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Novella-Navarro M, Iniesta-Chamorro JM, Benavent D, Bachiller-Corral J, Calvo-Aranda E, Borrell H, Berbel-Arcobé L, Navarro-Compan V, Michelena X, Lojo-Oliveira L, Arroyo-Palomo J, Diaz-Almiron M, García García V, Monjo-Henry I, Gómez González CM, Gomez EJ, Balsa A, Plasencia-Rodríguez C. Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study. JMIR Res Protoc 2024; 13:e55829. [PMID: 38501508 DOI: 10.2196/55829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. OBJECTIVE The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. METHODS This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. RESULTS Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. CONCLUSIONS This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. TRIAL REGISTRATION ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55829.
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Affiliation(s)
| | - Jose M Iniesta-Chamorro
- Biomedical Engineering and Telemedicine Centre, Center for Biomedical Technology, Escuela Tecnica Superior de Ingenieros de Telecomunicacion, Universidad Politecnica de Madrid, Madrid, Spain
| | - Diego Benavent
- Rheumatolgy Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | | | - Jaime Arroyo-Palomo
- Rheumatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - Irene Monjo-Henry
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Enrique J Gomez
- Biomedical Engineering and Telemedicine Centre, Center for Biomedical Technology, Escuela Tecnica Superior de Ingenieros de Telecomunicacion, Universidad Politecnica de Madrid, Madrid, Spain
- Centro De Investigación Biomédica En Red De Bioingeniería, Biomateriales Y Nanomedicina, Madrid, Spain
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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2
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Loganathan A, Zanframundo G, Yoshida A, Faghihi-Kashani S, Bauer Ventura I, Dourado E, Bozan F, Sambataro G, Yamano Y, Bae SS, Lim D, Ceribelli A, Isailovic N, Selmi C, Fertig N, Bravi E, Kaneko Y, Saraiva AP, Jovani V, Bachiller-Corral J, Cifrian J, Mera-Varela A, Moghadam-Kia S, Wolff V, Campagne J, Meyer A, Giannini M, Triantafyllias K, Knitza J, Gupta L, Molad Y, Iannone F, Cavazzana I, Piga M, De Luca G, Tansley S, Bozzalla-Cassione E, Bonella F, Corte TJ, Doyle TJ, Fiorentino D, Gonzalez-Gay MA, Hudson M, Kuwana M, Lundberg IE, Mammen AL, McHugh NJ, Miller FW, Montecucco C, Oddis CV, Rojas-Serrano J, Schmidt J, Scirè CA, Selva-O'Callaghan A, Werth VP, Alpini C, Bozzini S, Cavagna L, Aggarwal R. Agreement between local and central anti-synthetase antibodies detection: results from the Classification Criteria of Anti-Synthetase Syndrome project biobank. Clin Exp Rheumatol 2024; 42:277-287. [PMID: 38488094 DOI: 10.55563/clinexprheumatol/s14zq8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES The CLASS (Classification Criteria of Anti-Synthetase Syndrome) project is a large international multicentre study that aims to create the first data-driven anti-synthetase syndrome (ASSD) classification criteria. Identifying anti-aminoacyl tRNA synthetase antibodies (anti-ARS) is crucial for diagnosis, and several commercial immunoassays are now available for this purpose. However, using these assays risks yielding false-positive or false-negative results, potentially leading to misdiagnosis. The established reference standard for detecting anti-ARS is immunoprecipitation (IP), typically employed in research rather than routine autoantibody testing. We gathered samples from participating centers and results from local anti-ARS testing. As an "ad-interim" study within the CLASS project, we aimed to assess how local immunoassays perform in real-world settings compared to our central definition of anti-ARS positivity. METHODS We collected 787 serum samples from participating centres for the CLASS project and their local anti-ARS test results. These samples underwent initial central testing using RNA-IP. Following this, the specificity of ARS was reconfirmed centrally through ELISA, line-blot assay (LIA), and, in cases of conflicting results, protein-IP. The sensitivity, specificity, positive likelihood ratio and positive and negative predictive values were evaluated. We also calculated the inter-rater agreement between central and local results using a weighted κ co-efficient. RESULTS Our analysis demonstrates that local, real-world detection of anti-Jo1 is reliable with high sensitivity and specificity with a very good level of agreement with our central definition of anti-Jo1 antibody positivity. However, the agreement between local immunoassay and central determination of anti-non-Jo1 antibodies varied, especially among results obtained using local LIA, ELISA and "other" methods. CONCLUSIONS Our study evaluates the performance of real-world identification of anti-synthetase antibodies in a large cohort of multi-national patients with ASSD and controls. Our analysis reinforces the reliability of real-world anti-Jo1 detection methods. In contrast, challenges persist for anti-non-Jo1 identification, particularly anti-PL7 and rarer antibodies such as anti-OJ/KS. Clinicians should exercise caution when interpreting anti-synthetase antibodies, especially when commercial immunoassays test positive for non-anti-Jo1 antibodies.
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Affiliation(s)
- Aravinthan Loganathan
- Royal National Hospital for Rheumatic Diseases, Bath; Department of Life Sciences, University of Bath, UK; and Arthritis Australia, Broadway, Glebe, NSW, Australia
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Sara Faghihi-Kashani
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro; Aveiro Rheumatology Research Centre, Egas Moniz Health Alliance, Aveiro; and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Francisca Bozan
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Rheumatology, Chile
| | - Gianluca Sambataro
- Regional Referral Center for Rare Lung Disease, Policlinico G. Rodolico-San Marco, University of Catania, Italy
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
| | - Sharon Sangmee Bae
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Darosa Lim
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Natasa Isailovic
- Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Noreen Fertig
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elena Bravi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Yuko Kaneko
- Keio University School of Medicine, Tokyo, Japan
| | | | - Vega Jovani
- Department of Rheumatology, Hospital General Universitario Dr. Balmis Alicante, ISABIAL, Alicante, Spain
| | | | - Jose Cifrian
- Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Alain Meyer
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | - Margherita Giannini
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | | | | | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Yair Molad
- Rabin Medical Center, Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Matteo Piga
- University Clinic and AOU of Cagliari, Italy
| | - Giacomo De Luca
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Bath, and Department of Life Sciences, University of Bath, UK
| | - Emanuele Bozzalla-Cassione
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Tamera J Corte
- University of Sydney, NSW, and Royal Prince Alfred Hospital, NSW, Australia
| | - Tracy J Doyle
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Miguel Angel Gonzalez-Gay
- Medicine and Psychiatry Department, University of Cantabria, and Division of Rheumatology, IIS-Fundacion Jiménez Díaz, Madrid, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Andrew L Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Disorders, National Institutes of Health, Bethesda, MD, and Departments of Medicine and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Fredrick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | | | - Carlo Alberto Scirè
- IRCCS San Gerardo dei Tintori Foundation, Monza, and School of Medicine, University of Milano Bicocca, Milan, Italy
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Spain
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Claudia Alpini
- Laboratory of Biochemical-Chemistry, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Bozzini
- US Transplant Center, Laboratorio di Biologia Cellulare e Immunologia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Villalobos-Sánchez L, Blanco-Cáceres B, Bachiller-Corral J, Rodríguez-Serrano MT, Vázquez-Díaz M, Lázaro Y de Mercado P. Quality of life of patients with rheumatic diseases. Reumatol Clin (Engl Ed) 2024; 20:59-66. [PMID: 38395496 DOI: 10.1016/j.reumae.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. METHODS Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0-1 scale) and a visual analog scale (VAS, 0-100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. RESULTS 1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18-95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially "pain/discomfort", followed by "daily activities" and "mobility". This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the "peripheral and axial mechanical pathology" and the "soft tissue pathology" group. CONCLUSIONS Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.
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Affiliation(s)
| | - Boris Blanco-Cáceres
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina, Madrid, Spain
| | - Javier Bachiller-Corral
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina, Madrid, Spain
| | | | - Mónica Vázquez-Díaz
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain
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Boteanu A, Leon L, Pérez Esteban S, Rabadán Rubio E, Pavía Pascual M, Bonilla G, Bonilla González-Laganá C, García Fernandez A, Recuero Diaz S, Ruiz Gutierrez L, Sanmartín Martínez JJ, de la Torre-Rubio N, Nuño L, Sánchez Pernaute O, Del Bosque I, Lojo Oliveira L, Rodríguez Heredia JM, Clemente D, Abasolo L, Bachiller-Corral J. Severe COVID-19 in patients with immune-mediated rheumatic diseases: A stratified analysis from the SORCOM multicentre registry. Mod Rheumatol 2023; 34:97-105. [PMID: 36516217 DOI: 10.1093/mr/roac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. METHODS An observational, cross-sectional multicentre study was performed. Patients from 10 rheumatology departments in Madrid who presented with severe acute respiratory syndrome coronavirus-2 infection between February 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (socio-demographic, clinical, and treatments), using logistic regression analyses. RESULTS In total, 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age, and comorbidities such as diabetes mellitus, hypertension, and obesity were associated with severe COVID-19. Corticosteroid doses >10 mg/day, rituximab, sulfasalazine, and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, P < .001), although there were no differences in the overall severity in the multivariate analysis. CONCLUSIONS This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab, and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-tumour necrosis factor therapy were not associated with worse outcomes.
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Affiliation(s)
- Alina Boteanu
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Leticia Leon
- Rheumatology Department and IDISSC, Hospital Clínico San Carlos, Madrid, Spain
- Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | - Silvia Pérez Esteban
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Elena Rabadán Rubio
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Marina Pavía Pascual
- Rheumatology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Gema Bonilla
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Sheila Recuero Diaz
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Lucia Ruiz Gutierrez
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Laura Nuño
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Olga Sánchez Pernaute
- Rheumatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Iván Del Bosque
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Daniel Clemente
- Rheumatology Department, Hospital Universitario Infantil Niño Jesus, Madrid, Spain
| | - Lydia Abasolo
- Rheumatology Department and IDISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Bachiller-Corral
- Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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5
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Di Rocco M, Forleo-Neto E, Pignolo RJ, Keen R, Orcel P, Funck-Brentano T, Roux C, Kolta S, Madeo A, Bubbear JS, Tabarkiewicz J, Szczepanek M, Bachiller-Corral J, Cheung AM, Dahir KM, Botman E, Raijmakers PG, Al Mukaddam M, Tile L, Portal-Celhay C, Sarkar N, Hou P, Musser BJ, Boyapati A, Mohammadi K, Mellis SJ, Rankin AJ, Economides AN, Trotter DG, Herman GA, O'Meara SJ, DelGizzi R, Weinreich DM, Yancopoulos GD, Eekhoff EMW, Kaplan FS. Garetosmab in fibrodysplasia ossificans progressiva: a randomized, double-blind, placebo-controlled phase 2 trial. Nat Med 2023; 29:2615-2624. [PMID: 37770652 PMCID: PMC10579054 DOI: 10.1038/s41591-023-02561-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by heterotopic ossification (HO) in connective tissues and painful flare-ups. In the phase 2 LUMINA-1 trial, adult patients with FOP were randomized to garetosmab, an activin A-blocking antibody (n = 20) or placebo (n = 24) in period 1 (28 weeks), followed by an open-label period 2 (28 weeks; n = 43). The primary end points were safety and for period 1, the activity and size of HO lesions. All patients experienced at least one treatment-emergent adverse event during period 1, notably epistaxis, madarosis and skin abscesses. Five deaths (5 of 44; 11.4%) occurred in the open-label period and, while considered unlikely to be related, causality cannot be ruled out. The primary efficacy end point in period 1 (total lesion activity by PET-CT) was not met (P = 0.0741). As the development of new HO lesions was suppressed in period 1, the primary efficacy end point in period 2 was prospectively changed to the number of new HO lesions versus period 1. No placebo patients crossing over to garetosmab developed new HO lesions (0% in period 2 versus 40.9% in period 1; P = 0.0027). Further investigation of garetosmab in FOP is ongoing. ClinicalTrials.gov identifier NCT03188666 .
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Affiliation(s)
- Maja Di Rocco
- Department of Pediatrics, Unit of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Richard Keen
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Philippe Orcel
- Department of Rheumatology - DMU Locomotion, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM Université Paris Cité, Paris, France
| | - Thomas Funck-Brentano
- Department of Rheumatology - DMU Locomotion, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM Université Paris Cité, Paris, France
| | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sami Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Annalisa Madeo
- Department of Pediatrics, Unit of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Judith S Bubbear
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Jacek Tabarkiewicz
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszów, Poland
| | - Małgorzata Szczepanek
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszów, Poland
| | | | - Angela M Cheung
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn M Dahir
- Vanderbilt University Medical Center, Program for Metabolic Bone Disorders, Nashville, TN, USA
| | - Esmée Botman
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mona Al Mukaddam
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lianne Tile
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Peijie Hou
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - E Marelise W Eekhoff
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frederick S Kaplan
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Loarce-Martos J, Calvo Sanz L, Garrote-Corral S, Ballester González R, Pariente Rodríguez R, Rita CG, García-Soidan A, Bachiller-Corral J, Roy Ariño G. Myositis autoantibodies detected by line blot immunoassay: clinical associations and correlation with antibody signal intensity. Rheumatol Int 2023; 43:1101-1109. [PMID: 36763166 DOI: 10.1007/s00296-023-05279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
The aim of this study is to assess the relationship between myositis specific (MSA) and myositis associated (MAA) antibodies and diagnosis (including idiopathic inflammatory myopathies [IIM] and other systemic autoimmune diseases [SAID]), and to explore the impact of antibody signal intensity in diagnostic accuracy. We retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA by line immunoassay (LIA) between 01/01/2018 and 31/12/2020 in Ramón y Cajal University Hospital (Spain). Clinical true positive (CTP) MSAs and MAAs were defined as those patients with IIM or SAID with phenotypes expected of that MSA/MAA. Patients who did not have a phenotype compatible with that antibody were classified as clinical false positive (CFP). One hundred and thirty positive samples were analysed. Forty-six patients (33.38%) were classified as IIM, forty-two (32.3%) as SAID and forty-two (32.3%) as non-IIM/SAID. Among these 130 patients, 164 MSA/MAA were detected. Eighty-five (51.8%) positive MSA/MAA were classified as CTP, and seventy-nine (48.2%) as CFP. Strongly positive antibodies were more frequently CTP (35/47, 74.5%) than weak positives (54/68, 36.8%), (p ˂ 0.001). Antibodies classified as CTP had a higher signal intensity than CFP (36.77 AU vs 20.00 AU, CI95% 7.79-22.09, p ˂ 0.001). The probability of a CFP was associated to negative ANA, low ANA titer, and multiple positive MSA/MAA (p ˂ 0.001). In this study, we confirmed that CFP results using LIA are frequent, and are associated with low signal intensity MSA/MAA, negative ANA, lower titer ANA, and with multiple positive samples.
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Affiliation(s)
- Jesús Loarce-Martos
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Laura Calvo Sanz
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | - Ana García-Soidan
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Garbiñe Roy Ariño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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García-Fernández A, Morán-Álvarez P, Bachiller-Corral J, Vázquez-Díaz M. Low Positivity Rate of Anti-SARS-CoV-2 IgG in Unvaccinated Patients With Rheumatic Diseases Treated With Rituximab. J Clin Rheumatol 2022; 28:424-428. [PMID: 35696998 PMCID: PMC9722326 DOI: 10.1097/rhu.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Valero-Expósito M, Martín-López M, Guillén-Astete C, Joven B, Merino-Argumanez C, Emperiale V, Campos J, Pérez A, Bachiller-Corral J. Retention rate of secukinumab in psoriatic arthritis: Real-world data results from a Spanish multicenter cohort. Medicine (Baltimore) 2022; 101:e30444. [PMID: 36086678 PMCID: PMC10980406 DOI: 10.1097/md.0000000000030444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
Secukinumab is a novel anti-IL17 biologic treatment approved for the treatment of psoriatic arthritis (PsA). The purpose of the present study is to identify factors that can condition the retention rate of this drug in a real-world scenario. Methods: A multicentric retrospective study was conducted based on the registries of consecutive patients diagnosed with PsA who started secukinumab from January 2016 to December 2018. For purposes of Cox-regression analysis, the time spanning from the first administration of secukinumab until its interruption or the end of the follow-up was considered the independent variable. Variables of known relevance and those who demonstrated direct association with the drug retention rate were included in the model. Results: One hundred seventy-six registries were analyzed (average age at diagnosis 44.7 ± 12.1 years old, 114 females). The median retention rate of secukinumab was 636 days (95% confidence interval [CI] 542.4-729.5). Presence of peripheral arthritis (hazard ratio 0.424 [95% CI 0.213-0.847, P = .015]) and a time of evolution >6 years (hazard ratio 0.468 [95% CI 0.225-0.975, P = .043]) were the 2 variables that showed a significant influence on the drug retention rate. According to our results, patients who exhibit peripheral arthritis and those with a higher evolution time will have more probabilities of a larger secukinumab retention rate.
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Affiliation(s)
- Marta Valero-Expósito
- Rheumatology Department, Hospital Universitario Ramón y Cajal and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid, Spain
| | - María Martín-López
- Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Guillén-Astete
- Rheumatology Department, Hospital Universitario Ramón y Cajal and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid, Spain
| | - Beatriz Joven
- Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Valentina Emperiale
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá DE Henares, Madrid, Spain
| | - Jose Campos
- Rheumatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Pérez
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Alcalá DE Henares, Madrid, Spain
| | - Javier Bachiller-Corral
- Rheumatology Department, Hospital Universitario Ramón y Cajal and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid, Spain
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Loarce-Martos J, Calvo Sanz L, Garrote-Corral S, Rits C, Ballester Gonzalez R, García-Soidan A, Bachiller-Corral J, Roy G. POS0847 MYOSITIS AUTOANTIBODIES DETECTED BY LINE BLOT IMMUNOASSAY: CLINICAL ASSOCIATIONS AND CORRELATION WITH ANTIBODY TITERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIdiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases (AID) characterized by muscle inflammation and weakness, often accompanied with other organ involvement, such as skin rash or interstitial lung disease (ILD). Myositis specific (MSA) and myositis associated antibodies (MAA) can be detected in approximately 60% of patients with IIM. Besides, antibody titers have been suggested to be related with diagnostic accuracy, although it has not been widely studied. MSA are considered to be exclusive of patients with IIM, whilst MAA can occur in IIM and other systemic autoimmune diseases, nevertheless, most of the studies are focused exclusively on IIM patients.ObjectivesThe aim of this study is to assess the relationship between MSA/MAA and diagnosis (including IIM and other AID), and to explore the impact of antibody titers in diagnostic accuracy.MethodsWe retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA between 01/01/2018 and 31/12/2020 in the Immunology department of Ramón y Cajal University Hospital (Spain). These antibodies were tested by line blot immunoassay (LIA) (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag, Euroimmun, Lübeck, Germany). Positivity was stablished according to absorbance titer and adjusted by positive control of each test (arbitrary units, AU). True positive (TP) MSA and MAA were defined as those patients with IIM or AID with phenotypes expected of that MSA/MAA, according to the available information. The patients that did not have a phenotype compatible with that antibody were regarded as false positive (FP). Statistical analysis was carried out using IBM SPSS statistics version 22.ResultsWe analyzed 130 positive samples which corresponded to 130 patients, 85 were women and mean age was 55.08 years. 44 patients (33.8%) were classified as IIM, 43 (33.1%) as AID, and 43 (33.1%) as non-IIM/AID. Among these 130 patients, 164 MSA/MAA were detected. 83 (50.6%) positive MSA/MAA were regarded as TP, and 81 (49.4%) as FP (positive predictive value [PPV] 50.6%). Antibodies regarded as TP had a higher antibody titer compared to FP (49,19 AU vs 26,96 AU, p<0.001). This difference was statistically significant for MSA and MAA when analysed separately (Figure 1). FP antibodies were associated with negative ANA and low titer ANA (p<0.001). Multiple positive antibodies (antibodies included in samples that were positive for > 1 MSA/MAA) were more frequently FP in comparison with isolated positive MSA/MAA (p<0.001).Figure 1.Autoantibody titers comparison between false positives and true positives. MSA=myositis specific antibody, MAA=myositis associated antibody, FP=false positive, TP=true positiveConclusionIn this study we confirm that FP results using LIA are relatively frequent, and are associated with lower titer MSA/MAA, negative ANA, lower titer ANA, and with multiple positive MSA/MAA within one sample.References[1]Betteridge Z, Tansley S, Shaddick G, et al (2019) Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun 101:48–55. https://doi.org/10.1016/j.jaut.2019.04.001[2]Cavazzana I, Fredi M, Ceribelli A, et al (2016) Testing for myositis specific autoantibodies: Comparison between line blot and immunoprecipitation assays in 57 myositis sera. J Immunol Methods 433:1–5. https://doi.org/10.1016/j.jim.2016.02.017[3]Tansley SL, Li D, Betteridge ZE, McHugh NJ (2020) The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity. Rheumatol (United Kingdom) 59:2109–2114. https://doi.org/10.1093/rheumatology/keaa021[4]Mahler M, Betteridge Z, Bentow C, et al (2019) Comparison of Three Immunoassays for the Detection of Myositis Specific Antibodies. Front Immunol 10:848. https://doi.org/10.3389/fimmu.2019.00848Disclosure of InterestsNone declared
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Cavagna L, Meloni F, Meyer A, Sambataro G, Belliato M, De Langhe E, Cavazzana I, Pipitone N, Triantafyllias K, Mosca M, Barsotti S, Zampogna G, Biglia A, Emmi G, De Visser M, Van Der Kooi A, Parronchi P, Hirschi S, da Silva JAP, Scirè CA, Furini F, Giannini M, Martinez Gonzalez O, Damian L, Piette Y, Smith V, Mera-Valera A, Bachiller-Corral J, Cabezas Rodriguez I, Brandy-Garcia AM, Maurier F, Perrin J, Gonzalez-Moreno J, Drott U, Delbruck C, Schwarting A, Arrigoni E, Sebastiani GD, Iuliano A, Nannini C, Quartuccio L, Rodriguez Cambron AB, Blázquez Cañamero MÁ, Villa Blanco I, Cagnotto G, Pesci A, Luppi F, Dei G, Romero Bueno FI, Franceschini F, Chiapparoli I, Zanframundo G, Lettieri S, De Stefano L, Cutolo M, Mathieu A, Piga M, Prieto-González S, Moraes-Fontes MF, Fonseca JE, Jovani V, Riccieri V, Santaniello A, Montfort S, Bilocca D, Erre GL, Bartoloni E, Gerli R, Monti MC, Lorenz HM, Sambataro D, Bellando Randone S, Schneider U, Valenzuela C, Lopez-Mejias R, Cifrian J, Mejia M, Gonzalez Perez MI, Wendel S, Fornaro M, De Luca G, Orsolini G, Rossini M, Dieude P, Knitza J, Castañeda S, Voll RE, Rojas-Serrano J, Valentini A, Vancheri C, Matucci-Cerinic M, Feist E, Codullo V, Iannone F, Distler JH, Montecucco C, Gonzalez-Gay MA. Clinical spectrum time course in non-Asian patients positive for anti-MDA5 antibodies. Clin Exp Rheumatol 2022; 40:274-283. [PMID: 35200123 DOI: 10.55563/clinexprheumatol/di1083] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define the clinical spectrum time-course and prognosis of non-Asian patients positive for anti-MDA5 antibodies. METHODS We conducted a multicentre, international, retrospective cohort study. RESULTS 149 anti-MDA5 positive patients (median onset age 53 years, median disease duration 18 months), mainly females (100, 67%), were included. Dermatomyositis (64, 43%) and amyopathic dermatomyositis (47, 31%), were the main diagnosis; 15 patients (10%) were classified as interstitial pneumonia with autoimmune features (IPAF) and 7 (5%) as rheumatoid arthritis. The main clinical findings observed were myositis (84, 56%), interstitial lung disease (ILD) (108, 78%), skin lesions (111, 74%), and arthritis (76, 51%). The onset of these manifestations was not concomitant in 74 cases (50%). Of note, 32 (21.5%) patients were admitted to the intensive care unit for rapidly progressive-ILD, which occurred in median 2 months from lung involvement detection, in the majority of cases (28, 19%) despite previous immunosuppressive treatment. One-third of patients (47, 32% each) was ANA and anti-ENA antibodies negative and a similar percentage was anti-Ro52 kDa antibodies positive. Non-specific interstitial pneumonia (65, 60%), organising pneumonia (23, 21%), and usual interstitial pneumonia-like pattern (14, 13%) were the main ILD patterns observed. Twenty-six patients died (17%), 19 (13%) had a rapidly progressive-ILD. CONCLUSIONS The clinical spectrum of the anti-MDA5 antibodies-related disease is heterogeneous. Rapidly-progressive ILD deeply impacts the prognosis also in non-Asian patients, occurring early during the disease course. Anti-MDA5 antibody positivity should be considered even when baseline autoimmune screening is negative, anti-Ro52 kDa antibodies are positive, and radiology findings show a NSIP pattern.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | - Federica Meloni
- Transplant Centre Unit, IRCCS San Matteo Foundation and University of Pavia, Italy
| | - Alain Meyer
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Mirko Belliato
- UOC Anestesia e Rianimazione 2 Cardiopolmonare, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | - Marta Mosca
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Barsotti
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Alessandro Biglia
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Giacomo Emmi
- Internal Interdisciplinary Unit, Lupus Clinic, Careggi University Hospital and Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | | | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Sandrine Hirschi
- Pneumology, NHC, Strasbourg University Hospital, Strasbourg University, France
| | | | | | - Federica Furini
- Rheumatology, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Margherita Giannini
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Laura Damian
- Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Antonio Mera-Valera
- Rheumatology, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | | | | | | | | | - Julie Perrin
- Pneumology HPMetz, Hopital Belle-Ile, Metz, France
| | - Juan Gonzalez-Moreno
- Rheumatology, Internal Medicine Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Ulrich Drott
- Rheumatology, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
| | | | | | | | | | | | | | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine (DAME), University of Udine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | | | | | | | | | - Alberto Pesci
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabrizio Luppi
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giulia Dei
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | | | - Giovanni Zanframundo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Lettieri
- Pneumology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Ludovico De Stefano
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Maurizio Cutolo
- Rheumatology, University of Genova, DIMI, IRCCS San Martino, Genova, Italy
| | - Alessandro Mathieu
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | - Matteo Piga
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | | | | | - Joao Eurico Fonseca
- Serviço Reumatologia, Centro Hospitalar Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Vega Jovani
- Rheumatology, University Hospital, Alicante, Spain
| | - Valeria Riccieri
- Rheumatology, University La Sapienza and Policlinico Umberto I, Rome, Italy
| | - Alessandro Santaniello
- Scleroderma Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Gian Luca Erre
- Rheumatology, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | | | | | - M Cristina Monti
- Biostatistics Unit, Department of Public Health, University of Pavia, Italy
| | | | - Domenico Sambataro
- Artroreuma srl, Outpatient of Rheumatology accredited with the Italian National Health System, Mascalucia, Catania, Italy
| | | | - Udo Schneider
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Claudia Valenzuela
- Pneumology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Raquel Lopez-Mejias
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Jose Cifrian
- Pneumology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Mayra Mejia
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Monserrat-Ixchel Gonzalez Perez
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Sarah Wendel
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Giacomo De Luca
- Rheumatology, Università Vita-Salute, San Raffaele, Milano, Italy
| | | | | | - Philippe Dieude
- Rheumatology, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France
| | | | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Reinhard E Voll
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jorge Rojas-Serrano
- Rheumatology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | - Adele Valentini
- Radiology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Carlo Vancheri
- Pulmonology, Azienda Ospedaliera Universitaria Catania, Italy
| | | | - Eugen Feist
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Veronica Codullo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | | | | | - Miguel A Gonzalez-Gay
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
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Clemente D, Udaondo C, de Inocencio J, Nieto JC, Del Río PG, Fernández AG, Palomo JA, Bachiller-Corral J, Lopez Robledillo JC, Millán Longo C, Leon L, Abasolo L, Boteanu A. Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases. Pediatr Rheumatol Online J 2021; 19:162. [PMID: 34838054 PMCID: PMC8626725 DOI: 10.1186/s12969-021-00648-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/14/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death. METHODS An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020-March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes. RESULTS The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2-20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model. CONCLUSION No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.
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Affiliation(s)
- Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Clara Udaondo
- Pediatric Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Jaime de Inocencio
- Pediatric Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Carlos Nieto
- Rheumatology Department, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Pilar Galán Del Río
- Rheumatology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Jaime Arroyo Palomo
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Leticia Leon
- Rheumatology Department and IDISSC, Hospital Universitario Clinico San Carlos, Martin Lagos s/n, 28040, Madrid, Spain.
- Health Sciences Faculty, Universidad Camilo Jose Cela, Madrid, Spain.
| | - Lydia Abasolo
- Rheumatology Department and IDISSC, Hospital Universitario Clinico San Carlos, Martin Lagos s/n, 28040, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Strangfeld A, Schäfer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, Mateus EF, Richez C, Santos MJ, Schmajuk G, Scirè CA, Sirotich E, Sparks JA, Sufka P, Thomas T, Trupin L, Wallace ZS, Al-Adely S, Bachiller-Corral J, Bhana S, Cacoub P, Carmona L, Costello R, Costello W, Gossec L, Grainger R, Hachulla E, Hasseli R, Hausmann JS, Hyrich KL, Izadi Z, Jacobsohn L, Katz P, Kearsley-Fleet L, Robinson PC, Yazdany J, Machado PM. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021; 80:930-942. [PMID: 33504483 PMCID: PMC7843211 DOI: 10.1136/annrheumdis-2020-219498] [Citation(s) in RCA: 435] [Impact Index Per Article: 145.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/17/2020] [Accepted: 01/02/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To determine factors associated with COVID-19-related death in people with rheumatic diseases. METHODS Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. RESULTS Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. CONCLUSION Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
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Affiliation(s)
- Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Martin Schäfer
- Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Milena A Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
- European League Against Rheumatism (EULAR) Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Kilchberg, Switzerland
| | - Christophe Richez
- Club Rhumatismes et Inflammation (CRI) and Immune-Mediated Inflammatory Disease Alliance for Translational and Clinical Research Network (IMIDIATE), Bordeaux, France
| | - Maria J Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
- Rheumatic Diseases Portuguese Register (Reuma.pt), Portuguese Society of Rheumatology (SPR), Lisbon, Portugal
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Carlo A Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy and Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Thierry Thomas
- Société Française de Rhumatologie (SFR), Saint Etienne, France
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon-Université Jean Monnet, Saint-Etienne, France
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Zachary S Wallace
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Al-Adely
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Javier Bachiller-Corral
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de investigación IRYCIS, Universidad de Alcalá, Madrid, Spain
| | | | - Patrice Cacoub
- Département de Médecine Interne et Immunologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France
- Société Nationale Française de Médecine Interne (SNFMI), Paris, France
| | | | - Ruth Costello
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France
- AP-HP.Sorbonne Université, Rheumatology department, Pitié-Salpêtrière hospital, Paris, France
| | | | - Eric Hachulla
- Filière des maladies Auto-Immunes et Autoinflammatoires Rares (FAI2R), Lille University, France, Lille University, Lille, France
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, ustus-Liebig-University Giessen, Giessen, Germany
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, MA, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kimme L Hyrich
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Zara Izadi
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Pedro M Machado
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS TrustLondon North West University Healthcare NHS Trust, London, UK
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
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13
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Hernández-Breijo B, Plasencia-Rodríguez C, Navarro-Compán V, García-Hoz C, Nieto-Gañán I, Sobrino C, Bachiller-Corral J, Díaz-Almirón M, Martínez-Feito A, Jurado T, Lapuente-Suanzes P, Bonilla G, Pijoán-Moratalla C, Roy G, Vázquez-Díaz M, Balsa A, Villar LM, Pascual-Salcedo D, Rodríguez-Martín E. Remission Induced by TNF Inhibitors Plus Methotrexate is Associated With Changes in Peripheral Naïve B Cells in Patients With Rheumatoid Arthritis. Front Med (Lausanne) 2021; 8:683990. [PMID: 34222289 PMCID: PMC8245775 DOI: 10.3389/fmed.2021.683990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022] Open
Abstract
Biological therapies, such as TNF inhibitors (TNFi), are increasing remission (REM) rates in rheumatoid arthritis (RA) patients, although these are still limited. The aim of our study was to analyze changes in the profile of peripheral blood mononuclear cells (PBMC) in patients with RA treated with TNFi in relation to the clinical response. This is a prospective and observational study including 78 RA patients starting the first TNFi. PBMC were analyzed by flow cytometry both at baseline and at 6 months. Disease activity at the same time points was assessed by DAS28, establishing DAS28 ≤ 2.6 as the criteria for REM. Logistic regression models were employed to analyze the association between the changes in PBMC and REM. After 6 months of TNFi treatment, 37% patients achieved REM by DAS28. Patients who achieved REM showed a reduction in the percentage of naive B cells, but only when patients had received concomitant methotrexate (MTX) (OR: 0.59; 95% CI: 0.39–0.91). However, no association was found for patients who did not receive concomitant MTX (OR: 0.85; 95% CI: 0.63–1.16). In conclusion, PBMC, mainly the B-cell subsets, are modified in RA patients with TNFi who achieve clinical REM. A significant decrease in naive B-cell percentage is associated with achieving REM after 6 months of TNFi treatment in patients who received concomitant therapy with MTX.
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Affiliation(s)
- Borja Hernández-Breijo
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Chamaida Plasencia-Rodríguez
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.,Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Victoria Navarro-Compán
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.,Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Carlota García-Hoz
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Israel Nieto-Gañán
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Sobrino
- Rheumatology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Bachiller-Corral
- Rheumatology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariana Díaz-Almirón
- Biostatistics Unit, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Ana Martínez-Feito
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.,Immunology, La Paz University Hospital, Madrid, Spain
| | - Teresa Jurado
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Paloma Lapuente-Suanzes
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Gema Bonilla
- Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Cristina Pijoán-Moratalla
- Rheumatology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Garbiñe Roy
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mónica Vázquez-Díaz
- Rheumatology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alejandro Balsa
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.,Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Luisa M Villar
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Dora Pascual-Salcedo
- Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Eulalia Rodríguez-Martín
- Immunology, Ramón y Cajal Institute for Health Research, Hospital Universitario Ramón y Cajal, Madrid, Spain
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14
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Hernández-Breijo B, Rodríguez-Martín E, García-Hoz C, Navarro-Compán V, Sobrino C, Martínez-Feito A, Nieto-Gañán I, Bachiller-Corral J, Lapuente-Suanzes P, Bonilla G, Pijoán-Moratalla C, Vázquez M, Balsa A, Pascual-Salcedo D, Villar LM, Plasencia C. POS0623 CYTOKINE PRODUCTION BY BLOOD LYMPHOCYTES DEFINES A PROFILE ASSOCIATED WITH NON-REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF INHIBITORS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In clinical practice no more than 50% of the patients treated with TNF inhibitors (TNFi) achieve remission (REM). Previous investigations suggested that peripheral blood mononuclear cells (PBMC) may be markers associated with the TNFi treatment success1.Objectives:This study aims to analyse the intracellular cytokine production by PBMC and its association with REM achievement after 6 months (m) of TNFi treatment in patients with RA.Methods:This was a prospective study including 62 patients with RA starting the 1st TNFi. PBMC were isolated from patients at baseline and after 6m of treatment with TNFi and cryopreserved until studied. In vitro stimulation and intracellular cytokine production by PBMC was performed as follow: in the presence of 2µg/mL brefeldin and 2µmol/L monensin monocytes were stimulated with 20ng/mL LPS during 4h whereas lymphocytes were stimulated with 50ng/mL phorbol 12-myristate 13-acetate and 750ng/mL ionomycin for 4h at 37°C. To identify IL10-producing B cells, PBMC were pre-incubated with 3µg/mL of CpG oligonucleotide during 20h at 37°C prior to stimulation. Intracellular cytokine production (TNFα, IL6, GM-CSF, IL10) by the different cell subsets (monocytes, CD4+ and CD8+ T cells, naïve and memory B cells) was analysed by flow-cytometry. Clinical activity at baseline and after 6m was assessed by DAS28-ESR. REM was defined as DAS28≤2.6 at 6m. The association between cytokine production by each PBMC subset and REM was analysed through univariable and multivariable logistic regression models. Receiving operating curve (ROC) analysis was used to select the optimal ratio of cytokine production associated with REM status.Results:After 6m of TNFi treatment, 30 (48%) patients achieved REM. No significant differences between REM and non-REM groups were observed for patients’ characteristics at baseline except for DAS28, which was lower in the REM group (non-REM: 5.4±0.9; REM: 4.3±0.9; p<0.0001) (Table 1). Therefore, further analyses were adjusted by baseline DAS28. A lower ratio between calculated with the IL10 and TNFα production by B cells and by CD4+ T cells (IL10 B/TNF CD4) at 6m was found for non-REM patients (non-REM: 0.31 vs REM: 0.54; p=0.007). Based on a ROC analysis, we found that a (IL10 B/TNF CD4)<0.54 at 6 m was significantly associated with a higher probability of non-REM at 6 months (OR: 5.0; 95% CI: 1.1-21.7) (Figure 1).Table 1.Baseline predictors of reduction of disease activity at 12 months from start of abatacept. Linear regression.Baseline patients’ characteristicsTotal patients (n=62)DAS28>2.6(n=32; 52%)DAS28≤2.6(n=30; 48%)p-valueAge (years)53±1253±1352±100.8Female55 (89)30 (94)25 (83)0.2Disease duration (years)8 (4-11)8 (4-12)7 (3-11)0.7RF positive49 (79)23 (72)26 (87)0.1ACPA positive54 (87)26 (81)28 (93)0.2Smoking habit (n=55)0.2Non-smokers26 (47)16 (55)10 (38) Smoker29 (53)13 (45)16 (51)Body mass index (kg/m2)25.9±5.625.8±5.726.0±5.60.9DAS284.9±1.05.4±0.94.3±0.9<0.0001Concomitant csDMARDs60 (97)32 (100)28 (93)0.3MTX [±OD]46 (74)26 (81)20 (67)0.3Only OD14 (23)6 (19)8 (26)0.3Prednisone36 (58)19 (59)17 (57)0.9Conclusion:Our results show that the proinflammatory IL10 B/TNF CD4 ratio is associated with non-REM status. It could be useful to analyse the success of TNFi treatment in patients with RA.References:[1]Rodríguez-Martín E, et al. Front Immunol. 2020; 11: 1913.Acknowledgements:ISCIII (PI16/00474; PI16/01092)Disclosure of Interests:Borja Hernández-Breijo: None declared, Eulalia Rodríguez-Martín: None declared, Carlota García-Hoz: None declared, Victoria Navarro-Compán Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Cristina Sobrino: None declared, ANA MARTÍNEZ-FEITO: None declared, Israel Nieto-Gañán: None declared, Javier Bachiller-Corral Speakers bureau: Abbvie, MSD, BMS and Roche, Grant/research support from: Pfizer, Paloma Lapuente-Suanzes: None declared, Gemma Bonilla: None declared, Cristina Pijoán-Moratalla: None declared, Mónica Vázquez: None declared, Alejandro Balsa Speakers bureau: Abbvie, BMS, Nordic, Novartis, Pfizer, Sandoz, Sanofi, Roche and UCB, DORA PASCUAL-SALCEDO: None declared, Luisa María Villar: None declared, Chamaida Plasencia Speakers bureau: AbbVie, Lilly, Novartis, Pfizer, Sanofi, Biogen and UCB
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Boteanu A, García Fernández A, De la Torre N, Pavia Pascual M, Sanchez Pernaute O, Recuero Diaz S, Perez Esteban S, Bonilla G, Nuño L, Sanmartin Martinez JJ, Bonilla Gonzalez-Leganá C, Clemente Garulo D, Lojo Oliveira L, Rodríguez Herredia JM, Bachiller-Corral J. POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared
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García Fernández A, Morán Álvarez P, Bachiller-Corral J, Vázquez Díaz M. POS1204 LOW POSITIVITY RATE IN ANTIBODY SARS-COV2 TESTS IN PATIENTS WITH RHEUMATIC DISEASES TREATED WITH RITUXIMAB. A CASE CONTROL STUDY OF A HIGH IMPACT SARS-COV2 INFECTION AREA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Diagnosis of previous SARS-COV2 infection may be challenging in immunocompromised patients.Objectives:To analyze positivity rate to SARS-COV2 antibody tests (SC2AT) in patients diagnosed of rheumatic diseases (RMD) treated with Rituximab.Methods:We conducted a case-control study of patients diagnosed of RMD followed in a referral hospital in Madrid, Spain. Positivity rate to IgG-SC2AT were analyzed in Rituximab-treated patients (RTX) compared with patients treated with TNF inhibitors (TNFi) and/or conventional DMARDs (cDMARDs) (N-RTX).We included patients that received Rituximab in the previous year to a confirmed SARS-COV2 infection (defined as a positive polymerase chain reaction test (PCR) and/or compatible chest Xray), to a suspected SARS-COV2 infection (2 or more symptoms) or to SC2AT determination. Patients with RMD treated with other biological DMARDs (bDMARDs) rather than Rituximab or TNFi were excluded.Results:We included 152 patients with RMD who underwent a SC2AT. Main characteristics are reported in Table 1.Among RTX and N-RTX, 4/48 (8.3%) and 35/104 (33.7%) showed a positive IgG-SC2AT, respectively. Four out of 104 (38.5%) N-RTX tested positive without previous symptoms. No asymptomatic infection was diagnosed among RTX.Univariable analysis showed a lower rate of positivity to SC2AT in confirmed and suspected infection among RTX [Positive IgG-SC2AT in confirmed infection: RTX 4/10 (40%), N-RTX 16/20 (80%); p=0.045. Positive IgG-SC2AT in suspected infection: RTX 0/3 (0%), N-RTX 15/18 (83.3%); p=0.015].A logistic binary regression identified previous symptoms [OR 61.2, 95CI(13.3-280.6) p=0.0001], male sex [OR 4.8, 95CI(1.3-17.8) p=0.02], non-rituximab treatment [OR 19.7, 95CI(3.6-106.3) p=0.001] as independent factors associated with a higher probability of positive IgG-SC2AT. Age, previous PCR status, corticosteroid and cDMARD use showed no statistical significance. This model accounted for 47.6% of positive cases.Table 1.Main characteristics. AS, axial spondylitis; bDMARDs, biological disease-modifying anti-rheumatic drugs; cDMARDs, conventional DMARDs; COPD, Chronic obstructive pulmonary disease; CVD, Cardiovascular disease; IMM, immune-mediated myositis; JIA, Juvenile Idiopathic arthritis; PsoA, Psoriatic Arthritis; RA, Rheumatoid Arthrtis; SLE, Systemic Lupus Erythematosus; SSc, Systemic Sclerosis; SSj, Sjogren Syndrome.Rituximab (RTX)Non-Rituximab (N-RTX)p valuePatients, n (%)48 (31.6)104 (68.4)Age, years, median (IQR)65 (54-72)60 (47-71.8)p= 0.190Female, n (%)38 (79.2)74 (71.2)p=0.297Diagnosis, n (%)p=0.2- RA20 (41.7)42 (40.4)- SSj4 (8.3)6 (5.8)- RA SSj3 (6.3)0 (0)- SLE4 (8.3)8 (7.7)- Vasculitis7 (14.6)13 (12.5)- IMM1 (2.1)4 (3.8)- JIA2 (4.2)3 (2.9)- SSc7 (14.6)15 (14.4)- AS0 (0)4 (3.8)- PSoA0 (0)5 (4.8)- Othersa0 (0)4 (3.8)Comorbidities, n (%)- Hypertension18 (37.5)34 (32.7)p=0.561- Diabetes5 (10.4)10 (9.6)p=0.878- Dyslipidemia18 (37.5)30 (28.8)p=0.286- COPD/asthma6 (12.5)4 (3.8)p=0.049*- CVD11 (35.4)25 (24)p=0.831Interstitial lung disease, n (%)17 (35.4)8 (7.7)p<0.0001*Corticosteroids use, n (%)26 (54.2)33 (31.7)p=0.008*cDMARDs use, n (%)27 (56.3)73 (70.2)p=0.092bDMARDs, n (%)-- None0 (0)83 (79.8)- TNF inhibitors0 (0)21 (20.2)- Rituximab48 (100)0 (0)Previous positive PCR, n (%)- Time from positive PCR to SC2AT, days, mean ±SD8 (16.7)47.4 (38.7)20 (19.2)65.1 (49)p=0.191p=0.368Previous symptoms, n (%)- Time from symptom onset to SC2AT, days, mean ±SD13 (27.1)130.3 ±91.136 (34.6)93.5 ±72.6p=0.356p=0.15COVID, n (%)p=0.183- Non suspected35 (72.9)66 (63.5)- Suspected3 (6.3)18 (17.3)- Confirmed10 (20.8)b20 (19.2)aIncluding gout, polymyalgia rheumatica.bTwo patients had negative PCR but compatible symptoms and chest X-Ray.Conclusion:RTX had a lower rate of positivity to IgG-SC2AT compared to N-RTX. Previous symptoms, male sex and non-RTX treatment were independently associated with higher probability of positive IgG-SC2AT.Disclosure of Interests:None declared.
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Dahir KM, Mcginniss J, Mellis S, Sanchez RJ, Rocco MD, Keen R, Orcel P, Funck-Brentano T, Roux C, Kolta S, Madeo A, Bubbear JS, Tabarkiewicz J, Szczepanek M, Bachiller-Corral J, Cheung AM, Botman E, Mukaddam MA, Tile L, Portal-Celhay C, Sarkar N, Hou P, Forleo-Neto E, Rankin AJ, Economides AN, Trotter DG, Eekhoff EMW, Kaplan FS, Pignolo RJ. Garetosmab Reduces Flare-ups in Patients With Fibrodysplasia Ossificans Progressiva. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, autosomal dominant disorder driven by mutations in ACVR1 that render it responsive to Activin A. FOP is characterized by progressive heterotopic ossification (HO) and distressing inflammatory events called “flare-ups.” Flare-ups can precede new HO; however, limited prospective data exists on this phenomenon. Garetosmab (GAR), an investigational human monoclonal antibody against Activin A, blocks formation of new HO in FOP. Methods: This is a post-hoc analysis of LUMINA-1 (NCT03188666) a phase 2, randomized, double-blind, placebo-controlled study, which evaluated the safety and efficacy of GAR (10 mg/kg/week IV) versus placebo (PBO) in adult patients with FOP over 28 weeks. Patient-reported flare-ups were collected via a patient diary and severity level was reported as mild, moderate or severe. Clinician-reported flare-ups were collected as adverse events in the trial. HO lesions were imaged by 18F-NaF positron emission tomography (PET) and whole-body low-dose X-ray computed tomography (CT). Results: There was a two-fold higher proportion of patients who reported one or more flare-ups on PBO 17/24 (71%) compared with GAR 7/20 (35%). Clinicians reported a four-fold higher proportion of patients experiencing one or more flare-ups on PBO 10/24 (42%) compared with GAR 2/20 (10%). Overall rates of flare-up events were two-fold higher on PBO vs. GAR (1.4 vs. 0.65 events/patient/28 weeks) for patient-reported events and eight-fold higher on PBO vs. GAR by clinician report (0.83 vs. 0.10 events/patient/28 weeks). Most flare-ups occurred on the extremities and back; pain was the most commonly reported symptom. Patient-reported flare-ups on PBO were more frequently reported as severe (29.4%) compared with GAR (7.7%). Among subjects with at least 12 weeks of follow-up from start of patient-reported flare-up, development of new HO near the site was 5/27 (18.5%) on PBO and (0%) on GAR. Of all new HO lesions, 41% on PBO and 0% on GAR occurred with spatial and temporal relation to flare-up. Conclusions: Approximately two-thirds of patients on PBO reported flare-ups over 28 weeks. GAR was associated with reductions in frequency and severity of flare-ups. Fewer than 20% of patient-reported flare-ups were associated with new HO, indicating frequent discordance of these phenomena, and compatible with previous reports. GAR’s ability to reduce patient- and clinician-reported flare-ups, as well as new HO lesions may provide an important therapeutic option.
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Affiliation(s)
| | | | | | | | | | - Richard Keen
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, United Kingdom
| | - Philippe Orcel
- AP-HP.Nord - Université de Paris and INSERM U1132 Bioscar, Paris, France, Paris, France
| | - Thomas Funck-Brentano
- AP-HP.Nord - Université de Paris and INSERM U1132 Bioscar, Paris, France, Paris, France
| | - Christian Roux
- Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sami Kolta
- Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Judith S Bubbear
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, United Kingdom
| | | | | | | | | | - Esmée Botman
- Amsterdam UMC, Vrije Universiteit, Amsterdam Bone Center, Amsterdam, Netherlands
| | - Mona Al Mukaddam
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | - E Marelise W Eekhoff
- Amsterdam UMC, Vrije Universiteit, Amsterdam Bone Center, Amsterdam, Netherlands
| | - Frederick S Kaplan
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Bachiller-Corral J, Boteanu A, Garcia-Villanueva MJ, de la Puente C, Revenga M, Diaz-Miguel MC, Rodriguez-Garcia A, Morell-Hita JL, Valero M, Larena C, Blazquez-Cañamero M, Guillen-Astete CA, Garrote S, Sobrino C, Medina-Quiñones C, Vazquez-Diaz M. Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases. J Rheumatol 2021; 48:1098-1102. [PMID: 33722949 DOI: 10.3899/jrheum.200755] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD. METHODS This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19. RESULTS Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9). CONCLUSION Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.
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Affiliation(s)
- Javier Bachiller-Corral
- J. Bachiller-Corral, MD, Assistant Head, A. Boteanu, MD, Assistant Head, M. Vazquez-Diaz, MD, Department Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid;
| | - Alina Boteanu
- J. Bachiller-Corral, MD, Assistant Head, A. Boteanu, MD, Assistant Head, M. Vazquez-Diaz, MD, Department Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid
| | - Maria Jesus Garcia-Villanueva
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Carlos de la Puente
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Marcelino Revenga
- M. Revenga, MD, PhD, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, and Facultad de Medicina. Universidad de Alcalá, Alcalá de Henares, Spain
| | - M Consuelo Diaz-Miguel
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Ana Rodriguez-Garcia
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Jose Luis Morell-Hita
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Marta Valero
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Carmen Larena
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Maria Blazquez-Cañamero
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Carlos A Guillen-Astete
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Sandra Garrote
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Cristina Sobrino
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Carmen Medina-Quiñones
- M.J. Garcia-Villanueva, MD, Assistant Head, C. de la Puente, MD, Assistant Head, M.C. Diaz-Miguel, MD, Assistant Head, A. Rodriguez-Garcia, MD, Assistant Head, J.L. Morell-Hita, MD, Assistant Head, M. Valero, MD, Assistant Head, C. Larena, MD, Assistant Head, M. Blazquez-Cañamero, MD, Assistant Head, C.A. Guillen-Astete, MD, PhD, Assistant Head, S. Garrote, MD, Assistant Head, C. Sobrino, MD, Assistant Head, C. Medina-Quiñones, MD, Assistant Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid
| | - Mónica Vazquez-Diaz
- J. Bachiller-Corral, MD, Assistant Head, A. Boteanu, MD, Assistant Head, M. Vazquez-Diaz, MD, Department Head, Department of Rheumatology, Hospital Universitario Ramón y Cajal, and Irycis (Instituto Ramón y Cajal de investigación sanitaria), Madrid
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Martín-Martínez MA, Castañeda S, Sánchez-Alonso F, García-Gómez C, González-Juanatey C, Sánchez-Costa JT, Belmonte-López MA, Tornero-Molina J, Santos-Rey J, Sánchez González CO, Quesada E, Moreno-Gil MP, Cobo-Ibáñez T, Pinto-Tasnde JA, Babío-Herráez J, Bonilla G, Juan-Mas A, Manero-Ruiz FJ, Romera-Baurés M, Bachiller-Corral J, Chamizo-Carmona E, Uriarte-Ecenarro M, Barbadillo C, Fernández-Carballido C, Aurrecoechea E, Möller-Parrera I, Llorca J, González-Gay MA. Cardiovascular mortality and cardiovascular event rates in patients with inflammatory rheumatic diseases in the CARdiovascular in rheuMAtology (CARMA) prospective study—results at 5 years of follow-up. Rheumatology (Oxford) 2020; 60:2906-2915. [DOI: 10.1093/rheumatology/keaa737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Objectives
To determine cardiovascular (CV) mortality and incidence of the first CV event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) after 5 years of follow-up.
Methods
This is an analysis of the CARdiovascular in rheMAatology (CARMA) study after 5 years of follow-up. It includes patients with RA (n = 775), AS (n = 738) and PsA (n = 721), and individuals without CIRD (n = 677) attending outpatient rheumatology clinics from 67 public hospitals in Spain. Descriptive analyses were performed for the CV mortality at 5 years. The Systematic COronary Risk Evaluation (SCORE) function at 5 years was calculated to determine the expected risk of CV mortality. Poisson models were used to estimate the incidence rates of the first CVE. Hazard ratios of the risk factors involved in the development of the first CVE were evaluated using the Weibull proportional hazard model.
Results
Overall, 2382 subjects completed the follow-up visit at 5 years. Fifteen patients died due to CVE. CV deaths observed in the CIRD cohort were lower than that predicted by SCORE risk charts. The highest incidence rate of CVE [7.39 cases per 1000 person-years (95% CI 4.63, 11.18)] was found in PsA patients. However, after adjusting for age, sex and CV risk factors, AS was the inflammatory disease more commonly associated with CVE at 5 years [hazard ratio 4.60 (P =0.02)], compared with those without CIRD.
Conclusions
Cardiovascular mortality in patients with CIRD at 5 years of follow-up is lower than estimated. Patients with AS have a higher risk of developing a first CVE after 5 years of follow-up.
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Affiliation(s)
| | - Santos Castañeda
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
- Cátedra UAM-ROCHE, EPID-Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Carmen García-Gómez
- Division of Rheumatology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | | | | | | | - Jesús Tornero-Molina
- Division of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - José Santos-Rey
- Division of Rheumatology, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Estefanía Quesada
- Division of Rheumatology, Hospital Universitario Vall D’Hebron, Barcelona, Spain
| | - María P Moreno-Gil
- Division of Rheumatology, Complejo Hospitalario de Cáceres, Cáceres, Spain
| | - Tatiana Cobo-Ibáñez
- Division of Rheumatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - José A Pinto-Tasnde
- Division of Rheumatology, Complejo Hospitalario Universitario A Coruña, Spain
| | | | - Gema Bonilla
- Division of Rheumatology, Hospital Universitario de La Paz, Madrid, Spain
| | - Antonio Juan-Mas
- Division of Rheumatology, Hospital Sont Llatzer, Palma de Mallorca, Spain
| | | | | | | | | | - Mirem Uriarte-Ecenarro
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | - Carmen Barbadillo
- Division of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Elena Aurrecoechea
- Division of Rheumatology, Hospital U. Sierrallana, Torrelavega, Santander, Spain
| | | | - Javier Llorca
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain, Spain
- School of Physiology, Faculty of Health Sciences, Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, South Africa
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Morán Álvarez P, Bachiller-Corral J, Gorospe Sarasúa L, de la Puente Bujidos C. Pleuroparenchymal Fibroelastosis: A New Entity of Interstitial Pneumonia Related to Connective Tissue Diseases. Reumatol Clin (Engl Ed) 2020; 16:513-514. [PMID: 30391159 DOI: 10.1016/j.reuma.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Luis Gorospe Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
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Rivas-García S, Bernal J, Bachiller-Corral J. Rhabdomyolysis as the main manifestation of coronavirus disease 2019. Rheumatology (Oxford) 2020; 59:2174-2176. [PMID: 32584414 PMCID: PMC7337803 DOI: 10.1093/rheumatology/keaa351] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - J Bernal
- Internal Medicine Department, Madrid, Spain
| | - J Bachiller-Corral
- Rheumatology Department, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Briones-Figueroa A, Tortosa-Cabañas M, Blanco Cáceres BA, Bachiller-Corral J, Vázquez Díaz M. AB0279 IMPACT OF DISEASE-MODIFYING DRUGS IN SECOND BIOLOGICAL TREATMENT SURVIVAL IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Several studies have proposed that the immunosenescence of elderly patients with Rheumatoid Arthritis (RA) in treatment with biological therapies could eliminate the need for concomitant immunosuppression with disease-modifying drugs (DMARDs), due to a probable lower production of anti-drug antibodies; however, the evidence is limited.Objectives:To compare the characteristics of patients with RA who started a second biological agent, according to age groups. To analyse second biological agent survival and its relationship with DMARDs.Methods:Retrospective, observational and longitudinal study. Patients with RA who started a second biologic between 2000 and 2019, who discontinued a first-line TNF inhibitor, were included. Demographic, clinical and analytical data were obtained. The sample was divided in 2 groups: <70 and ≥70 years old. A comparative analysis was performed. Kaplan-Meier curves and Log-rank were used to conduct the survival analysis.Results:156 patients were included. 83.3% were women, with a mean age at the beginning of second biological treatment of 54.64±13.54 years. 22 patients (14.1%) were ≥70 years. Comparative analysis is detailed in table 1: patients ≥70 years presented a longer time from diagnosis to the start of biological treatment, and a higher prevalence of hypertension and diabetes mellitus. The main cause of withdrawal in this group was adverse events (46.67%) while in younger patients was treatment failure (25.27% primary failure, 29.66% secondary failure). The most frequent biological agent in ≥70 years was Rituximab (27.26%) while in <70 years was Etanercept (26.12%). 126 patients (80.8%) had a DMARD associated. In both groups, Methotrexate was the most frequent (table 2). The second biological agent survival analysis showed that patients who received a DMARD presented a higher survival [77 months (55.50-98.55) vs. 51.53 months (41.67-61.40); p=0.023]. After conducting a survival analysis in patients whose withdrawal cause was treatment failure, DMARDs use was associated with an increased biological agent survival in patients <70 years [103.48 months (82.28-124.68) vs. 81.95 months (66.05-97.86); p=0.037]; but statistical differences were not found in patients ≥70 years [117.33 months (82.15-152.52) vs. 65.07 months (40.72-89.42); p=0.291].Table 1.Variable<70 years = 134 (mean ± SD or %)≥70 years = 22 (mean ± SD or %)pAge at diagnosis (years)40.5 ± 12.358.8 ± 8.9<0.001Age at the beginning of the treatment (years)51.28 ± 11.4475.14 ± 3.5<0.001Time since diagnosis (years)10.65 ± 8.2016.27 ± 9.090.003Women113 (84.33%)17 (77.27%)0.373Smokers29 (21.64%)2 (9.09%)0.320Rheumatoid factor positive109 (81.34%)17 (77.27%)0.770Anti-CCP positive114 (90.48%)14 (82.35%)0.390Erosions92 (70.23%)16 (76.19%)0.576Arterial hypertension28 (21.37%)14 (66.67%)<0.001Diabetes mellitus3 (2.24%)4 (18.18%)<0.001Retirement91 (67.91%)15 (68.18%)0.980Infections10 (7.46%)3 (13.64%)0.397Second biological agent withdrawal causePrimary failure23 (25.27%)3 (20%)0.242Secondary failure27 (29.66%)3 (20%)Adverse events25 (27.47%)7 (46.67%)Remission2 (2.20%)0 (0%)Exitus3 (3.30%)0 (0%)Neoplasia3 (3.30%)0 (0%)Table 2.Disease-modifying drug<70 years old≥70 years oldpMethotrexate72 (53.73%)9 (40.91%)0.667Leflunomide22 (16.42%)5 (22.73%)Sulfasalazine2 (1.49%)1 (4.55%)Hydroxychloroquine6 (4.48%)0 (0%)At least two of the above7 (5.22%)1 (4.55%)Conclusion:DMARD concomitant treatment has been related to a higher second biological treatment survival. This beneficial effect was not observed in RA patients ≥70 years of age whose second biological agent withdrawal cause was failure. In this age group, withdrawal related to adverse events was more frequent.References:[1]Kalden JR, Schulze-Koops H. Immunogenicity and loss of response to TNF inhibitors: implications for rheumatoid arthritis treatment. Nature reviews Rheumatology. 2017;13(12):707-718.Disclosure of Interests:None declared
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Valero M, Bachiller-Corral J, Blanco Cáceres BA, Blázquez MÁ, Díaz-Miguel C, Garcia Villanueva MJ, Larena C, Morell Hita JL, De la Puente Bujidos C, Rodriguez-García A, Vázquez Díaz M, Moltó A. FRI0301 DO PATIENTS AND PHYSICIANS AGREE ON THE DEFINITION OF REMISSION AND LOW DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Current recommendations for axial Spondyloarthritis (axSpA) include the treat-to-target concept and suggest that the ideal target should be remission or low disease activity (LDA). Also, the importance of a shared decision is highlighted. Unfortunately, the definition of remission is not consensual, and most of the definitions are difficult to evaluate in clinical practiceObjectives:To propose an evaluation of remission by a single question to the patient, by comparing it to the different available definitions. To analyze the metric properties of the current definitions against patient’s perceptionMethods:One-center cross-sectional study in a tertiary care hospital including consecutive patients with a diagnosis of axSpA (and fulfilling the ASAS criteria) were included between February to November 2019. Patient’s perception of remission and LDA was evaluated by a single question. Physician’s perception of remission and LDA was assessed identically. The level of agreement between patients’ perception and the other available definitions was tested by the Prevalence and Bias adjusted Kappa (PABAK). The metric properties Sensitivity (S) and Specificity (Sp) of the available definitions (BASDAI cut-offs, ASDAS disease states, ASAS criteria for partial remission and patient acceptable symptom state), were tested against the patients perspective, as the gold standard.Results:A total of 105 axSpA patients were included. 63,8% were males and 67,6% had radiographic sacroiliitis (Table 1). 21% and 72% of them considered themselves in remission and LDA, respectively. Physician’s perception was 45.7% and 81% for remission and LDA, respectively. The prevalence of the different definitions are shown in Figure 1. The best agreement for patients’s perception of remission was found with a BASDAI <2 + normal CRP (Table 2). This definition was also the most sensitive (S=72,7%) and specific (Sp=83,1%) when taking the patient’s perception as a reference.Table 1.Characteristics of 105 patients with axSpAAll (N:105)Patients in self-defined REM (N:22)Patients in self-defined LDA (N:54)Patients No REM no LDA (N:29)Male, n (%)67 (63,8)18 (81,8)34 (63)15 (51,7)r-axSpA, n (%)71 (67,6)17 (77,3)33 (61,1)21 (72,4)Mean age, years (SD)49 (13)51(15)47 (13)50 (11)Mean AxSpA duration, years (SD)12,2 (13)17,1 (16,2)11,2 (11,7)10,3 (12,3)HLA- B27+, n (%)Data from 10472 (69,2)17/22 (77,3)33/54 (61,1)22/28 (78,6)Periferic arthritis, n (%)34 (32,4)7 (31,8)17 (31,5)10 (45,4)Uveitis, n (%)22 (21)6 (27,3)10 (18,5)6 (20,7)Biological treatment, n (%)43 (41)14 (63,6)19 (35,1)10 (34,5)CRP, mean (SD)3,61 (5,36)2,31 (2,17)2,84 (3,87)6,04 (8,14)ASDAS, mean (SD)1,78 (1,08)0,98 (0,71)1,63 (0,89)2,68 (1,03)BASDAI, mean (SD)3,35 (2,32)1,39 (1,30)3,13 (1,84)5,26 (2,33)BASFI, mean (SD)2,81 (2,45)1,24 (1,37)2,57 (2,00)4,43 (2,92)Table 1.REM: Remission; LDA: Low Disease Activity; SD: Standard Desviation; CRP: C-Reactive Protein IBD: Inflammatory Bowel Disease.Table 2.Agreement between different definitions of remissionASDAS <1,3BASDAI<2+Normal CRPPGA ≤1PhysicianREMPatientREMASAS PR0.53 (0.58)0.59 (0.68)0.76 (0.83)0.22 (0.26)0.39 (0.56)ASDAS <1,30.64 (0.68)0.50 (0.56)0.44 (0.45)0.28 (0.37)BASDAI <2+Normal CRP0.60 (0.69)0.25 (0.28)0.50 (0.62)PGA ≤10.20 (0.24)0.42 (0.62)Physician REM0.20 (0.24)Agreement is presented as Cohen’s Kappa (PABAK: prevalence and bias adjusted kappa).Patient and Physician remission (REM) are based on the single question; ASAS PR:ASAS partial remission; PGA: Patient global assessment.Conclusion:In this real-life population, the evaluation of remission by the patient through a single question was shown to be feasible and to present an acceptable agreement with other definitions.References:[1]Gorlier C, et al. Ann Rheum Dis 2019;78(2):201-8.Fig. 1.REM/LDA: remission/ low disease activity self-defined patient or physician through a simple question. ASDAS <1,3: inactive disease; ASDAS <2,1: low activity; PGA: Patient global assessment; PASS: Patient acceptable symptom state.Acknowledgments:To Ansgar Seyfferth and Alfonso Muriel. To Carlos Sanchez-Piedra, Fernando Alonso and Mercedes Guerra from Sociedad Española de Reumatología, Research Unit.Disclosure of Interests:Marta Valero Grant/research support from: Novartis, Pfizer, Abvie, Speakers bureau: Novartis, Celgene, Javier Bachiller-Corral: None declared, Boris Anthony Blanco Cáceres: None declared, M. Ángeles Blázquez: None declared, Consuelo Díaz-Miguel: None declared, Maria Jesus Garcia Villanueva: None declared, Carmen Larena: None declared, Jose Luis Morell Hita: None declared, Carlos De la Puente Bujidos: None declared, Ana Rodriguez-García: None declared, Mónica Vázquez Díaz: None declared, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB
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Arroyo Palomo J, Del Bosque Granero I, Corral Bote A, Blanco Cáceres BA, Bachiller-Corral J. AB0740 SECOND-LINE BIOLOGIC DMARDs SURVIVAL IN PSORIATIC ARTHRITIS. DATA FROM A SPANISH THIRD-LEVEL HOSPITAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Psoriatic arthritis (PsA) covers a wide spectrum of disease manifestations, including arthritis, enthesitis, dactylitis and axial spondylitis. This range of symptoms presents a challenge to the treating physician. Biologic disease-modifying antirheumatic drugs (bDMARDs) have proven effective through randomized clinical trials; and most international PsA guides include them as main option upon first-line treatment failure. However, studies regarding drug efficacy after bDMARD switching are scarce, lower response rates and drug survival on consecutive lines has been explored in previous research.Objectives:To assess bDMARDs survival after first-line failure in PsA patients treated in a third-level hospital and to determine baseline clinical and laboratory parameters associated with drug survival.Methods:We conducted a retrospective, single-centre study. 47 patients who received a second-line bDMARD were included, with diagnosis of PsA according to the criteria of an expert rheumatologist. All patients were studied according to a standard protocol. Data regarding bDMARD prescribed, baseline characteristics, axial or peripheral involvement and immunological profile (included both HLA-B27 and HLA-Cw6) were extracted. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at bDMARD start were included, as well. Kaplan-Meier, log-rank analyses and Cox regression models were applied.Results:Of 47 patients receiving a second bDMARD, 55,3% (26) were female and mean (S.D.) age was 40,6 (12,52) years. Median (interquartile range) disease duration was 10,1 (3,7-14,8) years. Prescribed drugs were Adalimumab (ADL) (36,2%, 17), Etanercept (ETN) (27,6%, 13), Infliximab (IFX) (6,4%, 3), Golimumab (GOL) (10,6%, 5), Certolizumab (CTZ) (4,3%, 2), Secukinumab (SCK) (8,5%, 4) and Apremilast (APR) (6,4%, 3). 42,3% cases suffered from axial involvement, rest of the sample (57,6%) presented a pure peripherical form of PsA. HLA-B27 and -Cw6 were assessed in 80,9% (38) and 68,1% (32), respectively; of whom, HLA-B27 carriers were 10,5% and HLA-Cw6 positive, 46,9%. Mean CRP level was 10,25 mg/L and mean ESR was 23,17 mm. Patients showed mean and median global drug retention of 44,57 (29,8-59,3) and 23 months. At 12-month visit, drug survival was 70%, 47% at 24 months, and 33% at 4 years from onset. Mean drug persistence by bDMARD prescribed was: ADL, 62,1 months; ETN, 51,9 months; IFX, 39 months; GOL, 22,8 months; CTZ, 9,5 months; SCK, 13,5 months; and APR, 16,3 months. Through log-rank analyses, differences in drug retention were investigated by several variables. Female sex (30,35m, 16,5-44,2 m.) was identified as statistically significant different than male patients (62,5m, 35,6-89,4m, p=0,021). Although not significant, other differences were remarkable: non-axial involvement, HLA-Cw6 negativity, HLA-B27 positivity and CRP level over 5 mg/L. No differences were found between altered and normal ESR patients.Conclusion:Second-line bDMARD survival is lower in female PsA patients, according to our data and previous bibliography. Despite our reduced sample and possible bias, non-axial involvement, absence of HLA-Cw6, presence of HLA-B27 and higher levels of CRP at biologic onset might be predictors of better drug persistence. Further investigations are required on this field.References:[1]Glintborg B et al. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy. Results from the Danish Nationwide DANBIO Registry. Arthritis Rheum 2013:65(5):1213-23.[2]Stober C et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2018:57(1):158-163.Table 1. Kaplan–Meier survival analysis of persistence according to sex.Table 2. Kaplan Meier survival analysis of persistence according to HLA-Cw6.Disclosure of Interests:None declared
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Martin-Martinez MA, Castañeda S, Sánchez-Alonso F, García Gomez C, Gonzalez Juanatey C, Belmonte MA, Tornero J, Santos Rey J, Sanchez Gonzalez CO, Quesada-Masachs E, Moreno Gil MD, Cobo-Ibáñez T, Pinto Tasende JA, Babío J, Bonilla G, Mas AJ, Manero J, Romera M, Bachiller-Corral J, Chamizo Carmona E, Calvo J, Sanmarti R, Erausquin MC, Garcia de Vicuna R, Barbadillo C, Ros Exposito S, Del Pino J, Gonzalez MJ, Pina Salvador JM, Llorca J, González-Gay MA. OP0002 INCIDENCE OF FIRST CARDIOVASCULAR EVENT IN SPANISH PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: PROSPECTIVE DATA FROM THE CARMA PROJECT AFTER 5 YEARS OF FOLLOW-UP. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:To determine the incidence and risk factors implicated in the development of first cardiovascular (CV) event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending Spanish rheumatology clinics after 5 years of follow-upMethods:Analysis of data of patients included in an observational prospective study [CARdiovascular in rheuMAtology (CARMA) project] after 5 years of follow-up. The study includes a cohort of 2234 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA), and another cohort of matched individuals (n=677) without CIRD from 67 hospitals in Spain. Cumulative incidence per 1000 patients of CVE was estimated in both cohorts at 5 years from the start. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence intervals (CI) of the risk factors involved in the development of CV events. Losses to follow-up and their causes were also analyzed.Results:The total number patient who completed the follow-up visit at 5 years was 2.382 (81.9%). Fifteen patients died due to CVE and sixty due to non-CVE. The patients with CIRD showed higher cardiovascular cumulative incidence (40.5; 95% CI: 36.2-44.8) than controls (28.3; 95% CI: 21.8-34.8). The higher risk of developing a first CVE during the 5 years of follow-up was seen in patients with AS (HR: 4.60; 95% CI: 1.32-15.99; p=0.02), those with older age (HR:1.09; 95% CI: 1.05-1.13; p<0.001), higher systolic blood pressure (HR: 2.64; 95% CI: 1.32-5.25; p=0.006), and those with longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12; p=0.002). In contrast, woman gender was a protective factor (HR: 0.45; 95% CI: 0.21-0.99; p=0.047).Conclusion:Patients with AS prospectively followed-up at rheumatology outpatient clinics showed higher risk of developing a first CVE than those without CIRD. Besides traditional CV disease risk factors, a longer time course of the disease is a risk factor for the development of CV disease in patients with CIRD.Acknowledgments:This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie.Disclosure of Interests:Maria Auxiliadora Martin-Martinez: None declared, Santos Castañeda: None declared, Fernando Sánchez-Alonso: None declared, Carmen García Gomez: None declared, Carlos Gonzalez Juanatey: None declared, Maria Angeles Belmonte: None declared, Jesús Tornero: None declared, José Santos Rey: None declared, CARMEN OLGA SANCHEZ GONZALEZ: None declared, Estefanía Quesada-Masachs: None declared, MARIA DELPUERTO MORENO GIL: None declared, Tatiana Cobo-Ibáñez: None declared, Jose Antonio Pinto Tasende: None declared, Jesús Babío: None declared, Gemma Bonilla: None declared, Antonio Juan Mas: None declared, Javier Manero: None declared, Montserrat Romera: None declared, Javier Bachiller-Corral: None declared, Eugenio Chamizo Carmona: None declared, Javier Calvo: None declared, Raimon Sanmarti: None declared, Maria Celia Erausquin: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Carmen Barbadillo: None declared, Sergio Ros Exposito: None declared, Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, MARIA JOSE GONZALEZ: None declared, José Manuel Pina Salvador: None declared, Javier Llorca: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD
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García Fernández A, Briones-Figueroa A, Calvo Sanz L, Andreu-Suárez Á, Bachiller-Corral J, Boteanu A. SAT0501 EARLY START OF BIOLOGICAL TREATMENT IN JUVENILE IDIOPHATIC ARTHRITIS: DOES A THERAPEUTIC WINDOW EXIST IN REAL LIFE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Biological therapy (BT) has changed the treatment and perspectives of JIA patients but little is known about when is the best moment to start BT and the impact of this prompt iniciation.Objectives:To analyze the response to BT of Juvenile Idiophatic Arthritis (JIA) patients according to the time when the BT was started.Methods:A retrospective, descriptive study was conducted on JIA patients followed up in a referal hospital that started BT up to 24 months after diagnosis from 2000 to 2018. Disease activity was measured, at 2 years after diagnosis, according to Wallace criteria for remission (absence of: active arthritis, active uveitis, fever, rash or any other manifestation attributable to JIA, normal CRP and ESR, PGA indicating no active disease) for at least 6 months.Results:55 JIA patients that started BT up to 24 months from diagnosis were analyzed. 69,1% were girls with a median age at diagnosis of 8 years old IQR(3-13), median age at the start of BT of 9 years old IQR(3-13). Regarding JIA categories: 25,5% were Oligoarticular Persistent (OligP), 18,2% Systemic JIA (sJIA), 16,4% Entesitis related Arthritis (ERA), 12,7% Psoriatic Arthritis (APso) and Polyarticular RF- (PolyRF-), 5,5% Oligoarticular Extended (OligE) and Polyarticular RF+ (PolyRF+), 3,6% Undifferentiated (Und). 20% of patients had uveitis during followup. Conventional DMARD (cDMARD) was indicated in 83,6% of patients (95,7% Methotrexate) at diagnosis [median 0 months IQR(0-2,3)]. At the end of followup (2 years) only 30,9% of patients continued with cDMARDs. The main causes of discontinuation were: adverse events (46,7%), remission (36,7%). TNF inhibitors were precribed in 81,8% of patients and 18,2% of patients recieved two BT during the first 2 years from diagnosis. 54,5% of BT were indicated during the first 6 months from diagnosis, 27,3% from 7 to 12 months, 12,7% from 13 to 18 months, 5,5% from 19 to 24 months.After 2 years from diagnosis, 78,2% of patients were on remission and 21,8% active. Among patients with active disease: 75% had arthritis, 16,7% had uveitis and 8,3% had both. There were no differences regarding disease activity among patients with uveitis and neither taking cDMARDs. Regarding JIA categories: 66,7% of OligE, 57,1% of PolyRF- and 57,1% of APso patients were active at 2 years from diagnosis when compared to the other categories (p=0.004).Patients on remission at 24 months from diagnosis started sooner the BT than active patients [CI 95% (0,46-8,29) p=0,029]. The time when the BT was started was correlated to the activity at 2 years (K= 0,294 p=0,029). When the BT was prescribed after 7,5months from diagnosis it was correlated, in a COR curve, with a higher probability of active disease at 2 years (S= 0,67 E= 0,63). There was a correlation, among patients on remission at 2 years, between prompt start of BT and less time to reach remission (K= -0,345 p=0,024). Patients with active disease at 2 years, regardless of moment of BT iniciation, required more BT during follow-up (p=0,002).Conclusion:Prompt iniciation of BT was correlated with a better outcome. JIA patients that started BT early after diagnosis had a higher probability of remission after 2 years. Starting BT after 7,5 months was correlated with a higher probability of active disease at 2 years. Active disease at 24 months was correlated with persistent active disease during follow-up.Disclosure of Interests:None declared
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López Gutiérrez F, García García V, Andreu-Suárez Á, Blanco Cáceres BA, Bachiller-Corral J, Vázquez Díaz M. AB0653 SURVIVAL OF BIOLOGIC THERAPHY AS SECOND LINE IN PATIENTS WITH ANKYLOSING SPONDYLITIS. EXPERIENCE IN A TERTIARY CARE CENTRE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In ankylosing spondylitis (AS) patients with lack of response to a first line of biologic disease modifying antirheumatic drugs (bDMARD), switching to another bDMARD is recommended, aiming either to the same or different therapeutic target. In several previous studies a decrease in drug survival has been noted when tumor necrosis factor alfa inhibitors (TNFai) are used as second or third treatment line (1,2).Objectives:Primary endpoint: To evaluate survival of bDMARD as second line treatment in patients with AS non responding to TNFai either because of lack or loss of efficacy. Secondary: To evaluate the impact on drug survival of several variables such as sex, HLA, peripheral arthritis, radiologic sacroiliitis, CRP, BASFI, BASDAI or bDMARD class.Methods:Observational, longitudinal and retrospective observational study. We included 67 patients diagnosed with AS who received treatment on second line with bDMARD (TNFai or anti IL7) after discontinuation of TNFai as first line of treatment. We analyze patients older than 18 yo, with at least 3 months of continuous treatment before and after switch, seen in our Hospital from 2006 to 2019. Data were collected regarding to demographics, HLA B27 positivity and functionality and activity index, CRP and treatment with cDMARDs.Results:All 67 patients included were still on follow up after switching to second bDMARD. Median age was 37 yo, 56.7% were male and 31%, smokers. 35.8% patients had axial AS; 1.5% peripheral arthritis; 62.7%, mixed and 9%, dactilitis. 76.1% had radiographic sacroiliitis and 74.6%, HLA B 27+. As first bDMARD, the most common was Infliximab (IFX) (47.8%), followed by Adalimumab (ADA) (19.4%) and Etanercept (ETN 14.9%). Mean survival was 32.4 months (IFX, 37 months; ETN, 45; Golimumab, 32.3 and ADA, 24.1). The commonest cause of treatment suspension was loss of efficacy (LoE) (56.7%), followed by lack of efficacy (LaE) (17.6%) and adverse effects (AE) (16.4%).As second bDMARD the most frequent was ADA (35.8%), followed by ETN (34.3%), Golimumab (9%), IFX (7.5%) and Secukinumab (6%) with a mean survival of 45 months (ETN 63.8, ADA 45.7, Golimumab 32). Treatment was discontinued in 47.8% of patients because of LoE (17.9%), LaE (17.9%) and EA (11.9%). A total of 16 AE were recorded, of which 6% were infections and 9%, allergic reactions. Regarding the analysis of the impact of other variables on drug survival, there was statistically significant differences on HLA B 27 carrier status (p=0.012), in which we observed an increase on survival when the patient is HLA B27 + and in whom BASDAI is higher before switching (p=0.02).Conclusion:In our study, we did not observe differences in survival of second line bDMARD in patients with AS regarding type of TNFai, case of discontinuation or type of radiographic involvement in the first line of treatment. Patients with HLA B27+ and high value of BASDAI at the beginning of second bDMARD showed an increased on drug survival. Contrary to literature, we did not see significant differences regarding CRP.References:[1]Glintborg B, Østergaard M, Krogh NS, Tarp U, Manilo N, Loft AGR, et al. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013 Jul;72(7):1149–55.[2]Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum. 2017 Dec;47(3):343–50.Disclosure of Interests:None declared
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Teran Tinedo MA, Bachiller-Corral J. AB1200 EARLY ARTHRITIS CLINICS IMPROVES THE EVOLUTION OF THE DISEASE AND DECREASES WORK ABSENTEEISM. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis is the most common inflammatory arthritis, and a significant cause of morbidity and mortality. Several clinical studies have shown that treatment introduced at an early stage, referred to as a “window of opportunity”, is associated with long-term benefits in the form of long-term remission and even complete remission of the disease.Objectives:Assess the advantages of a Early Arthritis clinic (EAC) in the management of RA until remission is reached and its impact on work absenteeism.Methods:We included a cohort of patients with early RA (≤12 months symptoms) who fullfield the ACR 2010 criteria, in an early arthritis clinic (EAC) from a tertiary hospital, between 2016-2019, followed for at least 2 years. Demographic, clinical, analytical and radiographic variables were included, and the dates of the visits during the follow-up were noted. Work absenteeism days was recorded before and after the first visit. Estadistic description and regressión analysis was performed.Results:Eighty-four patients with early RA were included, with loss of follow-up of tweelve patients. Fifty-one (70,8%) were women with a mean age 50 years ±15,84. Fifty-one patients were FR positive (70,8%) and sixty-eigth were ACPA positive (94,4%). Nine subjects (13%) had erosions. Acute phase reactans elevation was observed in fifty-five patients (76,3%). Thirty-seven subjects (51,3%) were smokers. Mean swollen joint count was 4 ± 4,79 and mean DAS28 was 4.01 ± 1.28. Inflammatory arthralgia was reported since mean time 6.7 months before the first visit. Seventy patients (97%) were treated with methotrexate and forty-nine (70%) did not require other treatment during follow-up. Ten patients (14.3%) required DMARDb, and half received 2 or more drugs of this clase. The mean cumulative time of exposure to corticosteroids was 8.37 ±9,26 months. Mean time between the date of derivation to Rheumatologist and the first visit was 44 days. Forty-nine patients (81%) achieved remission during follow-up and mean time required for this goal was 299 days with a mean 4.7 visits. We found a significant correlation between the time to reach remission with DAS28, NAT and N° treatments prescribed (0.38, 0.39 and 0.70 respectively, p <0.05). Twenty work absenteeism periods (mean 40.55 days) were reported in fourteen patients before the first visit associated with activity of RA, and tweelve periods (mean 19,75 days) in ten patients after the first visit (p <0.05).Conclusion:In our EAC, patients with RA usually reach remission in less than a year, requiring approximately 4 visits to achieve this goal. A significant correlation was found between the time to reach remission, DAS28 and the number of treatments required. Most patients respond to Methotrexate and suspend corticosteroids in less than a year. We found a significant reduction of work absenteeism associated with RA activity, after the first visit during the follow-up.References:[1]Kolarz K. Early reumatoid arthritis. Wiad Lek. 2018;71(5):1061-1065.[2]Nisar MK. Early arthritis clinic is effective for rheumatoid and psoriatic arthritides. Rheumatol Int. 2019 Apr;39(4):657-662.Disclosure of Interests:None declared
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Briones-Figueroa A, Tortosa-Cabañas M, Blanco Cáceres BA, Morell Hita JL, Bachiller-Corral J, Vázquez Díaz M. AB0280 SURVIVAL ANALYSIS ON SECOND BIOLOGIC THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS OLDER THAN 65 YEARS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with Rheumatoid Arthritis (RA) ≥65 years old constitute an important and not very well studied group. Even though the course of the disease may be similar to that of younger patients, treatment is usually less aggressive given the limited information on efficacy, especially of biological treatments, in this age group.Objectives:To describe the characteristics of patients with RA ≥65 years old who started a second biological agent. To compare the survival of this second-line treatment between patients ≥65 and <65 years old.Methods:Retrospective, observational and longitudinal study. Patients diagnosed of RA, who started a second biological agent between 2000 and 2019, who discontinued a first-line TNF inhibitor, were included. Demographic, clinical and analytical data were obtained. The sample was divided in 2 groups: <65 and ≥65 years old. Kaplan Meier and Log-rank survival analysis were performed, as well as Cox regression to identify related factors.Results:157 patients were identified, 42 (26.8%) were ≥65 years old. In this group, 73.8% were women, with a mean age at the beginning of second biological treatment of 71.43±4.76 years. Demographic and clinical data of ≥65 years old patients are shown in the table. The most frequent second biological agent was Rituximab (23.8%), followed by Adalimumab (21.4%) and Tocilizumab (19%). 76.2% of patients had a disease-modifying drug associated, being Methotrexate the most frequent (45.2%). Discontinuation of second biological agent occurred in 30 patients (71.42%) ≥65 years old, which is similar to the percentage found in patients <65 years old (66.96%; p=0.70). The main causes of withdrawal of second-line agent in patients ≥65 years were adverse effects (23.8%) and secondary failure (23.8%), whereas in <65 years were primary and secondary failure (18.3% in both). Infections were more frequent in patients ≥65 years (14.3%) in comparison with patients <65 years (6.1%). In the survival analysis of the second biological agent, patients ≥65 years presented a median survival of 45 months (IC-95%=14.10-75.90); while patients <65 years had a median survival of 47 months (IC-95%=29.55-64.46), without statistically significant differences (p=0.803) (See Figure). Among elderly patients no statistically significant differences were found after comparison of survival curves in the subgroups: 65-69, 70-74 and ≥75 years. Rituximab presented a higher survival rate in patients ≥65 years (84.3 months; p<0.001), followed by Abatacept (58.5 months). Smoking (HR=13.96; IC- 95%=2.12-91.93), erosions (HR=7.04; IC-95%=1.05-47.31) and diabetes mellitus (HR=13.37; IC-95%=1.25-143.46) were identified as risk factors for discontinuation of second biologic agent.Conclusion:The survival of second biological agent after the failure of a first TNF inhibitor in patients ≥65 years is similar to the survival in younger patients, although there was a higher percentage of adverse effects in the first group. Rituximab and Abatacept showed a higher survival in patients ≥65 years. Smoking, erosions and diabetes mellitus were associated with an increased risk for the withdrawal of the second-line biological therapy.References:[1]Richter M, Matteson E, DavisIII J, Achenbach S, Crowson C. Comparison of Biologic Discontinuation in Patients With Elderly-Onset Versus Younger-Onset Rheumatoid Arthritis. ACR Open Rheumatology. 2019; 1(10): 627–631.Variablesn= 42 (mean ± SD or %)Age at diagnosis (years)56.48 ± 9.94Age at the beginning of the treatment (years)71.43 ± 4.76Women31 (73.8%)Smokers11 (26.2%)RF (+)35 (83.3%)ACPA (+)30 (71.4%)Erosions29 (69%)Arterial hypertension21 (50%)Diabetes mellitus4 (9.5%)Dyslipidemia11 (26.2%)Disease-modifying drugMethotrexate19 (45.2%)Leflunomide10 (23.8%)Sulfasalazine1 (2.4%)Hydroxychloroquine0 (0%)InfectionsRespiratory infection3 (7.1%)Skin/Soft tissues infections2 (4.8%)Herpes zoster1 (2.4%)Disclosure of Interests:None declared
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García Fernández A, Briones-Figueroa A, Calvo Sanz L, Andreu-Suárez Á, Bachiller-Corral J, Boteanu A. FRI0467 DRUG SURVIVAL AND SAFETY OF BIOLOGICAL THERAPIES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Biological treatment (BT) has changed perspectives of JIA patients. Increasing data from real life experience have been reported.Objectives:To compare drug survival, safety and efficacy of BT in patients with Juvenile Idiopathic Arthritis (JIA).Methods:A retrospective observational study was conducted on JIA patients followed in a referal hospital and who had received at least one BT between 1999 and 2019.Results:218 BT in 130 JIA patients were analyzed. 67.7% were women with a median age at diagnosis of 8 years old IQR (3-13) and a median age at the beginning of the BT of 15 years old IQR(7.8-21). 21.5% of the patients had uveitis during follow-up. BT were indicated due to: arthritis(73.9%), uveitis(10.1%), arthritis and uveitis(2.7%), systemic activity(8.3%) and macrophage activation syndrome (1,8%).There were 130 BT started in 1st line, 55 in 2nd line, 20 in 3rd line, 10 in 4th line and 3 in 5th line.The 1st line BT most frequently indicated was Etarnecept(ETN) up to 40%, followed by 30% Adalimumab(ADA) and 16,2% Infliximab(INF). The median duration of the 1st line was 51 months IQR (14-109,3). However, 53.8% of the 1st line BT were swiched: 28.3% due to adverse events, 25.7% due to 1° failure and 25.7% due to 2° failure. The BT that were discontinued were: INF (76.2%) and Anakinra (ANAK) (75%) due to adverse events and ETN (59.6%) due to 1° and 2° failure. 55 patients started a 2nd BT: 43.6% received ADA and 20% Tocilizumab (TCZ) with a median duration of 43 months IQR (12-90). 22 of 55 BT required a change: 75% of ETN and 59% of INF prescribed in 2nd line were discotinued. The causes were: 40% 1° failure, 28% 2° failure and 12% remission. In 1st line 87,6% of patients received TNF inhibitors, 74% mantained the target in 2nd line. In 3rd line TCZ was the most frequent BT. 71.5% of patients continue on BT. BT was withdrawn in 20 of 130 patients due to remission (40%), adverse events (30%), and pregnancy (10%).In the analysis by decades, 80 BT (36.7%) were started from 1999 to 2008 and 138 BT (63.3%) from 2009 to 2019. In the 1st decade ETN and INF were the most frequently prescribed and in the 2nd decade, ADA and TCZ (p <0.0001). The 1st BT in the 2nd decade were indicated sooner compared to the 1st decade (1st decade: mean 119.5months SD(109.2); 2nd decade: mean 53.9 months SD(99.7); p <0.0001). In 1st line BT, the BT prescribed in the 2nd decade had a shorter duration than those in the 1st decade (1st decade: mean 84.1 months SD(71.8); 2nd decade: mean 51.7 months SD(5); p <0.0001).In the survival analysis, TCZ and ADA were the BT with the highest survival (p=0.001). Of the 31 patients that started TCZ, 61.3% continue on TCZ, with a median duration of 46 months IQR(25-99) and 36/68(52,9%) still on ADA with a median duration of 61,5 months IQR(30.5-98).Conclusion:42.3% of patients required more than one BT. Since the onset of the BT there has been a change in prescription, probably related to the emerge of new targets and the evidence provided by clinical trials and guidelines. TCZ and ADA were the BT with the highest survival rate. On the other hand, INF and ANAK were the ones with the lowest survival rate. The most common causes of BT change in 1st line were adverse events in relation to INF and ANAK. In 2nd line there was a high rate of change in those patients who maintained TNFi, related to 1° failure.Disclosure of Interests:None declared
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Loarce-Martos J, Rita C, Ballester Gonzalez R, Calvo Sanz L, Garrote Corral S, García-Soidan A, García-Hoz C, Iturrieta-Zuazo I, Bachiller-Corral J, Roy G. FRI0250 “ARE MYOSITIS ANTIBODIES SPECIFIC FOR IDIOPATHIC INFLAMMATORY MYOPATHY DIAGNOSIS?” CLINICAL CORRELATION OF A COHORT OF PATIENTS POSITIVE FOR MYOSITIS ANTIBODIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Idiopathic inflammatory myopathies (IIM) are a group of immune-mediated diseases characterized my muscle weakness, skin rash and systemic involvement. Myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) play a major role in IIM diagnosis, classification and prognosis. Nevertheless, MSA/MAA testing is not standardized and there very few studies addressing their relationship with other diseases.Objectives:To describe a cohort of patients tested positive for MSA/MAA, and to explore it´s relationship with IIM and other autoimmune diseases.Methods:We retrospectively review all the serum samples obtained from patients tested for MSA/MAA during 2019 in the Immunology department of Ramón y Cajal University Hospital (Madrid, Spain). These antibodies were tested by specific immunoblot (EUROLINE: Autoimmune Inflammatory Myopathies 16 Ag) with highly purified MSA/MAA. Positivity was stablished according to absorbance titer and adjusted by positive control of each test (arbitrary units, AU). Patients were diagnosed with IIM according to their clinician diagnosis. Diagnosis and classification were confirmed by an independent rheumatologist (JL) according to current understanding of IIM classification.Results:Three-hundred-seventy-five samples were tested for MSA during the study period. Two-hundred-seventy-nine were negative for all antibodies tested. Ninety-six samples were positive for one or more MSA/MAA, corresponding to 74 patients (11 patients had 2 different samples). Forty-nine (66.2%) of the patients who tested positive were female and 25 (33.8%) were male. Mean age was 58.65 years. Only 22 patients (29.7%) had a confirmed diagnosis of IIM, 24 (32.4%) had a diagnosis of other autoimmune disease, and 11 (14.9%) were diagnosed with interstitial lung disease (ILD) (Figure 1). Six ILD patients had anti-PM-Scl or anti-Ku antibodies, which are associated with scleroderma or overlap-CTD myositis, nevertheless, they remained classified as ILD as no other features were described in this group.Seventeen patients were positive for more than 1 MAA or MSA, including 14 patients positive for anti Ro-52. Antibody titer was higher in the IIM group compared to non-myositis group (59.59 vs 44.16, p=0.015). Anti Mi-2 was positive in 4 ILD without any other myositis features, and high titer anti-SRP (n=4, mean 59.75 AU) was found in primary biliary cirrhosis (PBC) patients. Additionally, 5 patients positive for antiJo-1 using ELIA (Thermo Fisher) were diagnosed with antisynthetase syndrome. IIM diagnosis and its relationship with antibody titer is represented in table 1.Table 1.Autoantibody titer according to diagnosis.Antibody (Number of patients)Number of samplesIIMIIM antibody titer (AU)Non-IIMNon-IIM antibody titer (AU)Other AI diseasesAnti Ro-52Anti Jo-1 (n=1)11 (100%)92.70-01 (100%)Anti PL-7 (n=8)113 (37.5%)29.595 (62.5%)25.595 (62.5%)2 (25%)Anti PL-12 (n=3)21 (33.3%)53.952 (66.6%)69.971 (33.3%)2 (50%)Anti EJ (n=1)11 (100%)99.460-01 (100%)Anti OJ (n=2)40-2 (100%)23.041 (50%)0Anti Ku (n=14)193 (21.4%)107.2511 (78.6%)31.855 (35.7%)0Anti Tif1gamma (n=5)63 (60%)40.122 (40%)23.841 (20%)0Anti NXP2 (n=2)30-2 (100%)13.991 (50%)1 (50%)Anti Mi2 (n=12)173 (25%)48.659 (75%)26.674 (33.3%)0Anti SAE (n=1)10-1 (100%)1800Anti MDA5 (n=2)32 (100%)30.5401 (50%)1 (50%)Anti SRP (n=9)124 (44.4%)42.695 (55.6%)68.165 (55.5%)2 (22.2%)Anti PM-Scl75 and PM-Scl100 (n=2)21 (50%)68.61 (50%)36.6700Anti PM-Scl75 (n=8)10016.268 (100%)22.723 (37.5%)1 (12.5%)Anti PM-Scl100 (n=4)50-4 (100%)23.622 (50%)0Conclusion:Only 28.7% of the patients that were MAA/MSA positive had a diagnosis of IIM. Other autoimmune diseases and ILD were commonly found in this group of MSA/MAA positive patients.References:[1]Damoiseaux J, Vulsteke JB, Tseng CW, Platteel ACM, Piette Y, Shovman O, et al. Autoantibodies in idiopathic inflammatory myopathies: Clinical associations and laboratory evaluation by mono- and multispecific immunoassays. Vol. 18, Autoimmunity Reviews. Elsevier B.V.; 2019. p. 293–305.Disclosure of Interests:None declared
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García Fernández A, Briones-Figueroa A, Calvo Sanz L, Andreu-Suárez Á, Bachiller-Corral J, Boteanu A. AB0984 BIOLOGICAL THERAPIES IN JUVENILE IDIOPHATIC ARTHRITIS: ARE THERE ANY DIFFERENCES BETWEEN CATEGORIES? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of pediatric diseases. Different response to biological treatment (BT) has been reported according to disease subtype.Objectives:To analyze the prescription and withdrawal of BT in JIA patients with focus on JIA category.Methods:A retrospective observational study was conducted on JIA patients followed in a referal hospital and who had received at least one BT between 1999 and 2019.Results:130 JIA patients were analyzed: 29 (22,4%) were Oligoarticular Persistent (OligP), 22 (16,9%) Enthesitis related Arthritis (ERA), 20 (15,4%) Systemic (sJIA), 19 (14,6%) Polyarticular RF- (PolyRF-), 14 (10,8%) Polyarticular RF+(PolyRF+), 13 (10%) Oligoarticular-Extended (OligE), 11 (8,4%) Psoriatic Arthritis (APso) and 2 (1,5%) Undifferentiated (Und).The main characteristics are summarized in table 1.The first line BT most frequently indicated was Etanercept up to 40% in all the categories except for ERA, where the most frequent BT was Adalimumab and sJIA, where the most frequent BT was Anakinra. The time between diagnosis and start of BT was different among the categories (p=0,007). In the Und category, the time until BT was the shortest (median: 1 month), since both patients had coxitis, followed by APso [median: 9 months IQR(1-57)] and sJIA [median: 17,5 months IQR(0,3-146,8)].The survival of the first BT was different among the categories (p=0,006): 94,7% of the ERA continue receiving the first BT, followed by 76,2% of OligP and 50% of PolyRF+ and APso. Only 42% of sJIA continue on the first BT prescribed [up to 53,3% were TNF inhibitors (TNFi)]. The categories with less retention of the first BT were: OligE (25%); PolyRF- (27,3%) and Und (0%). The most frequent cause of discontinuation, among these categories, was secondary failure.In the survival analysis between categories, there were differences on OligP (p=0,004), OligE (p=0,042) and PolyRF- (p=0,017). Tocilizumab and Adalimumab were the BT with highest survival with regards to Infliximab, Etanercept, Rituximab (OligE, PolyRF-), Abatacept (OligE, PolyRF-) and Certolizumab (OligP). The survival rate of IL1 inhibitiors and IL6 inhibitiors was higher regarding to TNFi in sJIA patients (p=0,013).Conclusion:Taking into account JIA category is mandatory to choose BT and to understand the response and discontinuation of BT. OligE and PolyRF - showed a high rate of change of the first BT related to secondary failure of Etanercept and Infliximab when compared to Adalimumab and Tocilizumab, as described in the survival analysis. The category with the highest retention of the first BT was ERA. UND patients started sooner BT due to the presence of coxitis. In sJIA, IL1 inhibitors and IL6 inhibitors were superior to TNFi in the survival analysis, as reported in existing literature.Table:Disclosure of Interests:None declared
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Hernández-Breijo B, Plasencia C, García-Hoz C, Sobrino C, Navarro-Compán V, Martínez-Feito A, Nieto-Gañán I, Lapuente-Suanzes P, Bachiller-Corral J, Bonilla G, Pijoan Moratalla C, Roy G, Vázquez Díaz M, Balsa A, Villar LM, Pascual-Salcedo D, Rodríguez-Martín E. FRI0582 GM-CSF PRODUCED BY CD4+ T CELLS AS A MARKER OF CLINICAL REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF INHIBITORS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:According to the EULAR recommendations, the therapeutic target in patients with RA should be remission (REM). However, no more than 50% of the patients treated with TNF inhibitors (TNFi) attains this outcome. Previous investigations suggested the peripheral blood mononuclear cells (PBMC) as markers associated with the TNFi treatment success1,2. Granulocyte-monocyte colony-stimulating factor (GM-CSF) plays a relevant role in the pathogenesis of rheumatoid arthritis (RA) because it promotes the macrophage differentiation, survival and activation3.Objectives:To analyse the intracellular cytokine production by PBMC and its association with REM attainment after 6 months (m) of TNFi treatment in patients with RA.Methods:This was a prospective bi-center pilot study including 36 patients with RA. PBMC were isolated from patients at baseline and after 6m of treatment with TNFi and cryopreserved until studied. Intracellular cytokine production by PBMC was stimulated in the presence of 2µg/mL brefeldin as follow: monocytes were stimulated with 20ng/mL LPS during 4h; and simultaneously lymphocytes were stimulated with 50ng/mL phorbol 12-myristate 13-acetate (PMA) and 750ng/mL ionomycin during 4h at 37°C. To identify IL-10-producing B cells, PBMC were pre-incubated with 3µg/mL of CpG oligonucleotide during 20h at 37°C prior to stimulation in presence of 2µmol/L monensin. Intracellular cytokine production (TNFα, IL6, GM-CSF, IL10) by the different cell subsets (monocytes, CD4+and CD8+T cells, naïve and memory B cells) was analysed by flow-cytometry. Clinical activity at baseline and after 6m was assessed by DAS28. REM was defined as DAS28≤2.6 at 6m. The association between REM and the change in cytokine production (Δ, 6m-0m) by each PBMC subset was analysed through univariable and multivariable logistic regression models.Results:Seventy-eight percent of the patients were female. After 6m of TNFi treatment, 47% patients attained REM. Univariable analyses was performed to investigate the association between REM and the baseline variables. Male sex (OR: 12.6; 95% CI: 1.35-117.57; p=0.03) and having lower baseline DAS28 (OR: 0.4; 95% CI: 0.19-0.85; p=0.02) were independently associated with attaining REM after 6m of TNFi. In the multivariable analysis, only being male (OR: 19.7; 95% CI: 1.4-273.9; p=0.03) remained independently associated with REM after 6m of treatment. Therefore, further analyses were adjusted by sex. Decreased production of GM-CSF by CD4+T cells percentage was found after 6m of TNFi treatment in REM patients (0m: 6.07%; 6m: 3.87%; p=0.007) while no-REM patients did not show differences with the baseline (0m: 3.70%; 6m: 3.75%; p=0.9). The decrease was significantly associated with attaining REM (OR: 0.56; 95% CI: 0.33-0.95; p: 0.03). No significant association was found between any other analysed intracellular cytokine produced by the different PBMC subsets and REM.Conclusion:GM-CSF intracellular production by CD4+T cells was significantly decreased by TNFi treatment only in patients who attained REM. Therefore, our results suggest that GM-CSF production by CD4+T cells may be a useful marker of REM to TNFi in RA.References:[1] Sobrino C, et al. Ann Rheum Dis. 2019; 78 (S2): A1665.[2] Hernández-Breijo B, et al. Ann Rheum Dis. 2019; 78 (S2): A711.[3] Avci AB, et al. Clin Exp Rheumatol. 2016; 34 (S98), 39-44.Figure. 1:Association between the change in intracellular cytokine production (Δ, 6m-0m) by each PBMC subset and REM. Adjusted logistic regression analyses were performed for each cytokine.Acknowledgments:ISCIII (PI16/00474; PI16/01092)Disclosure of Interests:Borja Hernández-Breijo: None declared, Chamaida Plasencia: None declared, Carlota García-Hoz: None declared, Cristina Sobrino: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, ANA MARTÍNEZ-FEITO: None declared, Israel Nieto-Gañán: None declared, Paloma Lapuente-Suanzes: None declared, Javier Bachiller-Corral: None declared, Gemma Bonilla: None declared, Cristina Pijoan Moratalla: None declared, Garbiñe Roy: None declared, Mónica Vázquez Díaz: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Luisa María Villar: None declared, DORA PASCUAL-SALCEDO Grant/research support from: Pfizer, Novartis & Progenika, Speakers bureau: Pfizer, Merck, Novartis, Takeda, Menarini & Grifols, Eulalia Rodríguez-Martín: None declared
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Fernández-Carballido C, Martín-Martínez MA, García-Gómez C, Castañeda S, González-Juanatey C, Sánchez-Alonso F, García de Vicuña R, Erausquin-Arruabarrena C, López-Longo J, Sánchez MD, Corrales A, Quesada-Masachs E, Chamizo E, Barbadillo C, Bachiller-Corral J, Cobo-Ibañez T, Turrión A, Giner E, Llorca J, González-Gay MA. Impact of Comorbidity on Physical Function in Patients With Ankylosing Spondylitis and Psoriatic Arthritis Attending Rheumatology Clinics: Results From a Cross-Sectional Study. Arthritis Care Res (Hoboken) 2020; 72:822-828. [PMID: 31033231 PMCID: PMC7318148 DOI: 10.1002/acr.23910] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of comorbidities on physical function in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHODS This was a cross-sectional analysis of the baseline visit from the Cardiovascular in Rheumatology study. Multivariate models with physical function as the dependent variable (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire for AS and PsA, respectively) were performed. Independent variables were a proxy for the Charlson Comorbidity Index (CCIp; range 0-27), sociodemographic data, disease activity (erythrocyte sedimentation rate [ESR] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] in AS; Disease Activity Score in 28 joints [DAS28] using the ESR in PsA), disease duration, radiographic damage, and treatments. Results were reported as beta coefficients, 95% confidence intervals (95% CIs), and P values. RESULTS We included 738 patients with AS and 721 with PsA; 21% of patients had >1 comorbidity. Comorbidity burden (CCIp) was independently associated with worse adjusted physical function in patients with PsA (β = 0.11). Also, female sex (β = 0.14), disease duration (β = 0.01), disease activity (DAS28-ESR; β = 0.19), and the use of nonsteroidal antiinflammatory drugs (β = 0.09), glucocorticoids (β = 0.11), and biologics (β = 0.15) were associated with worse function in patients with PsA. A higher education level was associated with less disability (β = -0.14). In patients with AS, age (β = 0.03), disease activity (BASDAI; β = 0.81), radiographic damage (β = 0.61), and the use of biologics (β = 0.51) were independently associated with worse function on multivariate analyses, but CCIp was not. CONCLUSION The presence of comorbidities in patients with PsA is independently associated with worse physical function. The detection and control of the comorbidities may yield an integral management of the disease.
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Affiliation(s)
| | | | | | - Santos Castañeda
- Hospital Universitario de La Princesa, IIS-IP, and cátedra UAM-Roche, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Turrión
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | | | | | - Miguel A González-Gay
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa
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Morán-Álvarez P, Bachiller-Corral J, Morell-Hita JL, Larena-Grijalba C, Gorospe-Sarasúa L. Pleural effusion: An uncommon manifestation of SAPHO syndrome? Int J Rheum Dis 2020; 23:599-601. [PMID: 32144849 DOI: 10.1111/1756-185x.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/09/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
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Cavagna L, Trallero-Araguás E, Meloni F, Cavazzana I, Rojas-Serrano J, Feist E, Zanframundo G, Morandi V, Meyer A, Pereira da Silva JA, Matos Costa CJ, Molberg O, Andersson H, Codullo V, Mosca M, Barsotti S, Neri R, Scirè C, Govoni M, Furini F, Lopez-Longo FJ, Martinez-Barrio J, Schneider U, Lorenz HM, Doria A, Ghirardello A, Ortego-Centeno N, Confalonieri M, Tomietto P, Pipitone N, Rodriguez Cambron AB, Blázquez Cañamero MÁ, Voll RE, Wendel S, Scarpato S, Maurier F, Limonta M, Colombelli P, Giannini M, Geny B, Arrigoni E, Bravi E, Migliorini P, Mathieu A, Piga M, Drott U, Delbrueck C, Bauhammer J, Cagnotto G, Vancheri C, Sambataro G, De Langhe E, Sainaghi PP, Monti C, Gigli Berzolari F, Romano M, Bonella F, Specker C, Schwarting A, Villa Blanco I, Selmi C, Ceribelli A, Nuno L, Mera-Varela A, Perez Gomez N, Fusaro E, Parisi S, Sinigaglia L, Del Papa N, Benucci M, Cimmino MA, Riccieri V, Conti F, Sebastiani GD, Iuliano A, Emmi G, Cammelli D, Sebastiani M, Manfredi A, Bachiller-Corral J, Sifuentes Giraldo WA, Paolazzi G, Saketkoo LA, Giorgi R, Salaffi F, Cifrian J, Caporali R, Locatelli F, Marchioni E, Pesci A, Dei G, Pozzi MR, Claudia L, Distler J, Knitza J, Schett G, Iannone F, Fornaro M, Franceschini F, Quartuccio L, Gerli R, Bartoloni E, Bellando Randone S, Zampogna G, Gonzalez Perez MI, Mejia M, Vicente E, Triantafyllias K, Lopez-Mejias R, Matucci-Cerinic M, Selva-O’Callaghan A, Castañeda S, Montecucco C, Gonzalez-Gay MA. Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum Time Course. J Clin Med 2019; 8:jcm8112013. [PMID: 31752231 PMCID: PMC6912490 DOI: 10.3390/jcm8112013] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/12/2019] [Accepted: 11/12/2019] [Indexed: 01/30/2023] Open
Abstract
Antisynthetase syndrome (ASSD) is a rare clinical condition that is characterized by the occurrence of a classic clinical triad, encompassing myositis, arthritis, and interstitial lung disease (ILD), along with specific autoantibodies that are addressed to different aminoacyl tRNA synthetases (ARS). Until now, it has been unknown whether the presence of a different ARS might affect the clinical presentation, evolution, and outcome of ASSD. In this study, we retrospectively recorded the time of onset, characteristics, clustering of triad findings, and survival of 828 ASSD patients (593 anti-Jo1, 95 anti-PL7, 84 anti-PL12, 38 anti-EJ, and 18 anti-OJ), referring to AENEAS (American and European NEtwork of Antisynthetase Syndrome) collaborative group’s cohort. Comparisons were performed first between all ARS cases and then, in the case of significance, while using anti-Jo1 positive patients as the reference group. The characteristics of triad findings were similar and the onset mainly began with a single triad finding in all groups despite some differences in overall prevalence. The “ex-novo” occurrence of triad findings was only reduced in the anti-PL12-positive cohort, however, it occurred in a clinically relevant percentage of patients (30%). Moreover, survival was not influenced by the underlying anti-aminoacyl tRNA synthetase antibodies’ positivity, which confirmed that antisynthetase syndrome is a heterogeneous condition and that antibody specificity only partially influences the clinical presentation and evolution of this condition.
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Affiliation(s)
- Lorenzo Cavagna
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN ReCONNET, 27100 Pavia, Italy; (G.Z.); (V.M.); (F.L.); (C.M.)
- Correspondence: ; Tel.: +39-0382-501878
| | - Ernesto Trallero-Araguás
- Department of Internal Medicine, Vall d’Hebron General Hospital, Universitat Autonoma de Barcelona, GEAS group, 08035 Barcelona, Spain; (E.T.-A.); (A.S.-O.)
| | - Federica Meloni
- Department of Pneumology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN Lung, 27100 Pavia, Italy;
| | - Ilaria Cavazzana
- Department of Rheumatology, University and ASST Spedali Civili—Brescia and ERN ReCONNET, 25123 Brescia, Italy; (I.C.); (F.F.)
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, 14080 Mexico City, Mexico; (J.R.-S.); (M.I.G.P.); (M.M.)
| | - Eugen Feist
- Department of Rheumatology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (E.F.); (U.S.)
| | - Giovanni Zanframundo
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN ReCONNET, 27100 Pavia, Italy; (G.Z.); (V.M.); (F.L.); (C.M.)
| | - Valentina Morandi
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN ReCONNET, 27100 Pavia, Italy; (G.Z.); (V.M.); (F.L.); (C.M.)
| | - Alain Meyer
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg and ERN ReCONNET, 67000 Strasbourg, France;
- Service de Physiologie des Explorations Fonctionnelles, NHC Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (M.G.); (B.G.)
| | - Jose Antonio Pereira da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; (J.A.P.d.S.); (C.J.M.C.)
| | - Carlo Jorge Matos Costa
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; (J.A.P.d.S.); (C.J.M.C.)
| | - Oyvind Molberg
- Department of Rheumatology, Oslo University Hospital, 0372 Oslo, Norway; (O.M.); (H.A.)
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, 0372 Oslo, Norway; (O.M.); (H.A.)
| | - Veronica Codullo
- Department of Rheumatology, Cochin Hospital, 75014 Paris, France;
| | - Marta Mosca
- Department of Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa and ERN ReCONNET, 56126 Pisa, Italy; (M.M.); (S.B.); (R.N.)
| | - Simone Barsotti
- Department of Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa and ERN ReCONNET, 56126 Pisa, Italy; (M.M.); (S.B.); (R.N.)
| | - Rossella Neri
- Department of Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa and ERN ReCONNET, 56126 Pisa, Italy; (M.M.); (S.B.); (R.N.)
| | - Carlo Scirè
- Department of Rheumatology, Azienda Ospedaliero Universitaria S. Anna, 44124 Ferrara, Italy; (C.S.); (M.G.); (F.F.)
| | - Marcello Govoni
- Department of Rheumatology, Azienda Ospedaliero Universitaria S. Anna, 44124 Ferrara, Italy; (C.S.); (M.G.); (F.F.)
| | - Federica Furini
- Department of Rheumatology, Azienda Ospedaliero Universitaria S. Anna, 44124 Ferrara, Italy; (C.S.); (M.G.); (F.F.)
| | - Francisco Javier Lopez-Longo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (F.J.L.-L.); (J.M.-B.)
| | - Julia Martinez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (F.J.L.-L.); (J.M.-B.)
| | - Udo Schneider
- Department of Rheumatology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (E.F.); (U.S.)
| | - Hanns-Martin Lorenz
- Department of Rheumatology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Andrea Doria
- Department of Rheumatology, University of Padua and ERN ReCONNET, 35122 Padova, Italy; (A.D.); (A.G.)
| | - Anna Ghirardello
- Department of Rheumatology, University of Padua and ERN ReCONNET, 35122 Padova, Italy; (A.D.); (A.G.)
| | | | - Marco Confalonieri
- Department of Pneumology, University Hospital of Cattinara, 34149 Trieste, Italy;
| | - Paola Tomietto
- Department of Rheumatology, University Hospital of Cattinara, 34149 Trieste, Italy;
| | - Nicolò Pipitone
- Department of Rheumatology, S. Maria Hospital—IRCCS, 42123 Reggio Emilia, Italy;
| | | | | | - Reinhard Edmund Voll
- Department of Rheumatology and Clinical Immunology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (R.E.V.); (S.W.)
| | - Sarah Wendel
- Department of Rheumatology and Clinical Immunology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (R.E.V.); (S.W.)
| | - Salvatore Scarpato
- Department of Rheumatology, Ospedale “ Scarlato” Scafati, 84018 Scafati, Italy;
| | - Francois Maurier
- Department of Rheumatology, HP Metz, Hopital Belle-Ile, 57000 Metz, France;
| | | | - Paolo Colombelli
- Department of Rheumatology, Ospedale di Treviglio, 24047 Treviglio, Italy;
| | - Margherita Giannini
- Service de Physiologie des Explorations Fonctionnelles, NHC Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (M.G.); (B.G.)
| | - Bernard Geny
- Service de Physiologie des Explorations Fonctionnelles, NHC Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (M.G.); (B.G.)
| | - Eugenio Arrigoni
- Department of Rheumatology, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (E.A.); (E.B.)
| | - Elena Bravi
- Department of Rheumatology, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (E.A.); (E.B.)
| | - Paola Migliorini
- Department of Immunology, Azienda Ospedaliera Universitaria Pisana, Pisa and ERN ReCONNET, 56126 Pisa, Italy;
| | - Alessandro Mathieu
- Department of Rheumatology, University Clinic and AOU of Cagliari, 09100 Cagliari, Italy; (A.M.); (M.P.)
| | - Matteo Piga
- Department of Rheumatology, University Clinic and AOU of Cagliari, 09100 Cagliari, Italy; (A.M.); (M.P.)
| | - Ulrich Drott
- Department of Rheumatology, Johann Wolfgang Goethe-Universität, 60590 Frankfurt, Germany; (U.D.); (C.D.)
| | - Christiane Delbrueck
- Department of Rheumatology, Johann Wolfgang Goethe-Universität, 60590 Frankfurt, Germany; (U.D.); (C.D.)
| | - Jutta Bauhammer
- Department of Rheumatology, ACURA Centre for Rheumatic Diseases, 76530 Baden-Baden, Germany;
| | - Giovanni Cagnotto
- Department of Rheumatology, Skane University Hospital, 22242 Lund, Sweden;
| | - Carlo Vancheri
- Department of Pneumology, AOU Catania, 95100 Catania, Italy; (C.V.); (G.S.)
| | - Gianluca Sambataro
- Department of Pneumology, AOU Catania, 95100 Catania, Italy; (C.V.); (G.S.)
| | - Ellen De Langhe
- Department of Rheumatology, University Hospitals, 3000 Leuven, Belgium;
| | - Pier Paolo Sainaghi
- Department of Rheumatology at CAAD, DiMet, University of Eastern Piedmont (UPO) and AOU “Maggiore della Carità”, 28100 Novara, Italy;
| | - Cristina Monti
- Department of Public Health, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy; (C.M.); (F.G.B.)
| | - Francesca Gigli Berzolari
- Department of Public Health, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy; (C.M.); (F.G.B.)
| | - Mariaeva Romano
- Department of Rheumatology, Niguarda Hospital, 20162 Milan, Italy;
| | - Francesco Bonella
- Department of Pneumology, Ruhrlandklinik, University of Duisburg-Essen and ERN Lung, 45239 Essen, Germany;
| | - Christof Specker
- Department of Rheumatology, Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany;
| | - Andreas Schwarting
- Department of Rheumatology, Johannes Gutenberg-University, 55122 Mainz, Germany;
| | | | - Carlo Selmi
- Department of Rheumatology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (C.S.); (A.C.)
| | - Angela Ceribelli
- Department of Rheumatology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (C.S.); (A.C.)
| | - Laura Nuno
- Department of Rheumatology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Antonio Mera-Varela
- Department of Rheumatology, Hospital Clínico Universitario de Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.M.-V.); (N.P.G.)
| | - Nair Perez Gomez
- Department of Rheumatology, Hospital Clínico Universitario de Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.M.-V.); (N.P.G.)
| | - Enrico Fusaro
- Department of Rheumatology, Città della Salute e della Scienza, 10126 Turin, Italy; (E.F.); (S.P.)
| | - Simone Parisi
- Department of Rheumatology, Città della Salute e della Scienza, 10126 Turin, Italy; (E.F.); (S.P.)
| | - Luigi Sinigaglia
- Department of Rheumatology, Hospital G. Pini—CTO, 20122 Milan, Italy; (L.S.); (N.D.P.)
| | - Nicoletta Del Papa
- Department of Rheumatology, Hospital G. Pini—CTO, 20122 Milan, Italy; (L.S.); (N.D.P.)
| | - Maurizio Benucci
- Department of Rheumatology, Azienda Ospedaliera San Giovanni di Dio, 50143 Firenze, Italy;
| | | | - Valeria Riccieri
- Department of Rheumatology, University La Sapienza and Policlinico Umberto I, 00161 Rome, Italy; (V.R.); (F.C.)
| | - Fabrizio Conti
- Department of Rheumatology, University La Sapienza and Policlinico Umberto I, 00161 Rome, Italy; (V.R.); (F.C.)
| | | | - Annamaria Iuliano
- Department of Rheumatology, Ospedale San Camillo, 00152 Rome, Italy; (G.D.S.); (A.I.)
| | - Giacomo Emmi
- Department of Internal Medicine, AOU Careggi, 50134 Firenze, Italy;
| | | | - Marco Sebastiani
- Department of Rheumatology, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy; (M.S.); (A.M.)
| | - Andreina Manfredi
- Department of Rheumatology, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy; (M.S.); (A.M.)
| | - Javier Bachiller-Corral
- Department of Rheumatology, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (J.B.-C.); (W.A.S.G.)
| | | | - Giuseppe Paolazzi
- Department of Rheumatology, Ospedale Santa Chiara, 38122 Trento, Italy;
| | - Lesley Ann Saketkoo
- University Medical Center- Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, Louisiana State University and Tulane University Schools of Medicine, Pulmonary Division New Orleans, New Orleans, LA 1542, USA
| | - Roberto Giorgi
- Department of Rheumatology, ASL Cuneo 2, 12051 Alba, Italy;
| | - Fausto Salaffi
- Department of Rheumatology, Polytechnic University of Marche, C. Urbani Hospital, 60035 Jesi, Italy;
| | - Jose Cifrian
- Department of Pneumology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria Santander, 39008 Santander, Spain;
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and Gaetano Pini Hospital, 20122 Milan, Italy;
| | - Francesco Locatelli
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN ReCONNET, 27100 Pavia, Italy; (G.Z.); (V.M.); (F.L.); (C.M.)
| | - Enrico Marchioni
- Department of Neurology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Alberto Pesci
- Department of Pneumology, Univerity of Milano Bicocca, San Gerardo Hospital, 20900 Monza, Italy; (A.P.); (G.D.); (M.R.P.)
| | - Giulia Dei
- Department of Pneumology, Univerity of Milano Bicocca, San Gerardo Hospital, 20900 Monza, Italy; (A.P.); (G.D.); (M.R.P.)
| | - Maria Rosa Pozzi
- Department of Pneumology, Univerity of Milano Bicocca, San Gerardo Hospital, 20900 Monza, Italy; (A.P.); (G.D.); (M.R.P.)
| | - Lomater Claudia
- Department of Rheumatology, Mauriziano Hospital, 10126 Turin, Italy;
| | - Jorg Distler
- Department of Internal Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.D.); (J.K.); (G.S.)
| | - Johannes Knitza
- Department of Internal Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.D.); (J.K.); (G.S.)
| | - George Schett
- Department of Internal Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.D.); (J.K.); (G.S.)
| | - Florenzo Iannone
- Rheumatology Unit—DETO, University of Bari, 70121 Bari, Italy; (F.I.); (M.F.)
| | - Marco Fornaro
- Rheumatology Unit—DETO, University of Bari, 70121 Bari, Italy; (F.I.); (M.F.)
| | - Franco Franceschini
- Department of Rheumatology, University and ASST Spedali Civili—Brescia and ERN ReCONNET, 25123 Brescia, Italy; (I.C.); (F.F.)
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, Santa Maria della Misericordia Hospital and University of Udine, 33100 Udine, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (R.G.); (E.B.)
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (R.G.); (E.B.)
| | | | | | - Montserrat I. Gonzalez Perez
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, 14080 Mexico City, Mexico; (J.R.-S.); (M.I.G.P.); (M.M.)
| | - Mayra Mejia
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, 14080 Mexico City, Mexico; (J.R.-S.); (M.I.G.P.); (M.M.)
| | - Esther Vicente
- Department of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, 28006 Madrid, Spain; (E.V.)
| | | | - Raquel Lopez-Mejias
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria Santander, 39008 Santander, Spain; (R.L.-M.); (M.A.G.-G.)
| | | | - Albert Selva-O’Callaghan
- Department of Internal Medicine, Vall d’Hebron General Hospital, Universitat Autonoma de Barcelona, GEAS group, 08035 Barcelona, Spain; (E.T.-A.); (A.S.-O.)
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, 28006 Madrid, Spain; (E.V.)
- Catedra UAM-Roche, EPID Future, Universitad Autonoma de Madrid, 28006 Madrid, Spain
| | - Carlomaurizio Montecucco
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia and ERN ReCONNET, 27100 Pavia, Italy; (G.Z.); (V.M.); (F.L.); (C.M.)
| | - Miguel Angel Gonzalez-Gay
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria Santander, 39008 Santander, Spain; (R.L.-M.); (M.A.G.-G.)
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Sánchez-Duffhues G, Williams E, Benderitter P, Orlova V, van Wijhe M, Garcia de Vinuesa A, Kerr G, Caradec J, Lodder K, de Boer HC, Goumans MJ, Eekhoff EMW, Morales-Piga A, Bachiller-Corral J, Koolwijk P, Bullock AN, Hoflack J, Ten Dijke P. Development of Macrocycle Kinase Inhibitors for ALK2 Using Fibrodysplasia Ossificans Progressiva-Derived Endothelial Cells. JBMR Plus 2019; 3:e10230. [PMID: 31768489 PMCID: PMC6874179 DOI: 10.1002/jbm4.10230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare congenital form of heterotopic ossification (HO), caused by heterozygous mutations in the activin A type I receptor (ACVR1), that encodes the bone morphogenetic protein (BMP) type I receptor ALK2. These mutations enable ALK2 to induce downstream signaling in response to activins, thereby turning them into bone-inducing agents. To date, there is no cure for FOP. The further development of FOP patient-derived models may contribute to the discovery of novel biomarkers and therapeutic approaches. Nevertheless, this has traditionally been a challenge, as biopsy sampling often triggers HO. We have characterized peripheral blood-derived endothelial colony-forming cells (ECFCs) from three independent FOP donors as a new model for FOP. FOP ECFCs are prone to undergo endothelial-to-mesenchymal transition and exhibit increased ALK2 downstream signaling and subsequent osteogenic differentiation upon stimulation with activin A. Moreover, we have identified a new class of small molecule macrocycles with potential activity against ALK2 kinase. Finally, using FOP ECFCs, we have selected OD36 and OD52 as potent inhibitors with excellent kinase selectivity profiles that potently antagonize mutant ALK2 signaling and osteogenic differentiation. We expect that these results will contribute to the development of novel ALK2 clinical candidates for the treatment of FOP. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Gonzalo Sánchez-Duffhues
- Department of Cell and Chemical Biology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
| | | | | | - Valeria Orlova
- Department of Anatomy and Embryology Leiden University Medical Center Leiden The Netherlands
| | - Michiel van Wijhe
- Amsterdam Cardiovascular Sciences, Department of Physiology and Amsterdam Bone Center Vrije University Medical Center Amsterdam The Netherlands
| | - Amaya Garcia de Vinuesa
- Department of Cell and Chemical Biology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
| | - Georgina Kerr
- Structural Genomics Consortium University of Oxford Oxford UK
| | | | - Kirsten Lodder
- Department of Cell and Chemical Biology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
| | - Hetty C de Boer
- Department of Nephrology Leiden University Medical Center and the Einthoven Laboratory for Experimental Vascular Medicine Leiden The Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
| | - Elisabeth M W Eekhoff
- Amsterdam Cardiovascular Sciences, Department of Physiology and Amsterdam Bone Center Vrije University Medical Center Amsterdam The Netherlands
| | - Antonio Morales-Piga
- Disease Research Institute, Carlos III Institute of Health (ISCIII) Madrid Spain
| | | | - Pieter Koolwijk
- Amsterdam Cardiovascular Sciences, Department of Physiology and Amsterdam Bone Center Vrije University Medical Center Amsterdam The Netherlands
| | - Alex N Bullock
- Structural Genomics Consortium University of Oxford Oxford UK
| | | | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
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Vázquez-Díaz M, Bachiller-Corral J. Adherence to biologic treatments: a balance between need and concern. Farm Hosp 2019; 43:119-120. [PMID: 31276442 DOI: 10.7399/fh.11289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
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Villalobos-Sánchez L, Bachiller-Corral J, Yeguas-Ramírez L, Cobeta-Marco I, Vázquez-Díaz M. Bamboo nodes as evidence of mixed connective tissue disease. Joint Bone Spine 2019; 86:645-646. [PMID: 30597217 DOI: 10.1016/j.jbspin.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Lourdes Villalobos-Sánchez
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain.
| | - Javier Bachiller-Corral
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Laura Yeguas-Ramírez
- Department of otorhinolaryngology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Ignacio Cobeta-Marco
- Department of otorhinolaryngology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Mónica Vázquez-Díaz
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
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González-Gay MA, Montecucco C, Selva-O'Callaghan A, Trallero-Araguas E, Molberg O, Andersson H, Rojas-Serrano J, Perez-Roman DI, Bauhammer J, Fiehn C, Neri R, Barsotti S, Lorenz HM, Doria A, Ghirardello A, Iannone F, Giannini M, Franceschini F, Cavazzana I, Triantafyllias K, Benucci M, Infantino M, Manfredi M, Conti F, Schwarting A, Sebastiani G, Iuliano A, Emmi G, Silvestri E, Govoni M, Scirè CA, Furini F, Lopez-Longo FJ, Martínez-Barrio J, Sebastiani M, Manfredi A, Bachiller-Corral J, Sifuentes Giraldo WA, Cimmino MA, Cosso C, Belotti Masserini A, Cagnotto G, Codullo V, Romano M, Paolazzi G, Pellerito R, Saketkoo LA, Ortego-Centeno N, Quartuccio L, Batticciotto A, Bartoloni Bocci E, Gerli R, Specker C, Bravi E, Selmi C, Parisi S, Salaffi F, Meloni F, Marchioni E, Pesci A, Dei G, Confalonieri M, Tomietto P, Nuno L, Bonella F, Pipitone N, Mera-Valera A, Perez-Gomez N, Gerzeli S, Lopez-Mejias R, Matos-Costa CJ, Pereira da Silva JA, Cifrian J, Alpini C, Olivieri I, Blázquez Cañamero MÁ, Rodriguez Cambrón AB, Castañeda S, Cavagna L. Timing of onset affects arthritis presentation pattern in antisyntethase syndrome. Clin Exp Rheumatol 2018; 36:44-49. [PMID: 28770709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 04/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate if the timing of appearance with respect to disease onset may influence the arthritis presentation pattern in antisynthetase syndrome (ASSD). METHODS The patients were selected from a retrospective large international cohort of ASSD patients regularly followed-up in centres referring to AENEAS collaborative group. Patients were eligible if they had an antisynthetase antibody testing positive in at least two determinations along with arthritis occurring either at ASSD onset (Group 1) or during the course of the disease (Group 2). RESULTS 445 (70%; 334 females, 110 males, 1 transsexual) out of the 636 ASSD we collected had arthritis, in the majority of cases (367, 83%) from disease onset (Group 1). Patients belonging to Group 1 with respect to Group 2 had an arthritis more commonly polyarticular and symmetrical (p=0.015), IgM-Rheumatoid factor positive (p=0.035), erosions at hands and feet plain x-rays (p=0.036) and more commonly satisfying the 1987 revised classification criteria for rheumatoid arthritis (RA) (p=0.004). Features such as Raynaud's phenomenon, mechanic's hands and fever (e.g. accompanying findings) were more frequently reported in Group 2 (p=0.005). CONCLUSIONS In ASSD, the timing of appearance with respect to disease onset influences arthritis characteristics. In particular, RA features are more common when arthritis occurs from ASSD onset, suggesting an overlap between RA and ASSD in these patients. When arthritis appears during the follow-up, it is very close to a connective tissue disease-related arthritis. Also, the different prevalence of accompanying features between these two groups is in line with this possibility.
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Affiliation(s)
- Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | | | | | - Ovynd Molberg
- Department of Rheumatology, Oslo University Hospital (OUH), Oslo, Norway
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital (OUH), Oslo, Norway
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | - Diana Isabel Perez-Roman
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | | | | | - Rossella Neri
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Simone Barsotti
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Hannes M Lorenz
- Department of Internal Medicine V, Division of Rheumatology, University of Heidelberg, Germany
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Anna Ghirardello
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Italy
| | - Margherita Giannini
- Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Italy
| | | | - Ilaria Cavazzana
- Rheumatology Unit, University and AO Spedali Civili, Brescia, Italy
| | | | - Maurizio Benucci
- Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Florence, Italy
| | - Maria Infantino
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Florence, Italy
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties-Rheumatology, Sapienza University of Rome, Italy
| | - Andreas Schwarting
- Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany
| | | | | | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Marcello Govoni
- UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Italy
| | - Carlo Alberto Scirè
- UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Italy
| | - Federica Furini
- UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Italy
| | | | - Julia Martínez-Barrio
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Italy
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Italy
| | | | | | - Marco A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy
| | - Claudio Cosso
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy
| | | | - Giovanni Cagnotto
- Lund University, Skane University Hospital, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - Veronica Codullo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Mariaeva Romano
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | | | - Lesley Ann Saketkoo
- Tulane University Lung Center Tulane, UMC Scleroderma and Sarcoidosis Patient Care and Research Center New Orleans, LA, USA
| | | | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences (DSMB), Santa Maria della Misericordia Hospital, Udine, Italy
| | | | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Christof Specker
- Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany
| | - Elena Bravi
- Rheumatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Simone Parisi
- Rheumatology Department, Città Della Salute e della Scienza, Torino, Italy
| | - Fausto Salaffi
- Rheumatology Department, Polytechnic University of Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Federica Meloni
- Pneumology Unit, Cardiothoracic and Vascular Department, University and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Alberto Pesci
- School of Medicine and Surgery, University of Milan-Bicocca, Respiratory Unit, ASST Monza, Italy
| | - Giulia Dei
- School of Medicine and Surgery, University of Milan-Bicocca, Respiratory Unit, ASST Monza, Italy
| | - Marco Confalonieri
- Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara, Trieste, Italy
| | - Paola Tomietto
- Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Italy
| | - Laura Nuno
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, S.Maria Hospital, IRCCS, Reggio Emilia, Italy
| | - Antonio Mera-Valera
- Division of Rheumatology, Instituto de Investigación Sanitaria, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Nair Perez-Gomez
- Division of Rheumatology, Instituto de Investigación Sanitaria, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Simone Gerzeli
- Department of Political and Social Sciences, Social Statistic studies, University of Pavia, Italy
| | - Raquel Lopez-Mejias
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | | | - José Cifrian
- Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Claudia Alpini
- Laboratory of Biochemical-Clinical Analyses, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ignazio Olivieri
- Rheumatology Institute of Lucania (IRel), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, and Basilicata Biomedica (BRB) Foundation, Italy
| | | | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foudation, Pavia, Italy.
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González-Álvaro I, Blasco AJ, Lázaro P, Sánchez-Piedra C, Almodovar R, Bachiller-Corral J, Balsa A, Caliz R, Candelas G, Fernández-Carballido C, García-Aparicio A, García-Magallón B, García-Vicuña R, Gómez-Centeno A, Ortiz AM, Sanmartí R, Sanz J, Tejera B. REDOSER project: optimising biological therapy dose for rheumatoid arthritis and spondyloarthritis patients. Heliyon 2017; 3:e00452. [PMID: 29264411 PMCID: PMC5727544 DOI: 10.1016/j.heliyon.2017.e00452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/01/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background Reducing the dose of biological therapy (BT) when patients with immune-mediated arthritis achieve a sustained therapeutic goal may help to decrease costs for national health services and reduce the risk of serious infection. However, there is little information about whether such a decision can be applied universally. Therefore, the objective of this study was to develop appropriateness criteria for reducing the dose of BT in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and peripheral spondyloarthritis (pSpA). Methods The RAND/UCLA appropriateness method was coordinated by experts in the methodology. Five rheumatologists with clinical research experience in RA and/or SpA selected and precisely defined the variables considered relevant when deciding to reduce the dose of BT in the 3 diseases, in order to define patient profiles. Ten rheumatologists with experience in prescribing BT anonymously rated each profile on a scale of 1 (completely inappropriate) to 9 (completely appropriate) after revising a summary of the evidence obtained from 4 systematic literature reviews carried out specifically for this project. Findings A total of 2,304 different profiles were obtained for RA, 768 for axSpA, and 3,072 for pSpA. Only 327 (14.2%) patient profiles in RA, 80 (10.4%) in axSpA, and 154 (5%) in pSpA were considered appropriate for reducing the dose of BT. By contrast, 749 (32.5%) patient profiles in RA, 270 (35.3%) in axSpA, and 1,243 (40.5%) in pSpA were considered inappropriate. The remaining profiles were considered uncertain. Interpretation Appropriateness criteria for reducing the dose of BT were developed in 3 inflammatory conditions. These criteria can help clinicians treating these disorders to optimize the BT dose. However, further research is needed, since more than 50% of the profiles were considered uncertain and the real prevalence of each profile in daily clinical practice remains unknown.
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Affiliation(s)
- Isidoro González-Álvaro
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
- Corresponding author.
| | | | - Pablo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| | - Carlos Sánchez-Piedra
- Research Unit, Spanish Society of Rheumatology, c/Marques del Duero 5, Madrid 28001, Spain
| | - Raquel Almodovar
- Rheumatology Section, Hospital Universitario Fundación Alcorcón, c/Budapest 1, Alcorcón 28922, Spain
| | - Javier Bachiller-Corral
- Rheumatology Service, Hospital Universitario Ramon y Cajal, C/Colmenar Viejo km 9.1, Madrid 28034, Spain
| | - Alejandro Balsa
- Rheumatology Service, Hospital Univeritario La Paz, IdIPaz, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Rafael Caliz
- Rheumatology Service, Hospital Universitario Virgen de la Nieves, Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Gloria Candelas
- Rheumatology Service, Hospital Clínico San Carlos, IdISSC, c/Profesor Martin Lagos s/n, Madrid 28040, Spain
| | | | - Angel García-Aparicio
- Rheumatology Service, Hospital Virgen de la Salud, Avda de Barber 30, Toledo 45004, Spain
| | - Blanca García-Magallón
- Rheumatology Unit, Hospital General San Jorge, Avda Martinez Velasco 36, Huesca 22004, Spain
| | - Rosario García-Vicuña
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
| | - Antonio Gómez-Centeno
- Rheumatology Service, Hospital Universitario Parc Taulí, Parc Taulí 1, Sabadell 08208, Spain
| | - Ana M. Ortiz
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
| | - Raimon Sanmartí
- Rheumatology Service, Hospital Clinic, c/Villarroel 170, Barcelona 08036, Spain
| | - Jesús Sanz
- Rheumatology Service, Hospital Universitario Puerta de Hierro, c/Manuel de Falla 1, Majadahonda 28222, Spain
| | - Beatriz Tejera
- Rheumatology Service, Hospital Universitario de Canarias, C/Ofra s/n, Santa Cruz de Tenerife 38320, Spain
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Loarce-Martos J, Garrote-Corral S, Gioia F, Bachiller-Corral J. Visceral leishmaniasis in a patient with rheumatoid arthritis treated with methotrexate. ACTA ACUST UNITED AC 2017; 15:e130-e132. [PMID: 28958842 DOI: 10.1016/j.reuma.2017.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 11/19/2022]
Abstract
A large number of complications have been associated with rheumatoid arthritis (RA), those of infectious etiology being of special relevance. Their high incidence is closely linked to the use of immunosuppressive medication. The spectrum of agents causing opportunistic infections in patients with RA is very broad; however, there are relatively few cases of Leishmania infection, especially in patients not being treated with biological drugs.
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Affiliation(s)
- Jesús Loarce-Martos
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Francesca Gioia
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
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Cavagna L, Andersson H, González-Gay M, Molberg O, Franceschini F, Cavazzana I, Castañeda S, Lopez Longo F, Balduzzi S, Montecucco C, Triantafyllias K, Weinmann-Menke J, Rojas-Serrano J, Sifuentes Giraldo A, Bachiller-Corral J, Salaffi F, Iannone F, Giannini M, Nuno L, Bonella F, Costabel U, Parisi S, Selmi C, Scirè C, Benucci M, Doria A, Caporali R, Pérez-Román D, Ghirardello A. FRI0291 Clinical Spectrum Time Course in Non Anti Jo-1 Positive Antisynthetase Syndrome: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morales-Piga A, Bachiller-Corral J, González-Herranz P, Medrano-SanIldelfonso M, Olmedo-Garzón J, Sánchez-Duffhues G. Osteochondromas in fibrodysplasia ossificans progressiva: a widespread trait with a streaking but overlooked appearance when arising at femoral bone end. Rheumatol Int 2015; 35:1759-67. [PMID: 26049728 DOI: 10.1007/s00296-015-3301-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/27/2015] [Indexed: 01/01/2023]
Abstract
Metaphyseal bony outgrowths are a well-recognized feature of fibrodysplasia ossificans progressiva (FOP) phenotype, but its genuine frequency, topographic distribution, morphological aspect, and potential implications are not fully established. To better ascertain the frequency and characteristics of osteocartilaginous exostoses in FOP disease, we conducted a cross-sectional radiological study based on all the traceable cases identified in a previous comprehensive national research. Metaphyseal exostoses were present in all the 17 cases of FOP studied. Although most often arising from the distal femoral (where metaphyseal exostoses adopt a peculiar not yet reported appearance) and proximal tibial bones, we have found that they are not restricted to these areas, but rather can be seen scattered at a variety of other skeletal sites. Using nuclear magnetic resonance imaging, we show that these exophytic outgrowths are true osteochondromas. As a whole, these results are in agreement with data coming from the literature review. Our study confirms the presence of metaphyseal osteochondromas as a very frequent trait of FOP phenotype and an outstanding feature of its anomalous skeletal developmental component. In line with recent evidences, this might imply that dysregulation of BMP signaling, in addition to promoting exuberant heterotopic ossification, could induce aberrant chondrogenesis and osteochondroma formation. Unveiling the molecular links between these physiopathological pathways could help to illuminate the mechanisms that govern bone morphogenesis.
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Affiliation(s)
- A Morales-Piga
- Rare Disease Research Institute (Instituto de Investigación de Enfermedades Raras - IIER), Carlos III Institute of Health (Instituto de Salud Carlos III - ISCIII), Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras - CIBERER), Madrid, Spain.
| | - J Bachiller-Corral
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain.
| | - P González-Herranz
- Orthopedic Surgery Children's Unit, "Teresa Herrera" Mother and Child Hospital, A Coruña, Spain.
| | | | - J Olmedo-Garzón
- Rheumatology Department, San Carlos University Clinic Hospital, Madrid, Spain.
| | - G Sánchez-Duffhues
- Department of Molecular Cell Biology, Leids Universitair Medisch Centrum (LUMC), Leiden, The Netherlands.
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Guillen Astete C, Bachiller-Corral J, Boteanu A. AB1112 Does the Specialized Rheumatology Assessment Produce a Pull Effect in an Accident & Emergency Department? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Guillen Astete C, Bachiller-Corral J, Boteanu A. AB0953 Comparison of Tapentadol Versus Conventional Treatment with Tramadol and/or Nsaids in the Management of Mechanical Low Back Pain with a Neuropathic Component. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Morales-Piga AA, García Callejo FJ, González Herranz P, Bachiller-Corral J. [Epidemiologic and public-health issues of progressive fibrodysplasia ossificans in Spain]. Med Clin (Barc) 2015; 144:183. [PMID: 24787683 DOI: 10.1016/j.medcli.2014.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/14/2014] [Accepted: 03/20/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio A Morales-Piga
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, España.
| | | | - Pedro González Herranz
- Servicio de Cirugía Ortopédica, Hospital Materno Infantil Teresa Herrera (CHU), La Coruña, España
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Maldonado-Romero LV, Sifuentes Giraldo WA, Larena-Grijalba C, Bachiller-Corral J. [Follicular non-Hodgkin lymphoma-associated dermatomyositis]. Rev Clin Esp 2014; 214:108-9. [PMID: 24444422 DOI: 10.1016/j.rce.2013.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/30/2013] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - C Larena-Grijalba
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Bachiller-Corral
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
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Bachiller-Corral J, Díaz-Miguel C, Morales-Piga A. Monostotic Paget's disease of the femur: a diagnostic challenge and an overlooked risk. Bone 2013; 57:517-21. [PMID: 24001926 DOI: 10.1016/j.bone.2013.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although radiological diagnosis of Paget's disease of bone (PD) is usually straightforward, monostotic cases may potentially raise specific problems which lead to performing invasive procedures. Therefore, the purpose of this study is to ascertain whether or not monostotic femoral Paget's disease (MFPD) presentation poses particular diagnostic difficulties which prompt excessive use of excisional biopsies. METHODS We retrospectively reviewed the medical records of 24 MFPD patients identified from a series of 412 patients; their clinical features were compared with those of the remaining 164 monostotic cases and the radiological images were systematically assessed. RESULTS When compared with the remaining monostotic cases, MFPD patients were more prone to having normal alkaline phosphatase levels (31.8% vs. 16.4%; 0.08) and a significantly higher percentage of patients have PD symptoms (75% vs. 51%; 0.02) and complain of bone pain (73.9% vs. 40.8%; 0.003). Six (25%) MFPD patients evidenced a fracture over the pagetic lesion. This incidence is higher than that of the monostotic cases of other locations (8.4%; p=0.02). The existence of PD lesion was not recognised initially in 10 cases and an excisional bone biopsy was performed in 7 (29%). One patient subsequently experienced a fracture through the biopsy site and another two experienced worsening of their previous bone pain. CONCLUSION The femur is a relatively common monostotic PD location which often causes diagnostic confusion, prompting a bone biopsy in many cases. Careful assessment of this lesion by X-ray examination may help attain an early appropriate diagnosis and avoidance of unnecessary surgical morbidity.
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Morales-Piga A, García Ribes M, Arribas Álvaro P, Casado Álvaro C, Posada de La Paz M, Bachiller-Corral J. [Is there a place in primary care for rare diseases? The case of fibrodysplasia ossificans progressiva]. Aten Primaria 2013; 45:324-8. [PMID: 23369643 PMCID: PMC6985523 DOI: 10.1016/j.aprim.2012.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/06/2022] Open
Abstract
La fibrodisplasia osificante progresiva es una de las enfermedades constitucionales óseas más devastadoras, y supone un ejemplo válido para establecer el papel de la asistencia primaria en la atención a las enfermedades poco frecuentes. Aunque las enfermedades raras suelen presentar alteraciones llamativas pueden remedar síntomas y signos de trastornos comunes, con riesgo de pasar desapercibidas. Por ello, todos los profesionales sanitarios deberían proceder con un grado de sospecha razonable ante un paciente con una enfermedad aparentemente común con rasgos atípicos o evolución no convencional. En el seguimiento integral e individualizado, los cuidados dispensados por el equipo de atención primaria en coordinación con otros dispositivos asistenciales, son fundamentales. La calidad de la atención a enfermedades raras no puede ser inferior a la que se presta a los demás procesos crónicos, ya que –además de ser un imperativo de justicia y equidad– estos pacientes son, en esencia, el «paradigma de la cronicidad».
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Affiliation(s)
- Antonio Morales-Piga
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain.
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