Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study.

Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.

Reproducibility of total and regional body composition using dual-energy X-ray absorptiometry in rheumatoid arthritis and ankylosing spondylitis.

Several studies have reported changes in body composition in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that body composition measurements obtained by absorptiometry were highly reproducible in patients suffering from these diseases. This study justifies the use of absorptiometry measurements in longitudinal studies in this population. PURPOSE: Our study aimed to assess the reproducibility of total and regional body composition in patients with rheumatoid arthritis (RA) and with ankylosing spondylitis (AS) and to compare them to healthy subjects. METHODS: The study enrolled 80 subjects including 32 healthy subjects, 31 RA patients, and 17 AS patients. Each subject had two scans in one day under the same standard conditions and none ate nor drunk before being repositioned on the table. The reproducibility was assessed through the coefficient of variation (CV), the least significant change (LSC), the intraclass correlation (ICC), and the smallest significant difference (SDD). RESULTS: Total body composition measurements obtained by dual-energy X-ray absorptiometry (DXA) were highly reproducible, and there was no statistically significant difference between reproducibility in healthy subjects, patients with RA, and patients with AS. For total body fat mass (FM), lean mass (LM), and bone mineral content (BMC) in the total population, CV values were 1.71%, 1.25%, and 1.74%, respectively; ICC values were 0.998, 0.996, and 0.993, respectively; LSC values were 4.88%, 3.7%, and 5.2%, respectively; and SDD values were ± 1.23 Kg, ± 1.47 Kg, and ± 126.0 g, respectively. For regional body FM, LM, and BMC in the total population, CV values in the arms were 8.46%, 4.17%, and 3.79%, respectively; in the legs 6.24%, 3.59%, and 2.04%, respectively, and in the trunk 5.02%, 2.92%, and 5.24%, respectively. CONCLUSION: Total body tissue mass, FM percentage, FM, LM, and BMC measurements obtained by DXA are highly reproducible in RA and AS.

Vitamin D status and abdominal aortic calcification in postmenopausal women.

Vitamin D has an important role in bone metabolism and may be involved in the process of vascular calcification. The objective of this study was to evaluate the effect of vitamin D status on the presence of abdominal aortic calcification (AAC). We enrolled, in a cross-sectional study, 429 postmenopausal women [mean age, weight, and BMI of 59.5 ± 8.3 (50-83) years, 75.8 ± 13.3 (35-165) kg, and 29.9 ± 5.2 (14.6-50.8) kg/m2, respectively]. Lateral vertebral fracture assessment (VFA) images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. Vertebral fractures (VFs) were defined using the Genant semiquantitative (SQ) approach. We used the Kauppila score to assess AAC extension. Clinical risk factors of osteoporosis were collected, and 25-hydroxy vitamin D was measured using electrochemiluminescence (Roche). Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0% and 78.1%, respectively. VFs grade 2/3 were identified in 76 patients (17.7%). Two thirds of the evaluable participants did not have any detectable AAC. The prevalence of significant atherosclerotic burden, defined as a radiographic 24-point AAC score of 5 or higher, was 7.9%. The group of women with extended AAC were older and had a statistically significant higher menopause duration and more prevalent grade 2/3 VFs. Compared to women with normal values of vitamin D, women with vitamin D insufficiency (<20 ng/ml) and deficiency (<10 ng/ml) had a lower BMD and more prevalent VFs. No difference was noted with regard to AAC among the three groups. Multiple stepwise conditional logistic regression analysis showed that the presence of AAC was associated significantly with age and the presence of VFs. Extended aortic calcifications are independently associated with prevalent VFA-identified VFs but not with serum vitamin D levels in postmenopausal women. VFA imaging using DXA may detect at the same time prevalent VFs and AAC, an important cardiovascular disease risk factor.

Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women.

BACKGROUND: It is well established that weight is an important determinant of bone health. Whereas obesity is associated with increased mortality and morbidity from diabetes and cardiovascular diseases, high body weight is widely believed to be associated to hypovitaminosis D and protective against the development of osteoporosis and fracture risk. The objective of the study was to evaluate the effect of BMI on vitamin D status and on densitometric vertebral fractures (VFs) in a large series of asymptomatic women aged over 50 who had a VFA examination during their bone mineral density (BMD) testing. METHODS: We enrolled 429 postmenopausal women (mean age, weight and BMI of 59.5 ± 8.3 (50 to 83) years, 75.8 ± 13.3 (35 to 165) kgs and 29.9 ± 5.2 (14.6 to 50.8) kg/m(2), respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. VFs were defined using the Genant semiquantitative (SQ) approach. Clinical risk factors of osteoporosis were collected and 25-hydroxivitamin D was measured using electrochimiluminescence (Roche). RESULTS: Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0 % and 78.1 % respectively. VFs grade 2/3were identified in 76 (17.7 %). Comparison between women according to their BMI showed that obese women had a higher BMD and less proportion of women with osteoporosis and VFs grade 2/3 than lean and overweight women. The prevalence of VFs globally increased with age and as BMI and BMD declined. Stepwise regression analysis showed that the presence of osteoporosis was independently related to BMI and history of fractures while the presence of grade 2/3 VFs was independently related to age, hypovitaminosis D and years of menopause. CONCLUSION: Obese women had a higher BMD and lower prevalence of VFs. VFs were significantly related to age, hypovitaminosis D and years since menopause. However, among obese women, prevalence of VFs was increased in osteoporotic women.