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Guo J, Yang L, Song H, Bai L. Prevention of bleomycin-induced pulmonary fibrosis by vaccination with the Tocilizumab mimotope. Hum Vaccin Immunother 2024; 20:2319965. [PMID: 38408907 PMCID: PMC10900270 DOI: 10.1080/21645515.2024.2319965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
Mimotope, a kind of peptide vaccine, is developed to bind natural receptor and inhibit the downstream signaling. We have demonstrated that the vaccination of Tocilizumab mimotopes could alleviate the renal fibrosis by interfering with both IL-6 and ferroptosis signaling. However, the effect of the vaccination of Tocilizumab mimotopes on the fibroblast was not investigated in previous study. Thus, we sought to explore the changes in the fibroblast induced by the Tocilizumab mimotopes vaccination. Bleomycin instillation was performed to construct the pulmonary fibrosis model after the immunization of Tocilizumab mimotopes. Lung histological analysis showed that the Tocilizumab mimotopes could significantly reduce the maladaptive repairment and abnormal remodeling. Immunoblotting assay and fluorescence staining showed that Immunization with the Tocilizumab mimotopes reduces the accumulation of fibrosis-related proteins. High level of lipid peroxidation product was observed in the animal model, while the Tocilizumab mimotopes vaccination could reduce the generation of lipid peroxidation product. Mechanism analysis further showed that Nrf-2 signaling, but not GPX-4 and FSP-1 signaling, was upregulated, and reduced the lipid peroxidation. Our results revealed that in the BLM-induced pulmonary fibrosis, high level of lipid peroxidation product was significantly accumulation in the lung tissues, which might lead to the occurrence of ferroptosis. The IL-6 pathway block therapy could inhibit lipid peroxidation product generation in the lung tissues by upregulating the Nrf-2 signaling, and further alleviate the pulmonary fibrosis.
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Affiliation(s)
- Jin Guo
- Department of Cardiorespiratory Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lin Yang
- Department of Nephrology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Haoming Song
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Bai
- The Central Lab, The First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou, China
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Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S, Dernis E, Maheu E, Saraux A, Besson FL, Alegria GC, Cortet B, Fautrel B, Felten R, Morel J, Ottaviani S, Querellou-Lefranc S, Ramon A, Ruyssen-Witrand A, Seror R, Tournadre A, Foulquier N, Verlhac B, Verhoeven F, Devauchelle-Pensec V. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint Bone Spine 2024; 91:105730. [PMID: 38583691 DOI: 10.1016/j.jbspin.2024.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR). METHODS Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts. RESULTS Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and five to the assessment of the disease, its activity and comorbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, five concern the reduction of corticosteroid therapy and follow-up, and two concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6). CONCLUSION These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR.
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Affiliation(s)
- Daniel Wendling
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France.
| | - Omar Al Tabaa
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France; Rhumatologie, Hôpital NOVO, Pontoise, France
| | - Baptiste Chevet
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Olivier Fakih
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Roba Ghossan
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France
| | | | | | - Emmanuel Maheu
- Service de rhumatologie, Hôpital St Antoine, AP-HP, et cabinet médical, Paris, France
| | - Alain Saraux
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Florent L Besson
- Service de médecine nucléaire-imagerie moléculaire, Hôpitaux universitaires Paris-Saclay AP-HP, CHU Bicêtre, DMU SMART IMAGING, Le Kremlin-Bicêtre, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, 59037 Lille, France
| | - Bruno Fautrel
- Service de rhumatologie, GH Pitié Salpêtrière, AP-HP.Sorbonne Université, INSERM UMRS 1136-5, Réseau de recherche clinique CRI-IMIDIATE, 75013 Paris, France
| | - Renaud Felten
- Service de rhumatologie et centre d'investigation clinique 1434, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jacques Morel
- Service de rhumatologie. CHU et Université de Montpellier, Montpellier, France
| | | | - Solène Querellou-Lefranc
- Nuclear Medicine department, University Hospital, Brest, France, University of Western Brittany (UBO), Brest, France, Inserm, University of Brest, CHRU Brest, UMR 1304, GETBO, Brest cedex, France
| | - André Ramon
- Service de rhumatologie, CHU Dijon Bourgogne, Dijon, France
| | - Adeline Ruyssen-Witrand
- Centre de rhumatologie, CHU de Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Raphaèle Seror
- Service de rhumatologie, CHU Kremlin-Bicetre, AP-HP, Paris, France
| | - Anne Tournadre
- Rhumatologie CHU Clermont-Ferrand, Université Clermont Auvergne INRAe, Clermont-Ferrand, France
| | - Nathan Foulquier
- LBAI, UMR1227, University of Brest, Inserm, CHU de Brest, Brest, France
| | | | - Frank Verhoeven
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France.
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3
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Allard B, Devauchelle-Pensec V, Saraux A, Nowak E, Tison A, Boukhlal S, Guellec D, Jousse-Joulin S, Cornec D, Marhadour T, Le Pennec R, Salaün PY, Querellou S. [ 18F]FDG PET/CT for therapeutic assessment of Abatacept in early-onset polymyalgia rheumatica. Eur J Nucl Med Mol Imaging 2024; 51:1297-1309. [PMID: 38095675 DOI: 10.1007/s00259-023-06557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE Evaluate the benefit of 2-deoxy-2-[18F]-fluoro-D-glucose ([18F] FDG) positron emission tomography/computed tomography (PET/CT) for the therapeutic assessment of Abatacept (ABA) as first-line therapy in early-onset polymyalgia rheumatica (PMR) patients. METHODS This was an ancillary study of ALORS trial (Abatacept in earLy Onset polymyalgia Rheumatica Study) assessing the ability of ABA versus placebo to achieve low disease activity (C-Reactive Protein PMR activity score (CRP PMR-AS) ≤ to 10) without glucocorticoid (GC) at week 12 in patients with early-onset PMR. The patients underwent [18F] FDG PET/CT at baseline and after 12 weeks of treatment. Responses to treatments were evaluated according to CRP PMR-AS, Erythrocyte Sedimentation Rate (ESR) PMR-AS, Clin PMR-AS, and CRP-Imputed (Imput-CRP) PMR-AS. Quantitative score by maximal standardized uptake value (SUVmax) and combined qualitative scores according to liver uptake (Leuven, Leuven/Groningen, and Besançon Scores) were used for assessment of [18F] FDG uptake in regions of interest (ROI) usually affected in PMR. Student's t-test was applied to evaluate the clinical, biological, and [18F] FDG uptake variation difference in ABA and placebo groups between W0 and W12. Subgroup analysis by GC rescue was performed. RESULTS At W12, there was no significant difference according to SUVmax between the ABA and the placebo groups in all ROI. Subgroup analysis according to GC administration demonstrated a significant (p 0.047) decrease in SUVmax within the left sternoclavicular joint ROI in the ABA group (- 0.8) compared to the placebo group (+ 0.6) without GC rescue. Other results did not reveal any significant difference between the ABA and placebo groups. According to combined qualitative scores, there was no significant difference between ABA and placebo groups for the direct comparison analysis and subgroup analysis according to GC rescue. CONCLUSION [18F] FDG PET/CT uptake did not decrease significantly after ABA compared to placebo in anatomical areas usually affected in PMR patients. These results are correlated with the clinical-biological therapeutic assessment. CLINICAL TRIAL REGISTRATION The study was approved by the appropriate ethics committee (CPP Sud-Est II Ref CPP: 2018-33), and all patients gave their written informed consent before study enrollment. The protocol was registered on Clinicaltrials.gov (NCT03632187).
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Affiliation(s)
- Bastien Allard
- Nuclear Medicine Department, University Hospital, Brest, France
- University of Western Brittany (UBO), Brest, France
| | - Valérie Devauchelle-Pensec
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Alain Saraux
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Emmanuel Nowak
- Clinical Research and Innovation Department (DRCI), INSERM CIC 0502, Brest University Hospital, Brest, France
| | - Alice Tison
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Sara Boukhlal
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Dewi Guellec
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Sandrine Jousse-Joulin
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Divi Cornec
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Thierry Marhadour
- University of Western Brittany (UBO), Brest, France
- Department of Rheumatology, Brest University Hospital, Brest, France
- INSERM (U1227), LabEx IGO, Brest University, Brest, France
| | - Romain Le Pennec
- Nuclear Medicine Department, University Hospital, Brest, France
- University of Western Brittany (UBO), Brest, France
- UMR 1304, Inserm, Univ Brest, CHRU, GETBO, Brest Cedex, France
| | - Pierre-Yves Salaün
- Nuclear Medicine Department, University Hospital, Brest, France
- University of Western Brittany (UBO), Brest, France
- UMR 1304, Inserm, Univ Brest, CHRU, GETBO, Brest Cedex, France
| | - Solène Querellou
- Nuclear Medicine Department, University Hospital, Brest, France.
- University of Western Brittany (UBO), Brest, France.
- UMR 1304, Inserm, Univ Brest, CHRU, GETBO, Brest Cedex, France.
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D'Agostino J, Souki A, Lohse A, Carvajal Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel B, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A, Devauchelle-Pensec V. Concordance and agreement between different activity scores in polymyalgia rheumatica. RMD Open 2024; 10:e003741. [PMID: 38490696 PMCID: PMC10946364 DOI: 10.1136/rmdopen-2023-003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs. METHOD Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots. RESULTS A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time. CONCLUSION The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used. TRIAL REGISTRATION NUMBER NTC02908217.
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Affiliation(s)
- Justine D'Agostino
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Aghiles Souki
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Anne Lohse
- Hopital Nord Franche-Comte-Site de Belfort, Belfort, France
| | | | - Emanuelle Dernis
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | - Christophe Richez
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
- UMR CNRS 5164, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Daniel Wendling
- Rheumatology and EA4266 Franche-Comté University, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Eric Toussirot
- INSERM Clinical Investigation Center 1431, Centre Hospitalier Universitaire de Besancon, Besancon, France
- Department of Rheumatology, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Bruno Fautrel
- Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM UMR-S 1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, France
| | - Laurent Chiche
- Internal Medicine, Marseille Public University Hospital System, Marseille, France
| | - Pascal Hilliquin
- Department of Rhumatology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Catherine Le Henaff
- Department of Rheumatology, Pays de Morlaix Hospital Centre, Morlaix, France
| | - Benjamin Dervieux
- Department of Rhuamtology, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Guillaume Direz
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Divi Cornec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Dewi Guellec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM Clinical Investigations Centre 1412, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Thierry Marhadour
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
- Centre Hospitalier Universitaire de Brest, Brest, INSERM Clinical Investigations Centre (CIC) 1412, France
| | - Alain Saraux
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
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Nageswaran P, Ahmed S, Tahir H. Review of phase 2/3 trials in polymyalgia rheumatica and giant cell arteritis. Expert Opin Emerg Drugs 2024; 29:5-17. [PMID: 38180809 DOI: 10.1080/14728214.2024.2303093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024]
Abstract
INTRODUCTION GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) are two overlapping inflammatory rheumatic conditions that are seen exclusively in older adults, sharing some common features. GCA is a clinical syndrome characterized by inflammation of the medium and large arteries, with both cranial and extracranial symptoms. PMR is a clinical syndrome characterized by stiffness in the neck, shoulder, and pelvic girdle muscles. Both are associated with constitutional symptoms. AREAS COVERED In this review, we assess the established and upcoming treatments for GCA and PMR. We review the current treatment landscape, completed trials, and upcoming trials in these conditions, to identify new and promising therapies. EXPERT OPINION Early use of glucocorticoids (GC) remains integral to the immediate management of PMR and GCA but being aware of patient co-morbidities that may influence treatment toxicity is paramount. As such GC sparing agents are required in the treatment of PMR. Currently there are limited treatment options available for PMR and GCA, and significant unmet needs remain. Newer mechanisms of action, and hence therapeutic options being studied include CD4 T cell co-stimulation blockade, IL-17 inhibition, IL-12/23 inhibition, GM-CSF inhibition, IL-1β inhibition, TNF-α antagonist and Jak inhibition, among others, which will be discussed in this review.
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Affiliation(s)
| | - Saad Ahmed
- Department of Rheumatology, East Suffolk and North Essex Foundation Trust, Colchester, UK
| | - Hasan Tahir
- Department of Rheumatology, Royal Free London NHS Trust, London, UK
- Department of Medicine, University College London, London, UK
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6
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Liew DF, Owen CE. Designing studies in newly diagnosed versus established polymyalgia rheumatica. THE LANCET. RHEUMATOLOGY 2023; 5:e701-e703. [PMID: 38251558 DOI: 10.1016/s2665-9913(23)00294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024]
Affiliation(s)
- David Fl Liew
- Department of Rheumatology, Austin Health, Melbourne, VIC 3081, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC 3081, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Melbourne, VIC 3081, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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7
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Keller KK, Mukhtyar CB, Nielsen AW, Hemmig AK, Mackie SL, Sattui SE, Hauge EM, Dua A, Helliwell T, Neill L, Blockmans D, Devauchelle-Pensec V, Hayes E, Venneboer AJ, Monti S, Ponte C, De Miguel E, Matza M, Warrington KJ, Byram K, Yaseen K, Peoples C, Putman M, Lally L, Finikiotis M, Appenzeller S, Caramori U, Toro-Gutiérrez CE, Backhouse E, Oviedo MCG, Pimentel-Quiroz VR, Keen HI, Owen CE, Daikeler T, de Thurah A, Schmidt WA, Brouwer E, Dejaco C. Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Ann Rheum Dis 2023:ard-2023-225134. [PMID: 38050004 DOI: 10.1136/ard-2023-225134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). METHODS A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated. RESULTS Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. CONCLUSIONS These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.
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Affiliation(s)
- Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sebastian Eduardo Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Anisha Dua
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Toby Helliwell
- School of Medicine, University of Staffordshire, Stafford, UK
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Dundee, UK
| | - Daniel Blockmans
- Clinical Department of General Internal Medicine Department, Research Department of Microbiology and Immunology, Laboratory of Clinical Infectious and Inflammatory Disorders, University Hospitals Leuven, Leuven, Belgium
- Universitaire Ziekenhuis Gasthuisberg, Leuven, Belgium
| | | | - Eric Hayes
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Jansen Venneboer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sara Monti
- Rheumatology, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Cristina Ponte
- Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | | | - Mark Matza
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kevin Byram
- Vanderbilt Rheumatology, Vanderbilt Health, Nashville, Tennessee, USA
| | - Kinanah Yaseen
- Orthopedic and Rheumatologic Insitute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine Peoples
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Putman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Lally
- Hospital for Special Surgery, New York, New York, USA
| | - Michael Finikiotis
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Simone Appenzeller
- Departamento de Clínica Médica, Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Ugo Caramori
- Department of Public Health, State University of Campinas, Campinas, Brazil
| | - Carlos Enrique Toro-Gutiérrez
- Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia
| | | | | | | | | | - Claire Elizabeth Owen
- Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Daikeler
- Clinic for Rheumatology, University Hospital, Basel, Switzerland
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christian Dejaco
- Rheumatology, Brunico Hospital, Brunico, Italy
- Rheumatology, Medical University of Graz, Graz, Austria
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8
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Florescu MM, Bobircă F, Florescu A, Pădureanu V, Bobircă A, Ciurea PL, Criveanu C, Florescu LM, Muşetescu AE. Polymyalgia rheumatica: An update (Review). Exp Ther Med 2023; 26:543. [PMID: 37928511 PMCID: PMC10623218 DOI: 10.3892/etm.2023.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023] Open
Abstract
Polymyalgia rheumatica (PMR) is a chronic inflammatory disease which affects the connective vascular tissue, characterized by pain accompanied by morning stiffness, predominantly of the neck muscles, hip and shoulder girdle. Usually, patients with this disease are >50 years of age and biological inflammatory syndrome is present with an increase in both the erythrocyte sedimentation rate and C-reactive protein levels, aspects similar to giant cell arteritis. The aim of the present review was to depict the current pathogenic hypothesis, diagnostic and treatment approach for patients with PMR, and novelties since the development of the currently used 2012 European League Against Rheumatism and American College of Rheumatology provisional classification criteria. PMR is a prevalent disease that can occasionally prove difficult to diagnose and treat. Possibly, the most abundant type of evidence and data revealed over the past decade have been acquired through musculoskeletal imaging, with implications in diagnosis, disease monitoring and relapse, prognosis and changes with treatment. Further research on pathophysiology is required to gain a deeper understanding of the underlying processes, which will serve as the foundation for future personalized treatments. In addition, there is an increasing demand for improved diagnostic techniques, which should include a further development of various imaging modalities, in order to provide accurate diagnosis and appropriate therapy.
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Affiliation(s)
- Mirela Marinela Florescu
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Florin Bobircă
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Dr I. Cantacuzino Clinical Hospital, 050474 Bucharest, Romania
| | - Alesandra Florescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Bobircă
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Paulina Lucia Ciurea
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cristina Criveanu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lucian Mihai Florescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Emanuela Muşetescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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9
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Saraux A, Le Henaff C, Dernis E, Carvajal-Alegria G, Tison A, Quere B, Petit H, Felten R, Jousse-Joulin S, Guellec D, Marhadour T, Kervarrec P, Cornec D, Querellou S, Nowak E, Souki A, Devauchelle-Pensec V. Abatacept in early polymyalgia rheumatica (ALORS): a proof-of-concept, randomised, placebo-controlled, parallel-group trial. THE LANCET. RHEUMATOLOGY 2023; 5:e728-e735. [PMID: 38251563 DOI: 10.1016/s2665-9913(23)00246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Medium-dose glucocorticoids can improve symptoms in nearly all patients with polymyalgia rheumatica. According to its good safety profile, abatacept could be used instead of glucocorticoids in early polymyalgia rheumatica. We aimed to determine whether the efficacy of abatacept is sufficient to justify larger studies in early polymyalgia rheumatica. METHODS To evaluate whether abatacept allows low disease activity without glucocorticoids in early polymyalgia rheumatica, we conducted a proof-of-concept, randomised, double-blind, placebo-controlled, parallel-group trial. Participants were recruited from five centres in France (in Brest, Le Mans, Morlaix, Dinan and Saint Malo, and Strasbourg) and were included if they had recent-onset (<6 months) polymyalgia rheumatica with a C-reactive protein (CRP) polymyalgia rheumatica activity score (PMR-AS) of more than 17 without any signs or symptoms of giant cell arteritis (clinical and [18F]fluorodeoxyglucose PET-CT evaluation). Participants were randomly assigned (1:1) to receive weekly subcutaneous abatacept (125 mg) or matching placebo, with glucocorticoid rescue therapy allowed in cases of high disease activity, for 12 weeks, and then glucocorticoid treatment based on disease activity, until week 36. Investigators, patients, outcome assessors, and sponsor personnel were masked to group assignments. The primary endpoint was low disease activity (CRP PMR-AS ≤10) at week 12 without glucocorticoids and without rescue treatment. The study was powered to demonstrate a 60% difference in response rates between groups. Open-ended adverse events were collected at each visit by clinicians and were categorised following system organ class classification after study completion. The ALORS trial is registered with ClinicalTrials.gov, NCT03632187. FINDINGS 34 patients (22 women and 12 men) were randomly assigned between Dec 13, 2018, and Oct 21, 2021. All patients who had been randomly assigned were included in the analysis. The primary endpoint was reached by eight (50%) of 16 patients in the abatacept group and four (22%) of 18 patients in the placebo group (relative risk 2·2 [0·9-5·5]); crude p=0·15; adjusted p=0·070). Eight (50%) patients in the abatacept and 15 (83%) in the placebo group had adverse events. Four patients (one [6%] in the abatacept group and three [17%] in the placebo group) had serious adverse events. There were no deaths or new safety concerns. INTERPRETATION This study suggests that the effect of abatacept alone is not strong enough to justify larger studies in early polymyalgia rheumatica. This is only a first step in deciding whether a larger study should be conducted in early polymyalgia rheumatica and does not exclude a potential effect of abatacept in glucocorticoid-dependent polymyalgia rheumatica. FUNDING BMS Pharma France.
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Affiliation(s)
- Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, Brest, France; Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France.
| | | | | | | | - Alice Tison
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Baptiste Quere
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Hélène Petit
- Service de rhumatologie, Groupement Hospitalier Rance Emeraude, CH de Dinan, Dinan, France
| | - Renaud Felten
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sandrine Jousse-Joulin
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Dewi Guellec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Thierry Marhadour
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Patrice Kervarrec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Divi Cornec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Solene Querellou
- Department of Nuclear Medicine, Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM, GETBO, Brest, France
| | - Emmanuel Nowak
- Clinical Research and Innovation Department (DRCI), INSERM, CHU Brest, Brest, France; Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
| | - Aghiles Souki
- Clinical Research and Innovation Department (DRCI), INSERM, CHU Brest, Brest, France; Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
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10
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Espígol-Frigolé G, Dejaco C, Mackie SL, Salvarani C, Matteson EL, Cid MC. Polymyalgia rheumatica. Lancet 2023; 402:1459-1472. [PMID: 37832573 DOI: 10.1016/s0140-6736(23)01310-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 10/15/2023]
Abstract
Polymyalgia rheumatica is an inflammatory disease producing pain and stiffness, mainly in the shoulders and pelvic girdle, in people older than 50 years. Elevation of acute phase reactants is common due to the inflammatory nature of the disease. Since there are no specific diagnostic tests, diagnosis requires the exclusion of other diseases with similar presentations. Imaging has helped to identify the pathological substrate of polymyalgia rheumatica and it is increasingly used to support clinical diagnosis or to detect coexistent giant cell arteritis. Although polymyalgia rheumatica does not clearly impair survival or organ function, it can have a detrimental effect on quality of life. Glucocorticoids at 12·5-25·0 mg prednisone per day are effective in inducing remission in most individuals but, when tapered, relapses occur in 40-60% of those affected and side-effects are common. Assessment of disease activity can be difficult because pain related to common comorbidities such as osteoarthritis and tendinopathies, can return when glucocorticoids are reduced, and acute phase reactants are increased less during flares in individuals undergoing treatment or might increase for other reasons. The role of imaging in assessing disease activity is not yet completely defined. In the search for more efficient and safer therapies, tocilizumab and sarilumab have shown efficacy in randomised controlled trials and additional targeted therapies are emerging. However, judicious risk-benefit balance is essential in applying therapeutic innovations to people with polymyalgia rheumatica.
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Affiliation(s)
- Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria; Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Brunico, Italy
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Carlo Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera-Universitaria di Modena, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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11
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Spiera RF, Unizony S, Warrington KJ, Sloane J, Giannelou A, Nivens MC, Akinlade B, Wong W, Bhore R, Lin Y, Buttgereit F, Devauchelle-Pensec V, Rubbert-Roth A, Yancopoulos GD, Marrache F, Patel N, Dasgupta B. Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper. N Engl J Med 2023; 389:1263-1272. [PMID: 37792612 DOI: 10.1056/nejmoa2303452] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND More than half of patients with polymyalgia rheumatica have a relapse during tapering of glucocorticoid therapy. Previous studies have suggested that interleukin-6 blockade may be clinically useful in the treatment of polymyalgia rheumatica. Sarilumab, a human monoclonal antibody, binds interleukin-6 receptor α and efficiently blocks the interleukin-6 pathway. METHODS In this phase 3 trial, we randomly assigned patients in a 1:1 ratio to receive 52 weeks of a twice-monthly subcutaneous injection of either sarilumab (at a dose of 200 mg) plus a 14-week prednisone taper or placebo plus a 52-week prednisone taper. The primary outcome at 52 weeks was sustained remission, which was defined as the resolution of signs and symptoms of polymyalgia rheumatica by week 12 and sustained normalization of the C-reactive protein level, absence of disease flare, and adherence to the prednisone taper from weeks 12 through 52. RESULTS A total of 118 patients underwent randomization (60 to receive sarilumab and 58 to receive placebo). At week 52, sustained remission occurred in 28% (17 of 60 patients) in the sarilumab group and in 10% (6 of 58 patients) in the placebo group (difference, 18 percentage points; 95% confidence interval, 4 to 32; P = 0.02). The median cumulative glucocorticoid dose at 52 weeks was significantly lower in the sarilumab group than in the placebo group (777 mg vs. 2044 mg; P<0.001). The most common adverse events with sarilumab as compared with placebo were neutropenia (15% vs. 0%), arthralgia (15% vs. 5%), and diarrhea (12% vs. 2%). More treatment-related discontinuations were observed in the sarilumab group than in the placebo group (12% vs. 7%). CONCLUSIONS Sarilumab showed significant efficacy in achieving sustained remission and reducing the cumulative glucocorticoid dose in patients with a relapse of polymyalgia rheumatica during glucocorticoid tapering. (Funded by Sanofi and Regeneron Pharmaceuticals; SAPHYR ClinicalTrials.gov number, NCT03600818.).
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Affiliation(s)
- Robert F Spiera
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Sebastian Unizony
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Kenneth J Warrington
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Jennifer Sloane
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Angeliki Giannelou
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Michael C Nivens
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bolanle Akinlade
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Wanling Wong
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Rafia Bhore
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Yong Lin
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frank Buttgereit
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Valerie Devauchelle-Pensec
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Andrea Rubbert-Roth
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - George D Yancopoulos
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Frederic Marrache
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Naimish Patel
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
| | - Bhaskar Dasgupta
- From the Hospital for Special Surgery, Weill Cornell Medical College, New York (R.F.S.), and Regeneron Pharmaceuticals, Tarrytown (A.G., M.C.N., B.A., R.B., G.D.Y.) - both in New York; the Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston (S.U.), and Sanofi, Cambridge (J.S., N.P.) - both in Massachusetts; the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN (K.J.W.); Sanofi, Bridgewater, NJ (W.W., Y.L.); the Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin (F.B.); CHRU de Brest, Service de Rhumatologie, Brest (V.D.-P.), and Sanofi, Chilly-Mazarin (F.M.) - both in France; the Division of Rheumatology and Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (A.R.-R.); and Anglia Ruskin University, Cambridge, United Kingdom (B.D.)
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12
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Gu J, Yang M, Zhang B, Wang H. Efficacy of JAK Inhibitors versus DMARDs in the Treatment of Polymyalgia Rheumatica in China. Int J Gen Med 2023; 16:2981-2986. [PMID: 37465555 PMCID: PMC10350461 DOI: 10.2147/ijgm.s414267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/24/2023] [Indexed: 07/20/2023] Open
Abstract
Objective This retrospective analysis was to assess the role of Janus kinases (JAK) inhibitors compared with conventional disease modifying anti-rheumatic drugs (DMRADs) in the treatment of polymyalgia rheumatica (PMR) with glucocorticoids (GCs) reduction. Methods Clinical information was collected from PMR patients in the JAK inhibitor group and the DMARDs group from January 2020 to August 2021 at Jiaxing first Hospital. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), albumin and dose of GCs before and after treatment were compared between two groups. Results Thirty female patients with PMR were included into this study. The dose of GCs in the JAK inhibitor group was significantly lower than in the DMARDs group at baseline and at 3 and 6 months after treatment. There were no significant differences in various laboratory parameters (including CRP, ESR, Hb and albumin) between two groups (P > 0.05) except that Hb in the DMARDs group was significantly higher than in the JAK inhibitor group at 3 and 6 months after treatment (P<0.05). One patient in the JAK inhibitor group developed herpes zoster, and received tofacitinib treatment after herpes zoster was relieved. Conclusion Our study indicates that JAK inhibitors in the treatment of PMR are as effective as DMRADs and are also helpful for the reduction of GCs dose.
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Affiliation(s)
- Juanfang Gu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, 314300, People’s Republic of China
- Jiaxing Key Laboratory of Osteoporosis and Bone Metabolism, Jiaxing, Zhejiang, 314300, People’s Republic of China
| | - Mingfeng Yang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, 314300, People’s Republic of China
- Jiaxing Key Laboratory of Osteoporosis and Bone Metabolism, Jiaxing, Zhejiang, 314300, People’s Republic of China
| | - Bin Zhang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, 314300, People’s Republic of China
- Jiaxing Key Laboratory of Osteoporosis and Bone Metabolism, Jiaxing, Zhejiang, 314300, People’s Republic of China
| | - Hongzhi Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, 314300, People’s Republic of China
- Jiaxing Key Laboratory of Osteoporosis and Bone Metabolism, Jiaxing, Zhejiang, 314300, People’s Republic of China
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13
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Wendling D. Biological therapy in polymyalgia rheumatica. Expert Opin Biol Ther 2023; 23:1255-1263. [PMID: 37994867 DOI: 10.1080/14712598.2023.2287097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of the elderly, treated mainly with systemic corticosteroids. The frequency of side effects of steroids is high in this aged population and increased due to comorbidities. The use of biological treatments could be of interest in this condition. AREAS COVERED This review takes into account literature data from the PubMed and clinical trial databases concerning the results of the use of biological treatments in PMR, in terms of efficacy and safety of these treatments. EXPERT OPINION Current data do not allow us to identify any particular efficacy of the various anti-TNF agents used in the treatment of PMR. Anti-interleukin 6 agents (tocilizumab, sarilumab) have shown consistent efficacy results, suggesting a particularly interesting steroid-sparing effect in the population under consideration. The safety profile appears acceptable. Other biologic targeted treatments are currently being evaluated. Anti-interleukin-6 agents may well have a place in the therapeutic strategy for PMR, particularly for patients with steroid-resistant disease or at high risk of complications of corticosteroid therapy.
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Affiliation(s)
- Daniel Wendling
- Rheumatology, CHU (University Teaching Hospital), Besançon, France
- EA4266 EPILAB, Université de Franche-Comté, Besançon, France
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14
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Ricordi C, Pipitone N, Marvisi C, Muratore F, Salvarani C. Steroid-sparing agents in polymyalgia rheumatica: how will they fit into the treatment paradigm? Expert Rev Clin Immunol 2023; 19:1195-1203. [PMID: 37480289 DOI: 10.1080/1744666x.2023.2240519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Polymyalgia rheumatica is a common inflammatory rheumatic disease in subjects aged 50 years or older and classically presents with shoulder and/or pelvic girdle pain and prolonged morning stiffness. Glucocorticoids represent the standard of treatment; glucocorticoid therapy is usually required for 1-2 years and often results in significant glucocorticoid-related side effects, especially in the elderly. AREAS COVERED In this review, we aimed to provide a comprehensive overview of the management of polymyalgia rheumatica, with a particular focus on adjunctive therapies to the standard glucocorticoid treatment. EXPERT OPINION Given the high frequency of disease relapses (one-third of patients) and the adverse events related to prolonged glucocorticoid use, the need for glucocorticoid-sparing agents remains an important issue in the management of polymyalgia rheumatica. In selected patients, who are at risk for glucocorticoid-related side effects or in those with glucocorticoid-refractory disease, the addition of a glucocorticoid-sparing agent, either a synthetic or biologic disease-modifying anti-rheumatic drug, may represent a reasonable and effective therapeutic approach.
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Affiliation(s)
- Caterina Ricordi
- Rheumatology Unit, Department of Medical Specialty, Azienda USL, Istituto di Ricovero E Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Università di Modena E Reggio Emilia, Modena, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Department of Medical Specialty, Azienda USL, Istituto di Ricovero E Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Department of Medical Specialty, Azienda USL, Istituto di Ricovero E Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Università di Modena E Reggio Emilia, Modena, Italy
| | - Francesco Muratore
- Rheumatology Unit, Department of Medical Specialty, Azienda USL, Istituto di Ricovero E Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Università di Modena E Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Medical Specialty, Azienda USL, Istituto di Ricovero E Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Università di Modena E Reggio Emilia, Modena, Italy
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15
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Reisch M, Dejaco C. [Methods for assessment of disease activity of polymyalgia rheumatica]. Z Rheumatol 2023:10.1007/s00393-023-01358-x. [PMID: 37184675 DOI: 10.1007/s00393-023-01358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/16/2023]
Abstract
Polymyalgia rheumatica (PMR) is the second most frequent inflammatory rheumatic disease in old age. Remission and recurrence are frequently used as endpoints in clinical trials; however, there is as yet no international consensus on the definition of these states, which limits the comparability of published studies. The PMR activity score (PMR-AS) is the only composite score specifically developed for PMR, which together with remission is used to define low, middle and high disease activity. In recent studies the PMR-AS was often used and low disease activity was established as endpoint. The most important limitation of the PMR-AS is the potential influence of the individual variables by comorbidities. The value of C‑reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) are of restricted value in studies using drugs that influence the interleukin 6 (IL-6) axis. In these cases, calprotectin and osteopontin are promising alternative biomarkers, as they have already been shown to reflect disease activity independently of CRP in rheumatoid arthritis. Furthermore, imaging modalities including sonography, magnetic resonance imaging and fluorodeoxyglucose (FDG) positron emission tomography could also be helpful in monitoring disease activity; however, these techniques must first be validated in further studies. The PMR impact scale (PMR-IS) is a composite score to assess the impact of PMR on the patients; however, it has not yet been used in clinical studies. The development of additional patient reported outcomes (PRO) for PMR and the definition of standardized criteria for documentation of remission and recurrence are important questions in the future research agenda for PMR.
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Affiliation(s)
- Myriam Reisch
- Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Graz, Österreich
| | - Christian Dejaco
- Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Graz, Österreich.
- Rheumatologie, Krankenhaus Bruneck, Südtiroler Sanitätsbetrieb: Azienda Sanitaria dell'Alto Adige, Spitalstr. 11, 39031, Bruneck (BZ), Italien.
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16
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Desvages A, Hives F, Deprez X, Pierache A, Béhal H, Flipo RM, Paccou J. Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in Diagnosing Polymyalgia Rheumatica and Large-Vessel Vasculitis: A Case-Control Study. J Clin Med 2023; 12:jcm12082844. [PMID: 37109181 PMCID: PMC10141365 DOI: 10.3390/jcm12082844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION We aimed to evaluate the utility of FDG-PET/CT in diagnosing polymyalgia rheumatica (PMR) and associated large-vessel vasculitis (LVV). METHODS We analyzed FDG-PET/CT completed between 2015 and 2019 on patients diagnosed with PMR. For comparisons, patients with PMR were matched 1:1 to controls based on age and gender. FDG-PET/CT had been completed on the controls over the same period. The FDG uptake was scored visually for 17 articular or periarticular sites and 13 vascular sites using a semi-quantitative scoring system (score of 0-3). RESULTS Eighty-one patients with PMR and eighty-one controls were included (mean age 70.7 (9.8) years; 44.4% women). Significant differences between the PMR and control groups were found at all articular and periarticular sites for the following: (i) the FDG uptake score (p < 0.001 for all locations); (ii) the number of patients per site with significant FDG uptake (score ≥ 2); (iii) the global FDG articular uptake scores (31 [IQR, 21 to 37] versus 6 [IQR, 3 to 10], p < 0.001); and (iv) the number of sites with significant FDG uptake (score ≥ 2) (scores of 0-17) (11 [IQR, 7 to 13] versus 1 [IQR, 0 to 2], p < 0.001). No significant differences in the global FDG vascular uptake scores were found between the patients who were considered isolated PMR and the control groups. CONCLUSIONS The FDG uptake score and the number of sites with significant FDG uptake could be pertinent criteria for the diagnosis of PMR. Unlike others, we did not confirm the presence of vascular involvement in patients with isolated PMR.
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Affiliation(s)
- Anne Desvages
- Department of Rheumatology, Lille University Hospital, University of Lille, CHU Lille, 59000 Lille, France
| | - Florent Hives
- Department of Nuclear Medicine, Lille University Hospital, University of Lille, CHU Lille, 59000 Lille, France
| | - Xavier Deprez
- Department of Rheumatology, Valenciennes Hospital, 59300 Valenciennes, France
| | - Adeline Pierache
- METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, CHU Lille, ULR 2694, 59000 Lille, France
| | - Hélène Béhal
- METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, CHU Lille, ULR 2694, 59000 Lille, France
| | - René-Marc Flipo
- Department of Rheumatology, Lille University Hospital, University of Lille, CHU Lille, 59000 Lille, France
| | - Julien Paccou
- Department of Rheumatology, Lille University Hospital, University of Lille, CHU Lille, 59000 Lille, France
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17
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Unmet need in the treatment of polymyalgia rheumatica and giant cell arteritis. Best Pract Res Clin Rheumatol 2023; 36:101822. [PMID: 36907732 DOI: 10.1016/j.berh.2023.101822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
For decades, aside from prednisone and the occasional use of immune suppressive drugs such as methotrexate, there was little to offer patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). However, there is a great interest in various steroid sparing treatments in both these conditions. This paper aims to provide an overview of our current knowledge of PMR and GCA, examining their similarities and distinctions in terms of clinical presentation, diagnosis, and treatment, with emphasis placed on reviewing recent and ongoing research efforts on emerging treatment. Multiple recent and ongoing clinical trials are demonstrating new therapeutics that will provide benefit and contribute to the evolution of clinical guidelines and standard of care for patients with GCA and/or PMR.
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18
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Wu J, Yang F, Ma X, Lin J, Chen W. Elderly-onset rheumatoid arthritis vs. polymyalgia rheumatica: Differences in pathogenesis. Front Med (Lausanne) 2023; 9:1083879. [PMID: 36714116 PMCID: PMC9879490 DOI: 10.3389/fmed.2022.1083879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Rheumatoid arthritis is a chronic autoimmune disease that mainly affects the facet joints. Elderly-onset rheumatoid arthritis appears to exhibit symptoms similar to those of polymyalgia rheumatica, characterized by morning stiffness and pain in the shoulder and hip joints. Both diseases develop in the elderly, and it is sometimes challenging to distinguish them. Here, we identify the differences in pathogenesis between elderly-onset rheumatoid arthritis and polymyalgia rheumatica to assist with a clear differential diagnosis and effective early intervention.
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19
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Zhang L, Li J, Yin H, Chen D, Li Y, Gu L, Fu Y, Chen J, Chen Z, Yang S, Ye S, Li T, Lu L. Efficacy and safety of tofacitinib in patients with polymyalgia rheumatica: a phase 2 study. Ann Rheum Dis 2023; 82:722-724. [PMID: 36604153 PMCID: PMC10176389 DOI: 10.1136/ard-2022-223562] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Le Zhang
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Li
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanlin Yin
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dandan Chen
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Li
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liyang Gu
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yakai Fu
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Chen
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoying Yang
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Ye
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Li
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Walz K, Elliott L, Pearson T. Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica. J Am Assoc Nurse Pract 2022; 34:1263-1270. [PMID: 35944226 DOI: 10.1097/jxx.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities. OBJECTIVES This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR. DATA SOURCES An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed. CONCLUSIONS Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted. IMPLICATIONS FOR PRACTICE Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.
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Affiliation(s)
- Kirsten Walz
- MS(N) Family Nurse Practitioner Program, School of Nursing, Western Carolina University, Asheville, NC
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21
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Pean De Ponfilly – Sotier M, Seror R, Nocturne G, Besson FL. 18F-FDG PET molecular imaging: A relevant tool to investigate chronic inflammatory rheumatisms in clinical practice? Front Med (Lausanne) 2022; 9:1070445. [PMID: 36530882 PMCID: PMC9748427 DOI: 10.3389/fmed.2022.1070445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2023] Open
Abstract
18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography (18F-FDG PET) is a molecular imaging tool commonly used in practice for the assessment of many cancers. Thanks to its properties, its use has been progressively extended to numerous inflammatory conditions, including chronic inflammatory rheumatism (CIR) such as rheumatoid arthritis (RA), spondylarthritis (SpAs) and polymyalgia rheumatica (PMR). 18F-FDG PET is currently not recommended for the diagnostic of CIRs. However, this whole-body imaging tool has emerged in clinical practice, providing a general overview of systemic involvement occurring in CIRs. Numerous studies have highlighted the capacity of 18F-FDG PET to detect articular and extra articular involvements in RA and PMR. However, the lack of specificity of 18F-FDG limits its use for diagnosis purpose. Finally, the key question is the definition of the best way to integrate this whole-body imaging tool in the patient's management workflow.
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Affiliation(s)
| | - Raphaële Seror
- Rheumatology, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, INSERM, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-immunes, Le Kremlin-Bicêtre, France
| | - Gaetane Nocturne
- Rheumatology, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, INSERM, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-immunes, Le Kremlin-Bicêtre, France
| | - Florent L. Besson
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Biophysics and Nuclear Medicine-Molecular Imaging, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
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Boukhlal S, Felten R, Gervais E, Grardel B, Le Cam Y, Gottenberg JE, Saraux A, Devauchelle-Pensec V. Polymyalgia rheumatica associated with primary Sjögren's syndrome: A French multicentric retrospective study. Joint Bone Spine 2022; 89:105447. [PMID: 35940546 DOI: 10.1016/j.jbspin.2022.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Sara Boukhlal
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France.
| | - Renaud Felten
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France; Laboratoire d'Immunopathologie et de chimie thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, Strasbourg, France
| | | | | | - Yoann Le Cam
- Service de rhumatologie, CHU de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France; Laboratoire d'Immunopathologie et de chimie thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, Strasbourg, France
| | - Alain Saraux
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France; Université de Brest, Lymphocytes B et Autoimmunité (LBAI), Inserm UMR1227, LabEx IGO, Brest, France
| | - Valérie Devauchelle-Pensec
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France; Université de Brest, Lymphocytes B et Autoimmunité (LBAI), Inserm UMR1227, LabEx IGO, Brest, France
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Devauchelle-Pensec V, Carvajal-Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel BJ, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A. Effect of Tocilizumab on Disease Activity in Patients With Active Polymyalgia Rheumatica Receiving Glucocorticoid Therapy: A Randomized Clinical Trial. JAMA 2022; 328:1053-1062. [PMID: 36125471 DOI: 10.1001/jama.2022.15459] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Few treatments are available for patients with glucocorticoid-dependent polymyalgia rheumatica. IL-6 antagonists may reduce disease activity in patients with active glucocorticoid-dependent polymyalgia rheumatica. OBJECTIVE To compare the efficacy of tocilizumab vs placebo in patients with glucocorticoid-dependent polymyalgia rheumatica. DESIGN, SETTING, AND PARTICIPANTS This double-blind, parallel-group, placebo-controlled randomized clinical trial enrolled 101 patients with polymyalgia rheumatica at 17 hospitals in France from February 2017 to October 2019. Final follow-up occurred in November 2020. Inclusion criteria were persistent disease activity (polymyalgia rheumatica activity score computed using the C-reactive protein level [CRP PMR-AS] >10) and prednisone dose greater than or equal to 10 mg per day. INTERVENTIONS Patients were randomly assigned to receive intravenous tocilizumab (8 mg/kg; n = 51) or placebo (n = 50) every 4 weeks for 24 weeks, combined with predefined standardized tapering of oral prednisone. MAIN OUTCOMES AND MEASURES The primary efficacy end point was CRP PMR-AS less than 10 (range, 0-100; higher values indicate greater activity; no minimal clinically important difference defined) combined with either prednisone dose less than or equal to 5 mg per day or a decrease in prednisone dose greater than or equal to 10 mg from baseline at week 24. There were 11 secondary outcomes assessed at week 24 included in this report, including disease activity (measured by CRP PMR-AS) and the proportion of patients no longer taking prednisone. RESULTS Of the 101 randomized patients (mean age, 67.2 years; 68 [67.3%] women), 100 (99%) received at least 1 infusion and 100 completed the trial. The primary end point was achieved in 67.3% of patients in the tocilizumab group and 31.4% of patients in the placebo group (adjusted difference, 36.0% [95% CI, 19.4%-52.6%]; adjusted relative risk, 2.3 [95% CI, 1.5-3.6]; P < .001). Of 11 reported secondary end points at 24 weeks, 7 showed significant differences favoring tocilizumab, including mean CRP PMR-AS score (7.5 [95% CI, 5.4-9.6] vs 14.9 [95% CI, 11.4-18.4]; adjusted difference, -7.5 [95% CI, -11.2 to -3.8]; P < .001) and the percentage of patients no longer receiving prednisone (49.0% vs 19.6%; adjusted difference, 29.3% [95% CI, 18.9%-39.7%]; adjusted relative risk, 2.5 [95% CI, 1.8-3.5]; P < .001). The most frequent adverse events were infections, experienced by 23 patients (46.9%) in the tocilizumab group and 20 (39.2%) in the placebo group. CONCLUSIONS AND RELEVANCE Among patients with active polymyalgia rheumatica despite prednisone therapy, tocilizumab, compared with placebo, resulted in a significantly greater percentage of patients with a CRP PMR-AS less than 10 with reduced prednisone requirements at week 24. Further research is needed to confirm efficacy and to determine the balance of potential benefits and harms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02908217.
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Affiliation(s)
- Valérie Devauchelle-Pensec
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | - Guillermo Carvajal-Alegria
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | | | - Christophe Richez
- Rheumatology Department, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Marie-Elise Truchetet
- Rheumatology Department, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Daniel Wendling
- Rheumatology Department, Besançon Regional University Hospital and Bourgogne Franche-Comté University, Besançon, France
| | - Eric Toussirot
- INSERM CIC-1431 Clinical Investigations Center, Besançon University Hospital Besançon, France
| | - Aleth Perdriger
- Rennes 1 University, School of Medicine, South Hospital, Rheumatology Department, Rennes, France
| | | | - Renaud Felten
- Department of Rheumatology, Strasbourg University Hospitals, Strasbourg, France
| | - Bruno Jean Fautrel
- Sorbonne Université - Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Rheumatology Department, Paris, France
| | - Laurent Chiche
- Internal Medicine Department, European Hospital, Marseille, France
| | - Pascal Hilliquin
- Department of Rheumatology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | | | | | - Guillaume Direz
- Rheumatology Department, Community Hospital, Le Mans, France
| | | | - Divi Cornec
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | - Dewi Guellec
- Clinical Investigations Centre (CIC) 1412, National Health and Medical Research Institute (INSERM), Brest, France
| | | | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
| | - Alain Saraux
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
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Antiochos B. Tocilizumab as a Novel Therapy for Steroid-Dependent Polymyalgia Rheumatica. JAMA 2022; 328:1047-1048. [PMID: 36125486 DOI: 10.1001/jama.2022.11526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kastrati K, Aletaha D, Burmester GR, Chwala E, Dejaco C, Dougados M, McInnes IB, Ravelli A, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar MJH, Winthrop K, Smolen JS, Kerschbaumer A. A systematic literature review informing the consensus statement on efficacy and safety of pharmacological treatment with interleukin-6 pathway inhibition with biological DMARDs in immune-mediated inflammatory diseases. RMD Open 2022; 8:rmdopen-2022-002359. [PMID: 36260501 PMCID: PMC9462104 DOI: 10.1136/rmdopen-2022-002359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/30/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Informing an international task force updating the consensus statement on efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) selectively targeting interleukin-6 (IL-6) pathway in the context of immune-mediated inflammatory diseases. Methods A systematic literature research of all publications on IL-6 axis inhibition with bDMARDs published between January 2012 and December 2020 was performed using MEDLINE, EMBASE and Cochrane CENTRAL databases. Efficacy and safety outcomes were assessed in clinical trials including their long-term extensions and observational studies. Meeting abstracts from ACR, EULAR conferences and results on clinicaltrials.gov were taken into consideration. Results 187 articles fulfilled the inclusion criteria. Evidence for positive effect of IL-6 inhibition was available in various inflammatory diseases such as rheumatoid arthritis, juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still’s disease, cytokine release syndrome due to chimeric antigen receptor T cell therapy and systemic sclerosis-associated interstitial lung disease. Newcomers like satralizumab and anti-IL-6 ligand antibody siltuximab have expanded therapeutic approaches for Castleman’s disease and neuromyelitis optica, respectively. IL-6 inhibition did not provide therapeutic benefits in psoriatic arthritis, ankylosing spondylitis and certain connective tissue diseases. In COVID-19, tocilizumab (TCZ) has proven to be therapeutic in advanced disease. Safety outcomes did not differ from other bDMARDs, except higher risks of diverticulitis and lower gastrointestinal perforations. Inconsistent results were observed in several studies investigating the risk for infections when comparing TCZ to TNF-inhibitors. Conclusion IL-6 inhibition is effective for treatment of several inflammatory diseases with a safety profile that is widely comparable to other bDMARDs.
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Affiliation(s)
- Kastriot Kastrati
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Eva Chwala
- University Library, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria
- Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, Istituto Giannina Gaslini, Genova, Italy
| | - Naveed Sattar
- Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna Department of Medicine III, Wien, Austria
| | | | - Marieke J H Voshaar
- Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Ubbergen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin Winthrop
- Schools of Medicine and Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
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Farinango M, Ansary A, Dakka A, Nazir Z, Shamim H, Jean M, Umair M, Muddaloor P, Chavarria Y, Khan S. Is Tocilizumab Effective and Safe in Polymyalgia Rheumatica and Giant-Cell Arteritis With Polymyalgia Rheumatica? Cureus 2022; 14:e27606. [PMID: 36059312 PMCID: PMC9435397 DOI: 10.7759/cureus.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022] Open
Abstract
Polymyalgia rheumatica (PMR) and giant-cell arteritis (GCA) with symptoms of PMR share some pathophysiologic features. Interleukin 6 (IL-6) levels are elevated in both groups. We investigated the effect of tocilizumab (TCZ), an IL-6 inhibitor, in both populations and whether there were any differences regarding effectiveness and safety between them. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching the following databases: PubMed, PMC, Medline, Scopus, Cochrane Library, and ClincalTrials.gov. We found eight articles including one systematic review, one randomized controlled trial (RCT), one posthoc analysis of an RCT, and five observational studies. A total of 668 patients were included in this study. After a comprehensive analysis, we can only infer that there is insufficient evidence to suggest TCZ as monotherapy. Nevertheless, using TCZ in combination with glucocorticoid can be an effective therapeutic option.
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27
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Zhao SS, Gill D. Genetically proxied IL-6 receptor inhibition and risk of polymyalgia rheumatica. Ann Rheum Dis 2022; 81:annrheumdis-2022-222578. [PMID: 35701152 DOI: 10.1136/annrheumdis-2022-222578] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester, UK
| | - Dipender Gill
- Centre of Excellence in Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
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van der Geest KSM, Sandovici M, Nienhuis PH, Slart RHJA, Heeringa P, Brouwer E, Jiemy WF. Novel PET Imaging of Inflammatory Targets and Cells for the Diagnosis and Monitoring of Giant Cell Arteritis and Polymyalgia Rheumatica. Front Med (Lausanne) 2022; 9:902155. [PMID: 35733858 PMCID: PMC9207253 DOI: 10.3389/fmed.2022.902155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 12/26/2022] Open
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two interrelated inflammatory diseases affecting patients above 50 years of age. Patients with GCA suffer from granulomatous inflammation of medium- to large-sized arteries. This inflammation can lead to severe ischemic complications (e.g., irreversible vision loss and stroke) and aneurysm-related complications (such as aortic dissection). On the other hand, patients suffering from PMR present with proximal stiffness and pain due to inflammation of the shoulder and pelvic girdles. PMR is observed in 40-60% of patients with GCA, while up to 21% of patients suffering from PMR are also affected by GCA. Due to the risk of ischemic complications, GCA has to be promptly treated upon clinical suspicion. The treatment of both GCA and PMR still heavily relies on glucocorticoids (GCs), although novel targeted therapies are emerging. Imaging has a central position in the diagnosis of GCA and PMR. While [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) has proven to be a valuable tool for diagnosis of GCA and PMR, it possesses major drawbacks such as unspecific uptake in cells with high glucose metabolism, high background activity in several non-target organs and a decrease of diagnostic accuracy already after a short course of GC treatment. In recent years, our understanding of the immunopathogenesis of GCA and, to some extent, PMR has advanced. In this review, we summarize the current knowledge on the cellular heterogeneity in the immunopathology of GCA/PMR and discuss how recent advances in specific tissue infiltrating leukocyte and stromal cell profiles may be exploited as a source of novel targets for imaging. Finally, we discuss prospective novel PET radiotracers that may be useful for the diagnosis and treatment monitoring in GCA and PMR.
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Affiliation(s)
- Kornelis S. M. van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Pieter H. Nienhuis
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - William F. Jiemy
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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29
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Marsman DE, Bolhuis TE, den Broeder N, den Broeder AA, van der Maas A. PolyMyalgia Rheumatica treatment with Methotrexate in Optimal Dose in an Early disease phase (PMR MODE): study protocol for a multicenter double-blind placebo controlled trial. Trials 2022; 23:318. [PMID: 35428320 PMCID: PMC9012047 DOI: 10.1186/s13063-022-06263-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease affecting people older than 50, resulting in pain and stiffness of the neck, shoulder, and pelvic girdle. To date, glucocorticoids (GC) remain the cornerstone of treatment, but these have several drawbacks. Firstly, a large proportion of patients do not achieve GC-free remission within either the first (over 70%) or second year of treatment (over 50%). Secondly, GC-related adverse events (AE) occur in up to 65% of patients and can be severe. The current EULAR/ACR guidelines for PMR recommend early introduction of methotrexate (MTX) as a GC sparing agent in patients at risk for worse prognosis. However, earlier trials of low to medium quality only studied MTX dosages of 7.5–10 mg/week with no to modest effect. These doses may be suboptimal as MTX is recommended in higher doses (25 mg/week) for other inflammatory rheumatic diseases. The exact role, timing, and dose of MTX in PMR remain unclear, and therefore, our objective is to study the efficacy of MTX 25 mg/week in recently diagnosed PMR patients. Methods We set up a double-blind, randomized, placebo-controlled superiority trial (PMR MODE) to assess the efficacy of MTX 25 mg/week versus placebo in a 1:1 ratio in 100 recently diagnosed PMR patients according to the 2012 EULAR/ACR criteria. All patients will receive prednisolone 15 mg/day, tapered to 0 mg over the course of 24 weeks. In case of primary non-response or disease relapse, prednisolone dose will be temporarily increased. Assessments will take place at baseline, 4, 12, 24, 32, and 52 weeks. The primary outcome is the difference in proportion of patients in GC-free remission at week 52. Discussion No relapsing PMR patients were chosen, since the possible benefits of MTX may not outweigh the risks at low doses and effect modification may occur. Accelerated tapering was chosen in order to more easily identify a GC-sparing effect if one exists. A composite endpoint of GC-free remission was chosen as a clinically relevant endpoint for both patients and rheumatologist and may reduce second order (treatment) effects. Trial registration Dutch Trial Registration, NL8366. Registered on 10 February 2020
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Bolhuis TE, Nizet LE, Owen C, den Broeder AA, van den Ende CH, van der Maas A. Measurement properties of the PolyMyalgia Rheumatica Activity Score (PMR-AS): a systematic literature review. J Rheumatol 2022; 49:627-634. [DOI: 10.3899/jrheum.211292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
Objective To perform a COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) based Systematic Literature Review of measurement properties of the Polymyalgia Rheumatica Activity Score (PMR-AS). Methods Pubmed, EMBASE, and CINAHL were broadly searched. English full text articles, with (quantitative) data on at least 5 PMR patients using the PMR-AS were selected. Seven hypotheses for construct validity and three for responsiveness, concerning associations with erythrocyte sedimentation rate, physical function, quality of life, clinical disease states, ultrasound, and treatment response, were formulated. Articles usable to assess - COSMIN based - structural validity, internal consistency, reliability, measurement error, or hypotheses on construct validity or responsiveness were selected and assessed based on COSMIN criteria. Results From the 26 articles using the PMR-AS we were able to use 12 articles. Structural validity, internal consistency, construct validity, and responsiveness were assessed in one, two, eight, and three articles respectively. Insufficient evidence was found to confirm structural validity and internal consistency. No data was found on reliability or measurement error. Although 60% and 67% of hypotheses tested for construct validity and responsiveness were confirmed respectively, there was insufficient evidence to meet criteria for good measurement properties. Conclusion Whilst there is some promising evidence for construct validity and responsiveness of the PMR-AS, it is lacking for other properties and overall falls short of criteria for good measurement properties. Therefore, further research is needed to assess its role in clinical research and care.
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Bonelli M, Radner H, Kerschbaumer A, Mrak D, Durechova M, Stieger J, Husic R, Mandl P, Smolen JS, Dejaco C, Aletaha D. Tocilizumab in patients with new onset polymyalgia rheumatica (PMR-SPARE): a phase 2/3 randomised controlled trial. Ann Rheum Dis 2022; 81:838-844. [PMID: 35210264 DOI: 10.1136/annrheumdis-2021-221126] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Polymyalgia rheumatica is the second most common inflammatory rheumatic disease of people >50 years. Glucocorticoid therapy is highly effective, but many patients require treatment for several years. Effective glucocorticoid sparing agents are still needed. METHODS In this double-blind, multi-centre phase 2/3 clinical trial, we randomly assigned 36 patients with new onset polymyalgia rheumatica from three centres to receive subcutaneous tocilizumab (162 mg per week) or placebo for 16 weeks (1:1 ratio). All patients received oral prednisone, tapered from 20 mg to 0 mg over 11 weeks.The primary endpoint was the proportion of patients in glucocorticoid-free remission at week 16; key secondary endpoints, including time to first relapse and cumulative glucocorticoid dose at weeks 16 and 24, were evaluated. RESULTS From 20 November 2017 to 28 October 2019 39 patients were screened for eligibility; 19 patients received tocilizumab and 17 placebo. Glucocorticoid-free remission at week 16 was achieved in 12 out of 19 patients on tocilizumab (63.2%) and 2 out of 17 patients receiving placebo (11.8%, p=0.002), corresponding to an OR of 12.9 (95 % CI: 2.2 to 73.6) in favour of tocilizumab. Mean (±SD) time to first relapse was 130±13 and 82±11 days (p=0.007), respectively, and the median (IQR) cumulative glucocorticoid dose was 727 (721-842) mg and 935 (861-1244) mg (p=0.003), respectively. Serious adverse events were observed in five placebo patients and one tocilizumab patient. CONCLUSION In patients with new onset polymyalgia rheumatica undergoing rapid glucocorticoid tapering, tocilizumab was superior to placebo regarding sustained glucocorticoid-free remission, time to relapse and cumulative glucocorticoid dose. TRIAL REGISTRATION NUMBER NCT03263715.
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Affiliation(s)
- Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helga Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Mrak
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Martina Durechova
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jutta Stieger
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Rusmir Husic
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Brunico Hospital, Brunico, Italy
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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So behandle ich – die Polymyalgia rheumatica mit möglichst geringer kumulativer Glukokortikoiddosis. Z Rheumatol 2022; 81:136-139. [DOI: 10.1007/s00393-022-01157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
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The Effect of Transcutaneous Vagus Nerve Stimulation in Patients with Polymyalgia Rheumatica. Pharmaceuticals (Basel) 2021; 14:ph14111166. [PMID: 34832948 PMCID: PMC8621661 DOI: 10.3390/ph14111166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Polymyalgia rheumatica (PMR) is an inflammatory disease characterised by pain, morning stiffness, and reduced quality of life. Recently, vagus nerve stimulation (VNS) was shown to have anti-inflammatory effects. We aimed to examine the effect of transcutaneous VNS (t-VNS) on PMR. (2) Fifteen treatment-naïve PMR patients completed the study. Patients underwent a 5-day protocol, receiving 2 min of t-VNS stimulation bilaterally on the neck, three times daily. Cardiac vagal tone (CVT) measured on a linear vagal scale (LVS), blood pressure, heart rate, patient-reported outcome, and biochemical changes were assessed. (3) t-VNS induced a 22% increase in CVT at 20 min after initial stimulations compared with baseline (3.4 ± 2.2 LVS vs. 4.1 ± 2.9 LVS, p = 0.02) and was accompanied by a 4 BPM reduction in heart rate (73 ± 11 BPM vs. 69 ± 9, p < 0.01). No long-term effects were observed. Furthermore, t-VNS induced a 14% reduction in the VAS score for the hips at day 5 compared with the baseline (5.1 ± 2.8 vs. 4.4 ± 2.8, p = 0.04). No changes in CRP or proinflammatory analytes were observed. (4) t-VNS modulates the autonomic nervous system in patients with PMR, but further investigation of t-VNS in PMR patients is warranted.
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Sandovici M, van der Geest KSM, Boots MAMH, Brouwer E. Encouraging data on rituximab in polymyalgia rheumatica. THE LANCET. RHEUMATOLOGY 2021; 3:e738-e739. [PMID: 38297517 DOI: 10.1016/s2665-9913(21)00279-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, Netherlands
| | - Mieke A M H Boots
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, Netherlands.
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Marsman DE, den Broeder N, van den Hoogen FHJ, den Broeder AA, van der Maas A. Efficacy of rituximab in patients with polymyalgia rheumatica: a double-blind, randomised, placebo-controlled, proof-of-concept trial. THE LANCET RHEUMATOLOGY 2021. [DOI: 10.1016/s2665-9913(21)00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Nam B, Sung YK, Choi CB, Kim TH, Jun JB, Bae SC, Yoo DH, Cho SK. Fracture Risk and Its Prevention Patterns in Korean Patients with Polymyalgia Rheumatica: a Retrospective Cohort Study. J Korean Med Sci 2021; 36:e263. [PMID: 34697929 PMCID: PMC8546306 DOI: 10.3346/jkms.2021.36.e263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To evaluate the incidence of fractures and fracture risk factors in Korean patients with polymyalgia rheumatica (PMR). METHODS All PMR patients who visited a rheumatology clinic at a tertiary referral hospital between March 2005 and March 2018 were retrospectively assessed. We estimated bone mineral density (BMD) screening rate within 6 months of the first visit and classified the patients according to the performance and results of BMD screening. Incidence rates (IRs) of fractures were calculated in each group and risk factors for fractures were identified using Poisson regression analysis. RESULTS A total of 95 PMR patients with median (interquartile range) age of 64.0 (56.0-72.0) years were included. Baseline BMD was assessed in only 55.8% of these patients (n = 53); 24 patients with osteoporosis, 20 with osteopenia, and 9 with normal BMD. During 433.1 person-years (PYs) of observation, 17 fractures occurred in 12 patients (IR, 3.93 [95% confidence interval (CI), 2.46-6.26]/100 PYs); 8.32 (95% CI, 4.09-16.90)/100 PYs in the osteopenia group, 3.40 (95% CI, 1.30-8.90)/100 PYs in the osteoporosis group, and 3.37 (95% CI, 1.53-7.39)/100 PYs in the no BMD test group. Risk factors for fractures were female sex, advanced age (≥ 65 years), longer follow-up duration, initial glucocorticoid dose ≥ 10 mg/day, and higher cumulative glucocorticoid dose over the first 6 months. CONCLUSION The incidence rate of fractures in Korean patients with PMR was 3.93/100 PYs. Female sex, advanced age, longer follow-up duration, and increased glucocorticoid dose are risk factors for osteoporotic fracture.
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Affiliation(s)
- Bora Nam
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Dae-Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea.
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Toussirot E, Michaud M, Wendling D, Devauchelle V. Abatacept as Adjunctive Therapy in Refractory Polymyalgia Rheumatica. J Rheumatol 2021; 48:1888-1889. [PMID: 34526393 DOI: 10.3899/jrheum.210455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431 Centre Investigation Clinique, Fédération Hospitalo-Universitaire INCREASE, and Rhumatologie, CHU de Besançon, and Département de Thérapeutique, and INSERM UMR1098 Relations Hôte Greffon Tumeurs, ingénierie cellulaire et génique, Université de Bourgogne Franche-Comté, Besançon;
| | | | | | - Valérie Devauchelle
- Rhumatologie, CHU de Brest, and INSERM 1227 LBAI Université de Bretagne Occidentale, Centre de Référence des Maladies Auto-Immunes Rares de l'Adulte, Brest, France
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Morel J, Tournadre A, Sellam J, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. Practical Management of patients on anti-IL6R therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105221. [PMID: 34183155 DOI: 10.1016/j.jbspin.2021.105221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland & Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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Steroid-Sparing Effect of Tocilizumab and Methotrexate in Patients with Polymyalgia Rheumatica: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10132948. [PMID: 34209126 PMCID: PMC8267957 DOI: 10.3390/jcm10132948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/23/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness in the shoulders, hips, and proximal limbs; it usually affects elderly patients. The effectiveness of methotrexate and tocilizumab in PMR treatment has not been extensively studied. Thus, we aimed to assess the steroid-sparing effect of tocilizumab and methotrexate in PMR in clinical practice. Consecutive patients with PMR in our hospitals, who were included in our retrospective cohort, were reviewed between 2005 and 2015 and divided into the following groups according to their treatments: prednisolone or none (prednisolone group), methotrexate ± prednisolone (methotrexate group), or tocilizumab ± prednisolone (tocilizumab group). The prednisolone dose at the last follow-up was compared. A total of 227 patients with an average age of 74 years were enrolled. No difference in baseline characteristics was found among the three groups. The prednisolone dose at the last follow-up was lower (0 vs. 3.0 vs. 3.5 mg/day, p < 0.001) and the prednisolone discontinuation rate was higher (80.0% vs. 28.3% vs. 18.8%, p < 0.0001) in the tocilizumab group than in the prednisolone and methotrexate groups. This study suggested that tocilizumab has a steroid-sparing effect in PMR. Tocilizumab can be an option in the management of PMR. Future studies are warranted to confirm our findings.
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Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MA. Predicting the risk of relapse in polymyalgia rheumatica: novel insights. Expert Rev Clin Immunol 2021; 17:225-232. [PMID: 33570454 DOI: 10.1080/1744666x.2021.1890032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Polymyalgia rheumatica (PMR) is a common inflammatory disease found in people older than 50 years of Northern European descent. It is characterized by pain and stiffness in the shoulders, arms, hips, and neck. Relapses are common in patients with PMR. AREAS COVERED This review describes when and how relapses occur in patients with PMR. Potential predisposing factors associated with relapses and management are also discussed. An extensive literature search on the PubMed database was conducted for publications on 'polymyalgia rheumatica' AND 'relapses' AND 'risk factors'. EXPERT OPINION Relapses are common in PMR being observed in approximately half of the patients. They often occur when the dose of prednisone is below 5-7.5 mg/day. The speed of glucocorticoid tapering is considered to be the main factor influencing the development of relapses in isolated PMRs. In addition, a genetic component may favor the presence of relapses in isolated PMRs. HLA-DRB1*0401 alleles were associated with an increased risk of relapse. An implication of the IL-6 promoter -174 G/C polymorphism and the GG241 ICAM-1 genotype was also reported. With regard to serological biomarkers, elevated levels of angiopoietin-2 were associated with an unfavorable course of PMR. Methotrexate and anti-IL6 receptor antibody tocilizumab may be required in PMR patients with multiple relapses.
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Affiliation(s)
- Diana Prieto-Peña
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Belén Atienza-Mateo
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain
| | - Miguel A González-Gay
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués De Valdecilla, IDIVAL, Santander, Spain.,Department of Medicine, University of Cantabria, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Inflammatory Markers are Quickly Improved by Tocilizumab in Early Polymyalgia Rheumatica and Might Predict Early Response to Interleukin-6 Blockade. Rheumatol Ther 2021; 8:751-760. [PMID: 33745124 PMCID: PMC7981388 DOI: 10.1007/s40744-021-00299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/06/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION It is unclear whether polymyalgia rheumatica (PMR) should be considered an inflammatory disease or an autoimmune disease. METHODS Eighteen untreated early PMR patients and 18 sex- and age-matched healthy controls (HCs) were included. PMR patients received tocilizumab from week 0 to week 12 and glucocorticoids from week 12 to week 24. Leukocytes, neutrophils, platelets, hemoglobin, γ-globulins, IgG, IgA, and IgM were compared between the PMR patients and HCs and before and after tocilizumab treatment in the PMR group. RESULTS The mean age was 68 ± 7 and 66 ± 11 years, and the mean serum C-reactive protein level was 82 ± 16 and 5 ± 2 mg/l for PMR patients and HCs, respectively. At inclusion, leukocytes (p < 0.0001), neutrophils (p < 0.0001), and platelets (p < 0.0001) were increased and hemoglobin (p < 0.0001) decreased in the PMR group compared to the HC group. After tocilizumab therapy, leukocytes, neutrophils, and platelets decreased, and hemoglobin increased. At inclusion, all four parameters were significantly associated with the serum IL-6 level, though it was not associated after tocilizumab therapy. Levels of γ-globulin were increased in the PMR patients compared to HCs (p = 0.0087), and PMR patients with γ-globulins levels over 11 g/l at inclusion responded more quickly to tocilizumab therapy. Autoantibody profiles did not differ between the PMR patients and HCs. CONCLUSIONS This study suggests that PMR is more an inflammatory disease than an autoimmune disease. Tocilizumab improves all markers of inflammation. Patients with elevated γ-globulins respond more quickly to tocilizumab.
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Spiera R, Unizony SH, Bao M, Luder Y, Han J, Pavlov A, Stone JH. Tocilizumab vs placebo for the treatment of giant cell arteritis with polymyalgia rheumatica symptoms, cranial symptoms or both in a randomized trial. Semin Arthritis Rheum 2021; 51:469-476. [PMID: 33784598 DOI: 10.1016/j.semarthrit.2021.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The randomized, placebo (PBO)-controlled GiACTA trial demonstrated the efficacy and safety of tocilizumab (TCZ) in patients with giant cell arteritis (GCA). The present study evaluated the efficacy of TCZ in patients with GCA presenting with polymyalgia rheumatica (PMR) symptoms only, cranial symptoms only or both PMR and cranial symptoms in the GiACTA trial. METHODS In GiACTA, 250 patients with GCA received either TCZ weekly or every other week plus a 26-week prednisone taper or PBO plus a 26- or 52-week prednisone taper. This post hoc analysis assessed baseline characteristics, sustained remission rate, number of flares, annualized flare rate, time to flare, cumulative prednisone dose, methotrexate use and safety in patients with PMR symptoms only, cranial symptoms only or both at baseline. RESULTS Overall, 52 patients had PMR symptoms only, 94 had cranial symptoms only and 104 had both symptoms at baseline. At Week 52, rates of sustained remission were significantly higher with TCZ vs PBO in all 3 groups (PMR only, 45.2% vs 19.0%, P = 0.0446; cranial only, 60.3% vs 19.4%, P = 0.0001; PMR and cranial, 55.0% vs 11.4%, P < 0.0001). Smaller proportions of TCZ-treated patients experienced disease flare than PBO-treated patients across all groups (PMR only, 41.9% vs 57.1%; cranial only, 20.7% vs 47.2%; PMR and cranial, 31.7% vs 81.8%). Annualized flare rate and risk of flare were significantly lower with TCZ vs PBO for patients with cranial symptoms only and both symptoms; they were numerically lower, but did not reach statistical significance, in the smaller group of patients with PMR symptoms only. CONCLUSIONS TCZ improved clinical outcomes in patients who presented with PMR symptoms only, cranial symptoms only or both at baseline, suggesting that TCZ is effective in patients with GCA regardless of the presenting clinical phenotype.
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Affiliation(s)
- Robert Spiera
- Hospital for Special Surgery, Department of Medicine, New York, NY, USA.
| | - Sebastian H Unizony
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Min Bao
- Genentech, Inc., South San Francisco, California, USA
| | - Yves Luder
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jian Han
- Genentech, Inc., South San Francisco, California, USA
| | | | - John H Stone
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Camellino D, Duftner C, Dejaco C. New insights into the role of imaging in polymyalgia rheumatica. Rheumatology (Oxford) 2021; 60:1016-1033. [PMID: 33200216 DOI: 10.1093/rheumatology/keaa646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 11/14/2022] Open
Abstract
PMR is an inflammatory rheumatic disease of elderly people characterized by pain and stiffness in the neck, shoulder and pelvic girdles. No specific diagnostic confirmatory tests exist and clinical symptoms, as well as increased acute phase reactants, are unspecific. The diagnostic value of imaging including ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with/without CT for PMR is increasingly studied. These techniques, particularly FDG-PET/CT, may help to detect underlying GCA in PMR patients with an incomplete response to glucocorticoids and/or recurrent relapses. Recent imaging studies provide novel insights into the anatomical basis of inflammation in PMR, particularly at hip and spine, which may help to distinguish this disease from other mimicking conditions. In this review, we discuss novel insights into the pathoanatomy of PMR, compare the diagnostic values of different imaging techniques and summarize current data on the role of imaging for monitoring and outcome prediction.
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Affiliation(s)
- Dario Camellino
- Division of Rheumatology, "La Colletta" Hospital, Local Health Trust 3, Arenzano, Italy.,Autoimmunology Laboratory, University of Genoa, Genoa, Italy
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken, Innsbruck, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
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Craig G, Knapp K, Salim B, Mohan SV, Michalska M. Treatment Patterns, Disease Burden, and Outcomes in Patients with Giant Cell Arteritis and Polymyalgia Rheumatica: A Real-World, Electronic Health Record-Based Study of Patients in Clinical Practice. Rheumatol Ther 2021; 8:529-539. [PMID: 33638132 PMCID: PMC7991019 DOI: 10.1007/s40744-021-00290-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Because of the chronic nature of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR), patients may require continued glucocorticoid treatment to achieve treatment targets or prevent disease relapse, resulting in high cumulative doses. This study evaluated patterns of glucocorticoid use and outcomes in patients with GCA, PMR, or both. METHODS This retrospective study used electronic medical records from a US rheumatology clinic utilizing the JointMan® (Discus Analytics, LLC) rheumatology software. Patients aged ≥ 50 years with a diagnosis of GCA or PMR and ≥ 1 entry for a glucocorticoid prescription after diagnosis were included. Outcomes at 2 years after glucocorticoid initiation included the proportion of patients discontinuing glucocorticoids for ≥ 6 months, proportion of patients discontinuing glucocorticoids for ≥ 6 months and remaining off glucocorticoids at 2 years, time to discontinuation of glucocorticoids for ≥ 6 months, and prednisone dose and were compared between patients with GCA only, PMR only, or GCA and PMR. RESULTS At 2 years after the initiation of glucocorticoids, 32% of patients (26/91) with GCA, 32% (248/779) with PMR, and 27% (26/97) with GCA and PMR discontinued glucocorticoids for ≥ 6 months; 17, 23, and 18% discontinued glucocorticoids for ≥ 6 months and remained off glucocorticoids at 2 years, respectively. Median (range) time to discontinuation of glucocorticoids for ≥ 6 months was 202.5 (0-635) days and shorter in patients with both GCA and PMR vs. GCA or PMR only. The majority of patients required daily prednisone at 2 years, with similar doses observed between groups. CONCLUSIONS Fewer than one-third of patients with GCA and/or PMR discontinued glucocorticoids for ≥ 6 months; the majority of patients required prednisone therapy for ≥ 2 years after its initiation. These data highlight the need for the use of more efficacious and glucocorticoid-sparing therapies in patients with GCA and/or PMR.
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Affiliation(s)
- Gary Craig
- Arthritis Northwest, PLLC, Spokane, WA, USA.
- Discus Analytics, LLC, Spokane, WA, USA.
| | | | - Bob Salim
- Axio Research, LLC, Seattle, WA, USA
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Ramon A, Guillibert-Karras C, Milas-Julien L, Garrot JF, Maillefert JF, Ornetti P. The frequency of occult solid malignancy in patients with polymyalgia rheumatica-like symptoms. Ther Adv Musculoskelet Dis 2021; 13:1759720X20984275. [PMID: 33552239 PMCID: PMC7844447 DOI: 10.1177/1759720x20984275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Aims: We aim to evaluate the clinical usefulness of systematic screening for occult cancer in patients with polymyalgia rheumatic (PMR)-like symptoms in real-life practice. Methods: All patients seen by rheumatologists in Burgundy, France, between March 2016 and December 2018 for new-onset PMR that met the 2012 ACR/EULAR classification criteria were prospectively included. Patients underwent systematic screening including determination of the erythrocyte sedimentation rate, serum C-reactive protein levels, thoracic, abdominal and pelvic computed tomography (CT-TAP) and, in men, serum prostate-specific antigen. The standardized incidence ratio (SIR) for cancers was calculated using 2012 national estimates of cancer incidence. Potential predictive factors for the diagnosis of cancer were then evaluated using univariate and multivariate analyses. Results: Among the 118 patients included, nine cases of cancer were confirmed and diagnosed with CT-TAP: kidney carcinoma (n = 4), lung cancer (n = 2), pancreatic, colon, and ampullary carcinoma (n = 1 each). Among these cancers, five were localized (four kidney, and one ampullary carcinoma) and were treated with complete surgical resection. The expected incidence of cancer in the general population was 1.95, leading to an overall SIR of 4.6 (95% CI 2.4–8.9, p < 0.0001). An additional analysis was performed for the kidney carcinoma, and it showed a highly significant increase in SIR: 80.8 (95% CI 30.3–215.4). In 80% of patients, the PMR-like syndrome regressed during cancer treatment. No other predictive factors for cancer were found. Conclusion: Systematic screening for cancer including CT-TAP in real-life practice revealed occult solid malignancy, mostly early-stage cancer, in a relevant proportion of patients presenting PMR-like symptoms. The high proportion of kidney cancer (40%) is worth highlighting, especially considering that it is not one of the most frequent cancers after 50 years of age.
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Affiliation(s)
- André Ramon
- Department of Rheumatology, Dijon University Hospital, Dijon, France
| | | | | | | | | | - Paul Ornetti
- Department of Rheumatology, INSERM, CIC 1432, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon University Hospital, Dijon, France
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Clinical outcomes of patients with giant cell arteritis treated with tocilizumab in real-world clinical practice: decreased incidence of new visual manifestations. Arthritis Res Ther 2021; 23:8. [PMID: 33407817 PMCID: PMC7789742 DOI: 10.1186/s13075-020-02377-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background Placebo-controlled clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for remission maintenance and glucocorticoid sparing in patients with giant cell arteritis (GCA). However, limited data exist on the effectiveness and safety of TCZ for GCA in real-world clinical practice. Methods This was a retrospective, single-center analysis of patients with GCA treated with intravenous or subcutaneous TCZ (2010–2018). Outcomes evaluated before and after TCZ initiation included occurrence of flare, time to flare, annualized flare rate, flare characteristics (i.e., polymyalgia rheumatica [PMR] symptoms, cranial manifestations), prednisone use, and safety. Flare was defined as the recurrence of unequivocal GCA manifestations requiring treatment intensification. Subgroup analyses of patients with PMR or visual manifestations at GCA diagnosis were performed. Results Sixty patients with GCA were included. The median (IQR) disease duration before and after the start of TCZ was 0.6 (0.2–1.6) and 0.5 (0.3–1.4) years, respectively. At least 1 flare was observed in 43 patients (71.7%) before and in 18 (30.0%) after TCZ initiation. Median (IQR) time to flare was 0.5 (0.3–0.7) years before TCZ treatment and 2.1 (0.6–2.6) years after TCZ initiation (HR 0.22; 95% CI 0.10–0.50; p = 0.0003). The annualized flare rate significantly decreased following TCZ use (before TCZ 1.4 [95% CI 1.0–2.1]; after TCZ 0.6 [95% CI 0.3–1.0] events/year; p < 0.001). Similar improvements were observed in patients with visual manifestations or PMR symptoms at GCA diagnosis. TCZ reduced the incidence of new visual manifestations, and no flares associated with permanent vision loss occurred while patients were receiving TCZ. Mean (SD) prednisone dose at TCZ onset and at the end of follow-up was 30 (18.3) and 5 (6.9) mg/day, respectively (p < 0.0001). After TCZ initiation, 46.6% of patients successfully discontinued prednisone. The incidence of adverse events, primarily attributed to glucocorticoids, was similar before and after TCZ initiation. Conclusions In this real-world setting, TCZ improved GCA clinical outcomes significantly and demonstrated effectiveness in the subgroups of patients with PMR symptoms and GCA-related visual manifestations at GCA diagnosis. No new cases of blindness occurred after TCZ initiation. Adverse events, many attributable to glucocorticoids, were comparable before and after TCZ treatment.
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van der Geest KSM, Treglia G, Glaudemans AWJM, Brouwer E, Jamar F, Slart RHJA, Gheysens O. Diagnostic value of [18F]FDG-PET/CT in polymyalgia rheumatica: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2020; 48:1876-1889. [PMID: 33372248 PMCID: PMC8113217 DOI: 10.1007/s00259-020-05162-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/08/2020] [Indexed: 02/01/2023]
Abstract
Purpose Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR. Methods PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model. Results Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84–8.71), hips (LR+ 2.91; 95% CI 2.09–4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91–4.28), shoulders (LR+ 2.57; 95% CI 1.24–5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33–4.02). Negative likelihood ratios (LR−) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42–6.32) and LR− of 0.19 (95% CI 0.10–0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria. Conclusion Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05162-6.
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Affiliation(s)
- K S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, the Netherlands.
| | - G Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, the Netherlands
| | - F Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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48
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Carvajal Alegria G, Garrigues F, Bettacchioli E, Loeuille D, Saraux A, Cornec D, Devauchelle-Pensec V, Renaudineau Y. Tocilizumab controls bone turnover in early polymyalgia rheumatica. Joint Bone Spine 2020; 88:105117. [PMID: 33301930 DOI: 10.1016/j.jbspin.2020.105117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study explores changes in the bone homeostasis by testing the N-terminal collagen type I extension propeptide (PINP) marker for osteo-formation and the carboxy-terminal region of collagen type I (CTX-I) marker for osteo-resorption in patients taking tocilizumab for polymyalgia rheumatica (PMR). METHODS Twenty patients were included in the prospective open-label TENOR study (Clinicaltrials.gov NCT01713842) and received three monthly tocilizumab infusions, followed by corticosteroids starting at week (W) 12. PINP and CTX-I were tested at inclusion (W0), after tocilizumab but before steroid initiation (W12), at the end of the protocol (W24) and were compared to healthy controls. Information regarding disease activity, bone mineral density using scanographic bone attenuation correlation (SBAC), inflammatory parameters and interleukin (IL)-6 levels were collected during the follow-up of the patients. RESULTS PMR patients were characterised by a reduction in bone mineral density and a higher level of CTX-I relative to healthy controls matched in age and sex at baseline. PINP levels increased at W12 (P< 0.001, versus W0) following tocilizumab introduction and CTX-I levels decreased at W24 and after steroid initiation (P=0.001, versus W0). Such modifications explain the altered correlation observed between PINP and CTX-I at W0 (r=0.255 at W0 versus r=0.641 in healthy controls) and its correction after treatment (r=0.760 at W12 and r=0.767 at W24). Finally, greater changes in PINP were observed in patients whose circulating IL-6 levels decreased after tocilizumab therapy. CONCLUSIONS Control of bone turnover, in part through the inhibition of the IL-6 axis, is observed during tocilizumab and subsequent steroid treatment of PMR.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France.
| | | | | | - Damien Loeuille
- Department of Rheumatology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC CIE6, Nancy, France University Hospital of Nancy, Epidemiology and Clinical Evaluation, 545 Vandoeuvre-lès-Nancy, France
| | - Alain Saraux
- Rheumatology department, CHRU Cavale Blanche, Brest, France
| | - Divi Cornec
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France
| | - Yves Renaudineau
- Laboratory of immunology and immunotherapy, UMR1227, CHRU Morvan, Brest, France
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49
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Carvajal Alegria G, Boukhlal S, Cornec D, Devauchelle-Pensec V. The pathophysiology of polymyalgia rheumatica, small pieces of a big puzzle. Autoimmun Rev 2020; 19:102670. [DOI: 10.1016/j.autrev.2020.102670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
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50
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Hattori K, Hirano Y, Kojima T. Predictors of glucocorticoid‐free remission in patients with polymyalgia rheumatica treated with prednisolone. Int J Rheum Dis 2020; 23:1581-1586. [DOI: 10.1111/1756-185x.13978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kyosuke Hattori
- Orthopedic Surgery Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuji Hirano
- Rheumatology Toyohashi Municipal Hospital Toyohashi Japan
| | - Toshihisa Kojima
- Orthopedic Surgery Nagoya University Graduate School of Medicine Nagoya Japan
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