Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry.

INTRODUCTION: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.

Differences and similarities between the EULAR/ASAS-EULAR and national recommendations for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe.

This is the first report comparing EULAR and national treatment recommendations for PsA patients across Europe, and the first this decade to compare ASAS-EULAR and national treatment recommendations in axSpA patients. An electronic survey was completed from October 2021-April 2022 by rheumatologists in 15 European countries. One and four countries followed all EULAR and ASAS-EULAR recommendations, respectively. Five countries had no national treatment recommendations for PsA and/or axSpA, but followed other regulations. In several countries, national treatment recommendations predated the most recent EULAR/ASAS-EULAR recommendations. Entry criteria for starting biologic/targeted synthetic disease-modifying anti-rheumatic drugs varied considerably. In several countries, for PsA patients with significant skin involvement, interleukin-17 inhibitors were not given preference. The positioning of Janus Kinase inhibitors differed and Phosphodiesterase-4 inhibitors were not in use/reimbursed in most countries. This study may motivate European countries to update their national treatment recommendations, to align them better with the latest international recommendations.

[Influence of gender on treatment response in a cohort of patients with early rheumatoid arthritis in the area 2 of Madrid]. / Influencia del género en la respuesta al tratamiento en una cohorte de pacientes con artritis reumatoide precoz del área 2 de la Comunidad de Madrid.

OBJECTIVE: To evaluate the differences between the responses to treatment using DAS28 based on erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in male and female patients. We then analyzed the individual behaviour of each component in a cohort of early arthritis patients in zone 2 of Madrid. PATIENTS AND METHODS: We studied a total of 134 patients (77.6% women) who met the American College of Rheumatology (ACR) criteria for the diagnosis of rheumatoid arthritis (RA) belonging to an early arthritis register of the Hospital de La Princesa. We performed 4 visits following a standardized protocol which included necessary variables to calculate the DAS28 with ESR and CRP as well as determining the treatment received by the patients. We analyzed the differences in responses to treatment in males and females using both indexes, as well as their component and the assessment of the disease by the physician. RESULTS: Women had higher disease activity and disability at baseline. Although they received more intensive treatment, their average value of DAS28 remained significantly higher compared to men during the follow-up. By contrast, the global disease assessment evaluated by the patient and by the physician remained similar in both gender. When we analyze the DAS28 components separately, it was observed that this discrepancy was due mainly to the tender joints count and the ESR. CONCLUSIONS: Women with early RA have higher DAS28ESR scores as a result of higher tender joint counts and ESR. This may represent bias when assessing the response to treatment using the DAS28ESR.

[Conventional Radiology: Total BASRI and SASSS]. / Radiografía convencional: BASRI total y SASSS.

Conventional radiology is a very important tool used to evaluate patients with spondyloarthropathies. It is necessary not only to evaluate the efficacy of the different treatments but also to reflect the history of the disease, maintaining a registry of the progression of the destructive process, evaluating the affection and quantifying the damage. We have at our disposal three methods specifically designed for the evaluation of structural damage in SA: the BSARI (Bath Ankylosing Spondylitis Radiology Index), the SASSS (Stoke Ankylosing Spondylitis Spine Score) and a modification of the latter. This review intends to perform a detailed description of each one of these methods and expose the advantages and disadvantages of their use.