Novel insights into the management of rheumatoid arthritis: one year in review 2023

Garaffoni, C.; Adinolfi, Antonella; Bortoluzzi, Alessandra; Filippou, Georgios; Giollo, Alessandro; Sakellariou, Garifallia; Silvagni, Ettore; Sirotti, Silvia; Ughi, Nicola; Scirè, Carlo Alberto

doi:10.55563/clinexprheumatol/nat8nl

Cited by 4 publications

(4 citation statements)

References 51 publications

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“…Male sex was the only predictor associated with reaching SR in our study. Male sex being a predictor of remission was also recently highlighted in a review by Garaffoni et al (39). Favalli et al showed that disease activity is higher and response to b/tsDMARDs is lower in women compared to men, which might explain the lower remission rates (40).…”

Section: Univariable Analysis Multivariable Analysismentioning

confidence: 91%

Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre

Gildemeister,

Redeker,

Buehring

et al. 2023

Clinical and Experimental Rheumatology

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ObjectiveWe aimed to study remission rates in patients with RA in a tertiary care centre over a long-term observation period. MethodsIn a monocentric cohort study with a prospective and a retrospective part, adult RA patients were included. Patient's characteristics and outcome parameters were documented prospectively (clinical visit). Data of the initial visit (index visit) and date of first occurrence of remission were taken retrospectively from the hospital information system. Remission was defined as DAS28 <2.6 and sustained remission (SR) was defined as remission lasting >6 months. Logistic regression analysis was used to analyse factors associated with remission and SR. ResultsA total of 136 RA patients were included with retrospective data available over a period of 47.9 (18.9) months. One third already had erosions and severe limitations in physical function at baseline. The vast majority (n=109) of patients achieved a state of remission at least once over time (80.1%). At the clinical visit, 40 patients (29.4%) were in remission. Remission was achieved 14.9 months (13.8) after the index visit and by 54.1%, 23.9%, 13.8%, and 8.3% of patients within the first, second, third, and fourth year, respectively. SR was achieved by 65 patients (47.8%) within the observation period. ConclusionMost patients achieved remission at least once within the observation period and almost 50% of patients also achieved SR. This study shows that the target of achieving remission should be constantly pursued, as we were able to show that even in the fourth year of treatment, patients still achieved remission.

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Section: Univariable Analysis Multivariable Analysismentioning

confidence: 91%

Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre

Gildemeister,

Redeker,

Buehring

et al. 2023

Clinical and Experimental Rheumatology

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“…Following our regular annual reviews on different aspects of rheumatology (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) we will here provide a critical digest of the recent literature on Ax-SpA of 2021 and 2022 (Medline search of articles published from 1st January 2021 to 31th December 2022). In particular, we performed an on-line search on MESH database, using as key terms "blood", "chemistry", "diagnosis", "diagnostic imaging", "drug therapy", "epidemiology", "metabolism",…”

Section: Methodsmentioning

confidence: 99%

Axial spondyloarthritis: one year in review 2023

Fattorini,

Gentileschi,

Cigolini

et al. 2023

Clinical and Experimental Rheumatology

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Axial spondyloarthritides (axSpA) are a group of systemic autoimmune diseases, characterised by an inflammatory involvement of the axial skeleton, which, in the earlier phases, cannot be detected by conventional radiology, but only by magnetic resonance imaging, thus defining the so-called non-radiographic axSpA (nr-axSpA). The initial osteitis then tends to complicate into bone reabsorption and aberrant bone deposition, which then determines the ankylosis of the axial skeleton in the latest phases of the disease. Peripheral joints may also be affected, enthesitis being its more characteristic manifestation. The radiographic form corresponds to ankylosing spondylitis which, with psoriatic arthritis, is the best-known subtype of SpA. AxSpA are rarely associated to laboratory abnormalities and are usually complicated by the presence of both extra-articular manifestations (particularly acute anterior uveitis, psoriasis and inflamatory bowel disease) and comorbidities, with a subsequent higher risk for patients of an impaired quality of life. In this paper we reviewed the literature on axSpA of 2021 and 2022 (Medline search of articles published from 1st January 2021 to 31st December 2022).

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“…When inadequately treated or refractory to standard treatments, IAs may lead to disability, impairment of health-related quality of life, and an increase in mortality. To date, treating rheumatologists have access to several effective disease-modifying anti-rheumatic drugs (DMARDs) approved for RA and PsA (conventional synthetic (cs), biological (b), and targeted synthetic (ts) DMARDs) ( 3 , 4 ). Most treatments are efficacious in different diseases, but still have a relevant proportion of failures, or suboptimal responses ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

Garaffoni,

Tamussin,

Calciolari

et al. 2024

Front. Immunol.

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BackgroundInflammatory arthritis (IAs), such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are characterized by the presence of chronic synovitis. The Krenn’s synovitis score (KSS), a simple tool detectable by haematoxylin/eosin staining of synovial biopsy samples, allows the discrimination between high-grade and low-grade synovitis. The aim of this study was to identify the clinical associations of KSS and to evaluate the relationship between high-grade synovitis and treatment response in IA patients.MethodsClinical, laboratory and ultrasound data were retrieved from RA and PsA patients recruited in the prospective MATRIX cohort study. Inclusion criteria were age≥18 years, RA or PsA diagnosis, and presence of active disease with eligibility to start/modify therapy. Patients underwent ultrasound-guided synovial biopsy of one of the most involved joints before starting/modifying treatment according to treat-to-target strategy. The samples were analysed by an expert pathologist for KSS calculation. Univariable and multivariable logistic regression analyses were performed to evaluate the relationship between KSS and baseline variables. The association between KSS and treatment response at 24 weeks of follow-up was investigated in univariable logistic regression analysis.Results53 patients, 34 RA and 19 PsA, completed 24 weeks of follow-up after synovial biopsy. Patients were either treatment naïve (N=6, 11%), csDMARDs-experienced (N=46, 87%) or b/tsDMARDs-experienced (N=20, 38%). Median KSS was 6.00 (Q1-Q3 4.00-7.00) in RA and 4.00 (3.00-6.00) in PsA (p=0.040), and inflammatory infiltrates score was significantly higher in RA than in PsA patients (median 3.00 vs 2.00, p=0.021). In multivariable analysis, synovial effusion in the biopsied joint (OR 9.26, 95%CI 2.12-53.91) and erythrocyte sedimentation rate (ESR) (OR 1.04, 95%CI 1.01-1.08) associated with high KSS. High-grade synovitis significantly associated with a higher probability of achieving DAS28 remission, ACR20/50 response, and Boolean2.0 remission, independently from diagnosis.ConclusionSeveral markers of pro-inflammatory pathways associated with the presence of high-grade synovitis, and patients with higher KSS shared a higher probability of treatment targets achievement in the follow up. The integration of a simple and feasible tool like KSS in the clinical and prognostic stratification of patients with IA might help in intercepting patients with a disease more prone to respond to available treatment paradigms.

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Novel insights into the management of rheumatoid arthritis: one year in review 2023

Cited by 4 publications

References 51 publications

Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre

Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre

Axial spondyloarthritis: one year in review 2023

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

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