'Difficult to treat' rheumatoid arthritis: current position and considerations for next steps

Tan, Yvonne; Buch, Maya H

doi:10.1136/rmdopen-2022-002387

Cited by 40 publications

(21 citation statements)

References 30 publications

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“…Previous studies questioned whether the sequence of DMARDs and/or resistance to specific drugs affects progression to D2T RA 20. Our analysis of drug choice and combinations showed no trend towards D2T RA.…”

Section: Discussioncontrasting

confidence: 63%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

et al. 2023

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ObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed.MethodsA longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA.ResultsThe study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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Section: Discussioncontrasting

confidence: 63%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

et al. 2023

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“…Previous studies questioned whether the sequence of DMARDs and/or resistance to specific drugs affects progression to D2T RA (21). Our analysis of drug choice and combinations showed no trend toward D2T RA.…”

Section: Discussionmentioning

confidence: 99%

“…The main characteristics of patients with D2T RA are younger age, high 28-joint Disease Activity Score (DAS28), comorbidity with fibromyalgia, marked disability according to the Health Assessment Questionnaire (HAQ), high visual analog scale (VAS) score, poorer quality of life, increased number of DMARDs, higher doses of glucocorticoids, patient desire to intensify treatment, and greater consumption of healthcare resources (18). Evidence for the EULARdefined D2T RA population is limited and based mainly on definitions that do not take into account features of active disease and the perception of challenging RA by the clinician and/or patient (21), focusing mainly on the first of them (failure of at least two b/tsDMARDs). In addition, almost all patients included have long-standing RA.…”

Section: Introductionmentioning

confidence: 99%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

León

Madrid

Lopez-Viejo

et al. 2022

Preprint

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Objectives. Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyze whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analyzed. Methods. A longitudinal multicenter study of RA patients was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease, and management being perceived as problematic by the rheumatologist and/or patient). The main outcome was disease activity in the early stages. The covariates were sociodemographic, clinical, and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. Weighting techniques were also applied to balance data. Results. The study population comprised 631 patients and 35 developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, DAS28 score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.50; p=0.02). Conclusions. In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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“…Следует подчеркнуть, что в патогенезе РА обсуждается участие аутоиммунных и аутовоспалительных механизмов [143]. Можно полагать, что перикардит может быть «маркером» аутовоспалительного компонента патогенеза РА, что в перспективе расширяет возможности персонифицированной терапии тяжелых (diffi cultto-treat) пациентов [105,144,145]. Представляет интерес применение анакинры при РП, развившемся при СКВ, который рецидивировал несмотря на ГК и иммуносупрессивную терапию и успешно контролировался анакинрой (в комбинации с ГК и колхицином) [143].…”

Section: применение анакинры при перикардитеunclassified

Problems of immunopathology and prospects for pharmacotherapy of idiopathic recurrent pericarditis: Using an interleukin 1 inhibitor (Anakinra)

Насонов

Sukmarova²,

Попкова³

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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Pericarditis, a clinical syndrome characterized by inflammation and thickening of the pericardium, is one of the most common forms of inflammatory diseases of the cardiovascular system. The most common and severe complication of acute pericarditis is idiopathic recurrent pericarditis (IRP), which has a poor prognosis associated with the risk of cardiac tamponade and constrictive pericarditis. The pathogenesis of pericarditis is associated with a complex interaction of environmental factors, genetic predisposition, and pathological activation of innate and acquired immunity. Autoinflammatory mechanisms associated with hyperproduction of interleukin (IL) 1 attract particular attention. Standard therapy for pericarditis includes non-steroidal antiinflammatory drugs, colchicine, glucocorticoids, and immunosuppressive drugs. A new direction in the pharmacotherapy of pericarditis is associated with the use of Anakinra (a recombinant non-glycosylated analog of an IL-1 receptor antagonist), which blocks the signaling of IL-1β and IL-1α. The materials of numerous studies are summarized, indicating that Anakinra is an effective drug for the treatment of patients with IRI who are resistant to standard therapy. It is assumed that the wider use of Anakinra, especially in the early stages of pericarditis, will not only improve the prognosis, but also be important for the identification of the autoinflammatory phenotype of IRI and the development of personalized therapy programs.

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'Difficult to treat' rheumatoid arthritis: current position and considerations for next steps

Cited by 40 publications

References 30 publications

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Problems of immunopathology and prospects for pharmacotherapy of idiopathic recurrent pericarditis: Using an interleukin 1 inhibitor (Anakinra)

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