Time to modify the DAS28 to make it fit for purpose(s) in rheumatoid arthritis?

Hensor, Elizabeth M A; Conaghan, Philip G.

doi:10.1080/1744666x.2019.1697679

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Multiple reports from around the world about the natural course of MIS-C and its epidemiology have been published following initial reports from Europe regarding MIS-C [ 25 , 28 , 29 •, 30 – 53 ]. Most studies compared MIS-C with severe COVID-19 shock and Kawasaki disease [ 26 , 35 , 39 , 41 , 44 , 54 – 87 ].…”

Section: Covid-19/mis-c Pandemic Timelinementioning

confidence: 99%

Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease

Bükülmez

2021

Curr Rheumatol Rep

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Purpose of Review In this article, I have reviewed current reports that explore differences and similarities between multisystem inflammatory syndrome in children (MIS-C) and other known multisystem inflammatory diseases seen in children, particularly Kawasaki disease. Recent Findings Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a human coronavirus causing the COVID-19 disease which emerged in China in December 2019 and spread rapidly to the entire country and quickly to other countries. Currently, there is a pandemic of SARS-CoV-2 infection that results in 20% of patients admitted to hospital with illness, with 3% developing intractable acute respiratory distress syndrome (ARDS) with high mortality. However, pediatric COVID-19 is still reported to be a mild disease, affecting only 8% of children. Pathogenesis in children is comparable to adults. There are suggested impaired activation of IFN-alpha and IFN regulator 3, decreased cell response causing impaired viral defense, yet the clinical course is mild, and almost all children recover from the infection without major complications. Interestingly, there is a subset of patients that develop a late but marked immunogenic response to COVID-19 and develop MIS-C. Summary Clinical features of MIS-C resemble certain pediatric rheumatologic diseases, such as Kawasaki disease (mucocutaneous lymph node syndrome) which affects small-medium vessels. Other features of MIS-C resemble those of macrophage activation syndrome (MAS). However, recent research suggests distinct clinical and laboratory differences between MIS-C, Kawasaki disease, and MAS. Since the start of the SARS-CoV-2 pandemic, MIS-C has become the candidate for the most common cause of acquired heart disease in children.

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Section: Covid-19/mis-c Pandemic Timelinementioning

confidence: 99%

Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease

Bükülmez

2021

Curr Rheumatol Rep

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“…The indication was approved in 2017 for PsA, based on the reported ACR20 in a higher proportion of patients when compared with placebo ( 22 ) and showing efficacy also on entheseal disease ( 23 ). In 2019 it was approved for active radiographic axSpA thanks to its efficacy and safety outcome results ( 24 , 25 ). More recently, ixekizumab was evaluated in the COAST-X trial in non-radiographic axSpA patients and it showed superiority to placebo at weeks 16 and 52, with similar rate of adverse events compared with previous ixekizumab studies.…”

Section: Clinical Trials In Axspa For Available Drugs Targeting the Il-17a/il-23 Axismentioning

confidence: 99%

Clinical Trials Supporting the Role of the IL-17/IL-23 Axis in Axial Spondyloarthritis

et al. 2021

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The term spondyloarthritis (SpA) encompasses a heterogeneous group of inflammatory musculoskeletal diseases with several common genetic background and clinical features, including the possible involvement of the axial skeleton with peripheral mono- or oligo- arthritis and frequently coexisting skin, eye and intestinal manifestations. When the sacroiliac joints or other parts of the spine or thoracic wall are predominantly affected at magnetic resonance or X-ray imaging with inflammatory back pain, the disease is classified as axial SpA and the therapeutic choices are significantly different compared to cases of peripheral arthritis. Moving from the narrow effectiveness and safety profiles of non-steroidal anti-inflammatory drugs, there has been a significant research effort aimed at identifying new treatments based on our better understanding of the pathogenesis of SpA. Indeed, in parallel with the solid data demonstrating that IL-17 and IL-23 are key cytokines in the development of enthesitis and spondylitis, monoclonal antibodies interfering with this pathway have been developed for the treatment of axial SpA. Furthermore, the IL-17/IL-23 axis is key to extra-articular manifestations such as inflammatory bowel disease, uveitis, and psoriasis which are frequent comorbidities of SpA. Currently available drugs act through these mechanisms recognizing IL-23 and targeting IL-17, such as secukinumab and ixekizumab. These therapeutic approaches are now envisioned in the international treatment recommendations for psoriatic arthritis with an axial phenotype as well as for ankylosing spondylitis (AS). We will provide herein a concise comprehensive overview of the clinical evidence supporting the use of these and other drugs acting on IL-23 and IL-17 in axial SpA.

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“…This approach is particularly evident in efforts to identify a reduced set of target joints for scanning in RA patients in clinical remission to detect subclinical synovitis efficiently, suggesting a streamlined, yet sensitive method for routine assessments. Moreover, the quantification of synovial and erosive changes through ultrasound not only facilitates the early diagnosis of RA but also aids in monitoring disease activity and response to therapy, highlighting the technique's critical role in the comprehensive management of RA (13,14). Our study seeks to bridge the gap between patient-reported symptoms, physical examination findings, and ultrasound-detected synovitis, highlighting the integral role of ultrasound in identifying subclinical disease activity.…”

Section: Introductionmentioning

confidence: 99%

The Concordance of Patient-Reported Symptoms, Physical Examination and Ultrasound-Detected Synovitis, in Active Rheumatoid Arthritis

Naz,

Rasheed,

Ilyas

et al. 2024

JHRR

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Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint synovitis and systemic inflammation, with joint swelling and tenderness as common clinical manifestations. Accurate assessment of disease activity is crucial for effective management and treatment planning. While ultrasound (US) has emerged as a sensitive tool for detecting synovitis, its concordance with clinical examination findings remains a subject of ongoing research. Objective: The objective of this study was to evaluate the concordance between clinical examination findings and ultrasound-detected synovitis in RA patients, with an emphasis on the diagnostic value of joint swelling and tenderness. Methods: This observational, cross-sectional study involved 40 RA patients with moderate to severe disease activity, assessed at a single center. Following ethical approval and informed consent, patients were evaluated for joint swelling, tenderness, and patient-reported symptoms. Ultrasound examinations were conducted to detect synovitis, employing gray scale (GS) and power Doppler (PD) modalities. Concordance between clinical findings and US-detected synovitis was analyzed using Cohen's kappa statistic. Disease activity was categorized using the DAS28 score, with subgroup analyses across different disease activity states. Results: Joint swelling demonstrated the highest concordance with US-detected synovitis (kappa = 0.44), while joint tenderness showed lower concordance (kappa = 0.23). Analysis across disease activity states revealed consistent concordance for joint swelling (kappa values ranging from 0.38 to 0.41), regardless of disease severity. Patient-reported symptoms and the use of specific treatments (methotrexate and biologics) were also analyzed, with 90% of patients on methotrexate and 10% on biologics. The study population was predominantly female (86%) and middle-aged (20 to 40 years: 66%). Conclusion: Our findings indicate that joint swelling is a more reliable clinical indicator of synovitis in RA patients compared to joint tenderness. This suggests that disease activity scoring systems in RA might benefit from placing greater emphasis on swelling and patient-reported symptoms. Future research should explore the integration of these parameters to enhance the accuracy and efficiency of RA management.

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Time to modify the DAS28 to make it fit for purpose(s) in rheumatoid arthritis?

Cited by 8 publications

References 20 publications

Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease

Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease

Clinical Trials Supporting the Role of the IL-17/IL-23 Axis in Axial Spondyloarthritis

The Concordance of Patient-Reported Symptoms, Physical Examination and Ultrasound-Detected Synovitis, in Active Rheumatoid Arthritis

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