported expertise in RA). Moreover, the range of answers for the same scenario was as high as 7.6 out of a possible 10, indicating vast discrepancies between physicians. We checked to ensure the questions were not answered backwards by individuals using the scenarios where a patient changed disease activity over time. The agreement was highest in the extreme scenarios (very low and very high disease activity, but in the spectrum in between agreement was extremely poor). Some scenarios outlined changes in individual patients, however physicians surveyed were often in disagreement as to how well the patient recovered or worsened. The change in MD globals between one time and the next in the cases had better agreement than the actual scores. Conclusions: This research emphasizes the need to establish stringent evaluation criteria of disease activity as rated by the physician in RA; particularly if remission and low disease activity is used clinically by CDAI or SDAI. Perhaps a catalogue examples of patient scenarios of MD globals that range from 0 to 10 should be developed, standardized and agreed upon; to decrease the wide variability of ranking by rheumatologists. References 1. Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol2005;23:S100–108. 2. Her M, Kavanaugh A. Patient-reported outcomes in rheumatoid arthritis. Curr Opin Rheumatol2012;24:327–34. 3. Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatol Oxf Engl2003;42:244–57. Disclosure of Interest: None declared
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- 2018
50. Performance of routine assessment of patient index data 3 (RAPID3) in monitoring disease activity of Chinese rheumatoid arthritis patients
- Author
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Yanjie Hao, Anzhi Xie, Guangtao Li, Lanlan Ji, Xiaohui Zhang, Xuerong Deng, Yu Wang, Zhuoli Zhang, and Yan Geng
- Subjects
musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,China ,Disease ,Blood Sedimentation ,Severity of Illness Index ,Disease activity ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Wrist joints ,Predictive Value of Tests ,Internal medicine ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,skin and connective tissue diseases ,Aged ,Ultrasonography ,030203 arthritis & rheumatology ,Synovitis ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Simplified disease activity index ,Middle Aged ,Clinical disease ,medicine.disease ,Prognosis ,C-Reactive Protein ,Erythrocyte sedimentation rate ,Rheumatoid arthritis ,Female ,Joints ,Self Report ,Inflammation Mediators ,business ,Kappa ,Biomarkers - Abstract
To explore the performance of routine assessment of patient index data 3 (RAPID3) in reflecting disease activity in Chinese rheumatoid arthritis (RA) patients.The clinical data of 189 consecutive RA patients, including RAPID3 questionnaire, Disease Activity Score based on 28-joint count (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI), and ultrasonography of hand and wrist joints were collected. The consistency between RAPID3 and DAS28, CDAI, SDAI in RA patients with different disease activities was performed by Spearman's correlations, kappa and/or weighted kappa coefficients.RAPID3 score was significantly associated with DAS28 and erythrocyte sedimentation rate (ESR), DAS28 with C-reactive protein (CRP), CDAI, SDAI (r = 0.797, 0.786, 0.784, and 0.760 respectively, P 0.001 for all). RAPID3 was also significantly correlated with tender joint count, swollen joint count, ESR and CRP. The agreement of RAPID3 with DAS28 scoring systems was better in patients with moderate/high disease activity than those in remission/low disease activity. Ultrasonographic subclinical synovitis was presented in 42.3%-48.6% of patients in remission/low disease activity defined by various scoring criteria including RAPID3 with no significant difference observed (P = 0.22,0.05).RAPID3 showed good correlation with DAS28 scoring systems, especially in patients with moderate/high disease activity. RAPID3 is a reliable and convenient tool to monitor disease activity.
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- 2018
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