ABSTRACT
To characterize disease activity trajectories and compare long-term drug retention between rheumatoid (RA) and spondylarthritis (SpA) patients initiating tumor necrosis factor inhibitor (TNFi) treatment (etanercept). Prospective observational study of RA, axial (AxSpA) and peripheral SpA (PerSpA) patients initiating etanercept during 2004-2020. Kaplan-Meier plots were used for drug retention comparisons and multivariable Cox regression models for predictors of discontinuation. Long-term disease activity trajectories were identified by latent class growth models using DAS28-ESR or ASDAS-CRP as outcome for RA and AxSpA respectively. We assessed 711 patients (450 RA, 178 AxSpA and 83 PerSpA) with a median (IQR) follow-up of 12 (5-32) months. At 5 years, 22%, 30% and 21% of RA, AxSpA and PerSpA patients, respectively, remained on therapy. Etanercept discontinuation was independent of the diagnosis and was predicted by gender and obesity in both RA and SpA groups. Four disease activity (DA) trajectories were identified from 6th month of treatment in both RA and AxSpA. RA patients in remission-low DA groups (33.7%) were younger, had shorter disease duration, fewer comorbidities and lower baseline disease activity compared to moderate (40.6%) & high DA (25.7%) groups. In AxSpA 74% were in inactive-low DA and they were more often males, non-obese and had lower number of comorbidities compared to higher ASDAS-CRP trajectories. In RA and AxSpA patients, disease activity trajectories revealed heterogeneity of TNFi treatment responses and prognosis. Male gender, lower baseline disease activity and fewer comorbidities, characterize a favourable outcome in terms of disease burden accrual and TNFi survival.
Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , Axial Spondyloarthritis , Spondylarthritis , Humans , Male , Etanercept/therapeutic use , Antirheumatic Agents/therapeutic use , Prospective Studies , Spondylarthritis/diagnosis , Spondylarthritis/drug therapy , Arthritis, Rheumatoid/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic use , Treatment Outcome , Tumor Necrosis Factor-alphaABSTRACT
New biologic and small molecule targeted agents have expanded the armamentarium of Spondyloarthritides (SpA), allowing more therapeutic options for patients who do not respond to therapy. The implementation of the treat-to-target (T2T) strategy with close monitoring and frequent treatment adaptations targeting disease remission has been proposed as the means to prevent radiographic progression and long-term adverse outcomes. In this project we will employ the "University of Crete Rheumatology Clinic Registry" to prospectively study in real-world practice musculoskeletal and extraarticular disease activity, patient function, comorbidities, sociodemographics, imaging, compliance to therapy and other lifestyle factors in axial and peripheral SpA patients. The predictive value of these variables in long-term (2years) outcomes will be evaluated. We will also assess the implementation of the T2T approach as well as its impact on long-term patients' outcomes (quality of life, productivity, adverse events). The successful completion of this study could pave the way for improved and personalized therapy in patients with SpA.
ABSTRACT
Gemella species are catalase-negative, facultative anaerobic, Gram-positive cocci, which are part of the human oral microbiome and may occasionally cause systemic infections. Infective endocarditis (IE) has been reported as the most common infection caused by Gemella species. We report the first case of IE due to Gemella sanguinis in Greece, in a patient with bicuspid aortic valve and review the available literature. The patient was successfully treated with antibiotics and aortic valve replacement.
Subject(s)
Aortic Valve , Endocarditis, Bacterial/diagnosis , Gemella/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Echocardiography , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Gram-Positive Bacterial Infections/diagnostic imaging , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/surgery , Greece , Heart Valve Prosthesis Implantation , Humans , Infusions, Intravenous , Male , Young AdultABSTRACT
Spondyloarthritides (SpA) are a group of interrelated rheumatic disorders that includes ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis related to inflammatory bowel disease and reactive arthritis. Since the latest classification criteria published from the ASAS (Assessment of SpondyloArthritis international Society), patients with these diagnoses can be classified either as having axial or peripheral SpA. In this study, these new criteria of ASAS will be applied to all patients with a clinical diagnosis of SpA that are followed in the Rheumatology Clinic of University Hospital of Heraklion. Furthermore, patients with non-radiographic axial SpA (nrAxSpA) will be monitored, both retrospectively and prospectively, for their long-term outcome in terms of imaging and clinical aspects (remission, disability, severe complications, eg, uveitis). This study is expected to give valuable information of the performance of these new criteria in daily clinical practice and of the prognosis of patients with non-radiographic axial SpA.