The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-α therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-α inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 ≤ 2.6) and 34.4 %, LDA (DAS28 ≤ 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate ≤ 7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03-5.81; OR 1.8, 95 % CI 1.09-6.68), Health Assessment Questionnaire Disability Index ≤  2 (OR 7.0, 95 % CI 1.56-31.91; OR 1.3, 95 % CI 1.03-5.79), C-reactive protein level ≤ 20 mg/l (OR 1.5, 95 % CI 0.29-8.22; OR 0.5, 95 % CI0.08-2.97), rheumatoid factor ≤ 20 IU/ml (OR 18.9, 95 % CI 10.79-38.36; OR 32.9, 95 % CI 4.03-269), anti-cyclic citrullinated peptide antibodies ≤ 40 IU/ml (OR 3.5, 95 % CI 0.67-18.19; OR 1.2, 95 % CI 1.02-1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05-0.36; OR 0.2, 95 % CI 0.06-0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2-13.53; OR 2.9, 95 % CI 1.20-4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-α inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-α therapy.

Despite recent advances in understanding the pathological pathways, clinical pattern and management opportunities for new-onset psoriasis as a paradoxical adverse event in patients receiving TNF inhibitors for their immune-mediated disorder, there is a subset of patients who are either partial responders or non-responders, whatever the therapeutic scenario. We present the case of new-onset psoriasis and severe alopecia development in a case study of long-standing rheumatoid arthritis (RA) treated with adalimumab (ADA) and leflunomide. Since skin lesions and alopecia are resistant to the classic protocol (topical treatment, ADA discontinuation) and RA becomes highly active, rituximab (RTX) was started. Dramatic improvement in joint disease, total remission of alopecia and partial remission of pustular psoriasis were described after the first RTX cycle. Although B-cell-depleting agents result in controversial effects on psoriatic skin lesions, this is the first case of ADA-induced psoriasis and alopecia that improved under RTX, suggesting a possible role in treating such a patient population.

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Background treat-to-target and tight control strategies are actually the two main paradigms in the treatment of rheumatoid arthritis (RA), aiming to improve patients outcome by achieving either remission or minimal disease activity status. There is actually no consensus regarding the right assessment tools for monitoring the magnitude of improvement and the absolute reached level in routine clinical practice. Objectives to compare EULAR-DAS28 with RAPID3 (a patient-reported outcome based on pain, patient global assessment of disease activity, and multidimensional HAQ)response criteria in patients with moderate to severe active RA treated with rituximab (RTX). Methods prospective observational study on 72 moderate to severe active RA (DAS28>3.2) receiving one cycle of RTX (two infusions of 1000 mg at two weeks interval). Response to treatment was appreciated at six months by: (i) EULAR-DAS28 response criteria, classified as EULAR good (decrease with 1.2 units), moderate (decrease of 0.6–1.2 units) or non-responder (decrease ≤0.6 units); and (ii) RAPID3 response categories defined as good (decrease with 3.6 units), moderate (decrease of 1.8–3.6 units) and poor (decrease ≤1.8 units). Statistical analysis was done in SPSS.16 (weighted kappa statistics, p<0.05. Results up to 85% of RA has been classified as good and moderate responders based on RAPID3, while about 75% have been responders according to EULAR-DAS28; moreover, nearly 45% of the RAPID3 good responders have also been categorized as moderate EULAR-DAS28 responders. Statistical significant moderate agreement between the EULAR-DAS28 response criteria and RAPID3 has been demonstrated (p<0.05). Conclusions Patient-centered tools such as RAPID3 allow more easily and quickly to quantify disease activity levels and patient responses to therapy, providing a more complex insight into the patient’s perception of disease status. Disclosure of Interest None Declared