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3.
Int J Rheum Dis ; 25(5): 630, 2022 05.
Article in English | MEDLINE | ID: mdl-35491973
4.
BMC Musculoskelet Disord ; 23(1): 433, 2022 May 09.
Article in English | MEDLINE | ID: mdl-35534813

ABSTRACT

BACKGROUND: Arthritis is a common condition, and the prompt and accurate assessment of hand arthritis in primary care is an area of unmet clinical need. We have previously developed and tested a screening tool combining machine-learning algorithms, to help primary care physicians assess patients presenting with arthritis affecting the hands. The aim of this study was to assess the validity of the screening tool among a number of different Rheumatologists. METHODS: Two hundred and forty-eight consecutive new patients presenting to 7 private Rheumatology practices across Australia were enrolled. Using a smartphone application, each patient had photographs taken of their hands, completed a brief 9-part questionnaire, and had a single examination result (wrist irritability) recorded. The Rheumatologist diagnosis was entered following a 45-minute consultation. Multiple machine learning models were applied to both the photographic and survey/examination results, to generate a screening outcome for the primary diagnoses of osteoarthritis, rheumatoid and psoriatic arthritis. RESULTS: The combined algorithms in the application performed well in identifying and discriminating between different forms of hand arthritis. The algorithms were able to predict rheumatoid arthritis with accuracy, precision, recall and specificity of 85.1, 80.0, 88.1 and 82.7% respectively. The corresponding results for psoriatic arthritis were 95.2, 76.9, 90.9 and 95.8%, and for osteoarthritis were 77.4, 78.3, 80.6 and 73.7%. The results were maintained when each contributor was excluded from the analysis. The median time to capture all data across the group was 2 minutes and 59 seconds. CONCLUSIONS: This multicentre study confirms the results of the pilot study, and indicates that the performance of the screening tool is maintained across a group of different Rheumatologists. The smartphone application can provide a screening result from a combination of machine-learning algorithms applied to hand images and patient symptom responses. This could be used to assist primary care physicians in the assessment of patients presenting with hand arthritis, and has the potential to improve the clinical assessment and management of such patients.


Subject(s)
Arthritis, Psoriatic , Osteoarthritis , Rheumatology , Arthritis, Psoriatic/diagnosis , Humans , Osteoarthritis/diagnosis , Pilot Projects , Rheumatology/methods , Smartphone
5.
BMC Med Educ ; 22(1): 355, 2022 May 10.
Article in English | MEDLINE | ID: mdl-35538536

ABSTRACT

BACKGROUND: Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents' competency and comfort with knee examinations when compared to the rotation alone. METHODS: Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. RESULTS: Fifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025). CONCLUSION: An elective in rheumatology augmented residents' MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.


Subject(s)
Internship and Residency , Rheumatology , Clinical Competence , Humans , Internal Medicine/education , Physical Examination/methods , Rheumatology/education , Teaching
6.
RMD Open ; 8(1)2022 Apr.
Article in English | MEDLINE | ID: mdl-35387864

ABSTRACT

OBJECTIVE: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. METHODS: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. RESULTS: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. CONCLUSION: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.


Subject(s)
COVID-19 , Rheumatic Diseases , Rheumatology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Female , Humans , Male , Middle Aged , Registries , Rheumatic Diseases/complications , Rheumatic Diseases/drug therapy , Rheumatic Diseases/epidemiology , SARS-CoV-2
7.
Rheum Dis Clin North Am ; 48(2): 507-521, 2022 May.
Article in English | MEDLINE | ID: mdl-35400375

ABSTRACT

Spondyloarthritis is a common rheumatologic disease, present in up to 2% of the population, characterized by inflammatory arthritis, often with enthesitis, dactylitis, spondylitis, and skin disease. It has historically been characterized as ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, and undifferentiated spondyloarthritis. These subsets are now classified as axial-predominant and peripheral-predominant spondyloarthritis. This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy.


Subject(s)
Arthritis, Psoriatic , Enthesopathy , Rheumatology , Spondylarthritis , Spondylitis, Ankylosing , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/drug therapy , Humans , Spondylarthritis/complications , Spondylarthritis/diagnosis , Spondylarthritis/therapy , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/therapy
8.
9.
Arthritis Rheumatol ; 74(5): e21-e36, 2022 05.
Article in English | MEDLINE | ID: mdl-35474640

ABSTRACT

OBJECTIVE: To provide guidance to rheumatology providers on the use of COVID-19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). METHODS: A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings. RESULTS: Despite a paucity of direct evidence, statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines, including supplemental/booster dosing, in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. CONCLUSION: These guidance statements are intended to provide direction to rheumatology health care providers on how to best use COVID-19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.


Subject(s)
COVID-19 , Musculoskeletal Diseases , Rheumatic Diseases , Rheumatology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Humans , Muscular Diseases , United States , Vaccination
10.
RMD Open ; 8(1)2022 Apr.
Article in English | MEDLINE | ID: mdl-35383122

ABSTRACT

OBJECTIVES: The European Alliance of Associations for Rheumatology (EULAR) recommendations for the use of imaging in large vessel vasculitis establish that an imaging test supported by clinical pretest probability (PTP) is sufficient for the diagnosis of giant cell arteritis (GCA). Our objective was to determine the validity of the EULAR recommendations on the use of Colour duplex ultrasound (CDUS) in GCA after calculating the PTP. METHODS: We collected data of all patients referred to our fast-track clinic between 2016 and 2020. The Southend pretest probability score (SPTPS) was calculated and classified as low (LR), intermediate and high risk (HR) according to the values obtained by its authors, <9, 9-12 and >12, respectively. All patients underwent a CDUS of the temporal arteries with their common, parietal and frontal branches, and the most also axillary (86.5%), and subclavian and carotid arteries. The gold-standard diagnosis was made according to the physician's criteria after at least 9 months of follow-up. RESULTS: Of the 297 referred patients, 97 (32.7%) were diagnosed with GCA. The SPTPS area under the ROC curve was 0.787. The LR category included 105 patients (35.4%), of which 10 (9.5%) had GCA and 1 had a CDUS false negative result. The HR category included 67 patients (22.5%), 47 with GCA, and in 1 case the CDUS result was a false positive. CONCLUSION: Combining the results of a PTP score, such as SPTPS, and the CDUS allows for an accurate diagnosis of GCA, as established by the EULAR group, with less than 2% misclassification of diagnosis.


Subject(s)
Giant Cell Arteritis , Rheumatology , Giant Cell Arteritis/diagnostic imaging , Humans , Temporal Arteries/diagnostic imaging , Ultrasonography/methods
11.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35443383

ABSTRACT

SLE is a systemic inflammatory condition which affects 0.1%-0.2% of the population, that can affect almost any organ system, mainly the skin, joints, kidneys, blood cells, heart, and nervous system. Its cardiovascular manifestation has variable course, ranging from indolent to fulminant. Mostly many patients are asymptomatic. SLE can affect the pericardium, myocardium, endocardium, valves and the coronary arteries. The patients with cardiac involvement are mostly asymptomatic. MATERIAL: This is a hospital based, single center cross-section study. This study includes known cases of SLE patients attending Rheumatology OPD, SLE patients admitted in various wards(medicine, rheumatology and nephrology) and newly diagnosed cases of SLE according to new ACR/EULAR criteria. Patients were assessed for cardiac symptoms and signs. ECG, CXR and ECHO was performed in all the patients. EXCLUSION CRITERIA: Patients with clinical features of mixed connective tissue Disorders. OBSERVATION: Out of 34 patients cardiovascular involvement seen in SLE was 52% (18 patients.) Of these, 29% (10 patients) had symptoms that could be attributed to the cardiovascular system. In this study, Hypertension is the most common presentation occurring in 17.1% (6 patients). Pericarditis was the next common finding present in 14.7% (5 patients), of which the majority were asymptomatic. Valvular abnormalities seen in 2 (5.8%)patients. Myocarditis was seen in 2.9% patients. Cardiomyopathy present in 2.9% patients. CONCLUSION: Cardiovascular manifestation in SLE should be promptly screened as this may worsen the clinical course of patients and it is one of the causes of important cause of death in SLE patients. Hence SLE patients must be screened for cardiovascular manifestations frequently.


Subject(s)
Lupus Erythematosus, Systemic , Rheumatology , Cross-Sectional Studies , Heart , Humans , Lupus Erythematosus, Systemic/diagnosis , Tertiary Care Centers
12.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35443429

ABSTRACT

Rheumatoid Arthritis is a chronic inflammatory disease of unknown etiology characterised by presence of symmetric involvement of multiple joints, mainly small joints that rapidly progresses to multisystem inflammation. Common haematological abnormalities observed are anemia,leucocytosis, neutropenia, thrombocytosis, thrombocytopenia, eosinophilia and haematological malignancies. This study is aimed at the various haematological parameters observed in newly diagnosed patients of rheumatoid arthritis and correlating it with disease activity measured by indices like DAS 28 CRP and HAQDI. MATERIAL: Patients more than 16 years of age and newly diagnosed cases of rheumatoid arthritis according to the ACR EULAR 2010 criteria who presented in the rheumatology opd were included in the study. A total of 20 patients fulfilling the inclusion criteria were studied.Any patient with active blood loss from any site, infection,chronic liver or kidney disease, malignancies,hematological diseases,those already on disease modifying drugs,other autoimuune diseases were excluded from the study. OBSERVATION: Out of 20 patients of rheumatoid arthritis studied,55%(11) had anemia of chronic disease and 27.5%(5) had iron deficiency anemia,3%(1) had eosinophilia. The disease activity was measured using DAS 28 CRP and HAQ DI. A negative correlation was observed between Hb level and disease activity whereas a positive correlation was observed between platelet count and disease activity. CONCLUSION: In our study it was observed that Hb is significantly lower in patients with high disease activity whereas platelet count and MPV are significantly higher with high disease activity compared to patients with low to moderate disease activity.So, from Hb level, platelet count and MPV, we can predict disease activity in RA patients which can guide us for proper and aggressive management to prevent further disease progression.


Subject(s)
Anemia , Arthritis, Rheumatoid , Rheumatology , Anemia/etiology , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Chronic Disease , Disease Progression , Humans , Severity of Illness Index
13.
BMC Health Serv Res ; 22(1): 327, 2022 Mar 11.
Article in English | MEDLINE | ID: mdl-35277162

ABSTRACT

BACKGROUND: In 2011 the British Columbia (BC) Ministry of Health introduced a new fee-for-service billing code that allowed "Multidisciplinary Care Assessment" (MCA). This change has the potential to change access to and quality of care for patients. This study aimed to explore the impact on access to rheumatology services in the province. METHODS: Fee-for-service rheumatology billings were evaluated for each rheumatologist 2 years before and after use of the MCA code. Numbers of 1) unique patients and 2) services provided per month were used as proxy measures of access to care. A multiple-baseline interrupted time series model assessed the impact of the MCA on levels and trends of the access outcomes. RESULTS: Our analysis consisted of 82,360 patients cared for by 26 rheumatologists who billed for an MCA. In our primary analysis we observed a sustained increase in the mean number of unique patients of 4.9% (95% CI: 0.0% to 9.9%, p = 0.049) and the mean number of services of 7.1% (95% CI: 1.0% to 13.6%, (p = 0.021), per month provided by a rheumatologist, corresponding to the initial use of MCA. CONCLUSION: The introduction of the MCA code was associated with an initial increase in the measures of access, which was maintained but did not increase over time. Our study suggests that the use of Multidisciplinary Care Assessment can contribute to expanding and/or sustaining access to care for people with complex chronic conditions, like rheumatic diseases.


Subject(s)
Rheumatic Diseases , Rheumatology , British Columbia , Health Services Accessibility , Humans , Interrupted Time Series Analysis , Rheumatic Diseases/therapy
14.
Med Clin North Am ; 106(2): 349-363, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35227435

ABSTRACT

Inflammation plays a well-established role in the development and progression of atherosclerosis. Individuals exposed to chronic inflammation are at an increased risk of developing cardiovascular disease, including coronary artery disease and heart failure, independent of associated traditional risk factors. Traditional risk assessment tools and calculators underestimate the true cardiac risk in this population. In addition to this, there is a lack of awareness on the association between inflammation and cardiovascular disease. These factors lead to undertreatment in terms of preventive cardiac care in patients with chronic inflammatory disease.


Subject(s)
Atherosclerosis , Cardiovascular Diseases , Lupus Erythematosus, Systemic , Rheumatology , Atherosclerosis/complications , Cardiovascular Diseases/epidemiology , Humans , Inflammation/complications , Risk Factors
15.
Clin Med (Lond) ; 22(2): 107-111, 2022 03.
Article in English | MEDLINE | ID: mdl-35304369

ABSTRACT

Recent national and international guidance from rheumatology societies have reflected the advances in evidence for both the investigation and management of giant cell arteritis. Cranial ultrasound reduces diagnostic delay and improves clinical outcomes. Immediate high-dose glucocorticoids remain the standard treatment for giant cell arteritis. Randomised controlled trial evidence using tocilizumab, an interleukin-6 receptor antagonist, has been shown to have good clinical efficacy with glucocorticoid sparing effects. Overall patient outcomes appear to be improved by formalising pathways for diagnosis to include clinical experts' opinion early in decision making.


Subject(s)
Giant Cell Arteritis , Rheumatology , Delayed Diagnosis , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/drug therapy , Glucocorticoids/therapeutic use , Humans , Treatment Outcome
16.
J Comput Assist Tomogr ; 46(2): 190-196, 2022.
Article in English | MEDLINE | ID: mdl-35297576

ABSTRACT

AIM: To test the diagnostic efficacy of a multiparametric rheumatology lumbosacral magnetic resonance (MR) imaging protocol in detection and characterization of axial spondylarthritis (SpA) and compare it with serology and clinical findings. METHODS: A consecutive series of multiparametric rheumatology lumbosacral MR imaging examinations performed on 3T MR scanner. Three-dimensional inversion recovery turbo spin echo, precontrast and postcontrast fat-suppressed T1-weighted images, as well as diffusion-weighted images were used to detect active erosions and enthesitis using established criteria. Pearson χ2 was used for categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for magnetic resonance imaging (MRI) and serology, based on the final diagnosis from rheumatologists. An alpha error below 0.05 was considered statistically significant. RESULTS: The final study sample included 130 consecutive patients (80 women and 50 men; mean ± SD 44 ± 13 and 45 ± 14 years, respectively). Seventy-eight subjects were diagnosed with axial SpA and 52 with non-SpA arthropathy. In the non-SpA group, 27 patients were diagnosed with osteoarthritis, 6 had unremarkable imaging, whereas 19 were considered as clinically undetermined. There was positive correlation between positive MRI results and SpA diagnosis (P < 0.00001). No correlation existed between positive serology alone and SpA diagnosis (P = 0.0634). Although MRI and serology proved equally sensitive in detecting SpA, the specificity and overall accuracy of MRI were significantly higher. Inflammatory activity was detected in 45 (57.7%) cases, in the pelvic enthesis in 29 (37.2%) cases, in the lumbosacral spine in 16 (20.5%) cases, in the hip joints in 15 (19.2%) cases, and in the pubic symphysis in 5 (6.4%). Inactive sacral disease was seen in 7 of 35 enthesitis patients (20.0%), and in 2 SpA cases, there were no sacral lesions. CONCLUSIONS: The results suggest that in patients with suspected SpA, MRI should not be limited to the sacroiliac joints, but also include enthesitis sites and other joints of the axial skeleton. The multiparametric rheumatology protocol increases the efficacy of MRI in detecting enthesitis and joint inflammatory disease, thereby offering additional information to the clinician and assisting in the early diagnosis/detecting disease activity.


Subject(s)
Rheumatology , Spondylarthritis , Spondylarthropathies , Female , Humans , Magnetic Resonance Imaging/methods , Male , Sacroiliac Joint/diagnostic imaging , Spondylarthritis/complications , Spondylarthritis/diagnostic imaging , Spondylarthropathies/diagnostic imaging , Spondylarthropathies/pathology
17.
Rev Med Suisse ; 18(773): 467-470, 2022 Mar 16.
Article in French | MEDLINE | ID: mdl-35306766

ABSTRACT

Regular blood monitoring allows for treatment adjustments and early detection or even prevention of some side effects of antirheumatic dugs. Guidelines may vary between national societies for rheumatology, but largely recommend baseline screening followed by regular blood tests depending on the specific drug and duration of treatment. In this article we discuss the monitoring of the major antirheumatic drugs and further develop on some significant and specific drug side effects.


Le suivi biologique des traitements de fond rhumatologiques permet non seulement de les adapter en fonction des cibles thérapeutiques, mais également de détecter précocement et parfois prévenir certains effets toxiques indésirables, liés aux médicaments. Les recommandations varient selon la société experte et le pays, mais s'accordent sur un bilan biologique préalable, puis des contrôles sanguins périodiques dont la fréquence dépend de la molécule et de sa durée d'utilisation. Dans cet article, nous discutons du suivi biologique des principaux traitements de fond et abordons quelques effets indésirables biologiques significatifs, spécifiques à certaines molécules.


Subject(s)
Antirheumatic Agents , Rheumatology , Antirheumatic Agents/adverse effects , Humans , Mass Screening
18.
RMD Open ; 8(1)2022 03.
Article in English | MEDLINE | ID: mdl-35246471

ABSTRACT

OBJECTIVES: To obtain an overview of gender equity at European rheumatology conferences. METHODS: The proportion of women invited as either moderators or speakers to the European Alliance of Associations for Rheumatology (EULAR) annual congresses and national conferences in Europe was calculated from the published congress materials from EULAR annual congresses (2015-2019) and the 2019 national conferences of France, Germany, Italy, Spain and the UK. Data from EULAR congresses were further categorised by type of session. Significance testing was conducted using χ2 tests with the level of statistical significance set at p<0.05. RESULTS: The proportion of combined women moderators and speakers at EULAR varied from 40% to 43% between 2015 and 2019 with no obvious trend over time. There were higher proportions of women in the Health Professionals in Rheumatology and People with Arthritis and Rheumatism sessions (>50% consistently). However, these sessions represent <25% of EULAR congress invitations. Representation of women at the EULAR congress in 2019 (39.6%) was significantly higher than at the national congresses in France (28.6%) and Germany (29.6%) but similar to that observed in Italy (33.7%), Spain (41.7%) and the UK (42%). CONCLUSION: Women account for less than half of invited moderators and speakers at the conferences reviewed. Compared with historical EULAR data in 2003 (16%) and in 2004 (19%), the gender gap at EULAR congresses has narrowed considerably, but there remains a need to monitor and improve women's representation.


Subject(s)
Rheumatology , Europe , Female , Gender Equity , Humans , Sex Factors , Societies, Medical
19.
Adv Med Sci ; 67(1): 163-169, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35279619

ABSTRACT

PURPOSE: The variation in the immune response to Bartonella spp. infection in humans remains unclear. The present study compares the expression of selected interleukins, cytokines and cathelicidin (LL-37) in rheumatology clinic patients suffering from musculoskeletal symptoms with healthy blood donors. The patients had previously been tested for the presence of Bartonella henselae antibodies. METHODS: Gene expression of LL-37, interleukin (IL)-2, IL-4, IL-6, IL-12, interferon-(IFN)-γ, and tumor necrosis factor (TNF-α)-α was determined in blood samples using quantitative Polymerase Chain Reaction (qPCR). Statistical analysis was prepared with STATISTICA. RESULTS: Statistically significant differences in the mRNA levels of the tested cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-12; p<0.0001) were observed between the healthy controls and patients; however, no difference was observed for LL37 mRNA (p â€‹= â€‹0.1974). No significant differences in mRNA expression were observed between IgG in anti-Bartonella seropositive and seronegative individuals (p>0.05). The only significant differences between the Bartonella spp. DNA positive and negative patients, indicated by PCR, were observed for TNF-α and IL-12 mRNA (p â€‹= â€‹0.0045 and p â€‹= â€‹0.0255, respectively). CONCLUSION: A broadly similar immune response to the tested cytokines was observed among the participants irrespective of anti-Bartonella spp. IgG seropositivity. However, the Bartonella DNA-positive participants demonstrated significantly lower expression of IL-12 and TNF-α mRNA; this may indicate that these bacteria have a suppressive influence on the immune system.


Subject(s)
Antimicrobial Cationic Peptides , Bartonella Infections , Cytokines , Antimicrobial Cationic Peptides/genetics , Bartonella , Cytokines/genetics , Gene Expression , Humans , Rheumatology
20.
Arthritis Res Ther ; 24(1): 61, 2022 03 01.
Article in English | MEDLINE | ID: mdl-35232462

ABSTRACT

BACKGROUNDS: Treatment of difficult-to-treat rheumatoid arthritis (D2T RA) is one of the greatest unmet needs in rheumatology. This study aims to find out preferable treatment options for a group of D2T RA patients who are refractory to multiple biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). METHODS: Data were obtained from patients enrolled in the FIRST Registry who started either TNF inhibitor (TNFi), interleukin-6 receptor inhibitor, cytotoxic T-lymphocyte-associated antigen-4 immunoglobulin, or Janus-kinase inhibitor (JAKi) in the period of August 2013 to December 2020. Those who failed to ≥ 2 and ≥ 3 b/tsDMARDs were categorised as D2T RA and very D2T RA (vD2T RA), respectively. Change in Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire Disability Index were compared among the groups using propensity-based inverse probability treatment weighted (IPTW) method. RESULTS: Of 2128 cases included, 353 were categorised as D2T RA. Among the D2T RA, 106 were identified as vD2T RA. JAKi showed a significant improvement in CDAI in the patients with D2T RA and vD2T RA, compared to IPTW-adjusted patients treated with the other 3 regimens. Latent class analysis of the trajectories of treatment response revealed that the proportion of a group of patients who showed poor response was lower among the JAKi subgroup than among those with other subgroups. This superiority of JAKi was more apparent among methotrexate- and glucocorticoid-free individuals. The hazard ratio of severe adverse events was comparable among the four treatment subgroups in both the D2T RA and b/tsDMARD-naïve groups. CONCLUSIONS: This study compared responsiveness to different classes of b/tsDMARDs among D2T RA and vD2T RA patients who were refractory to multiple b/tsDMARDs. The results suggest JAKi is a preferable treatment choice for this type of D2T RA.


Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , Janus Kinase Inhibitors , Rheumatology , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Humans , Janus Kinase Inhibitors/therapeutic use , Registries
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