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Management of Psoriatic Arthritis
Published in Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi, Psoriasis and Psoriatic Arthritis, 2017
Siba P. Raychaudhuri, Reason Wilken, Debashis Sarkar, Emanual Maverakis, Smriti K. Raychaudhuri
Because patients with PsA are mostly associated with significant peripheral arthritis, we often apply the same outcome measures developed and validated for RA [20]. These include the Disease Activity Score for 28 joints (DAS28) and the American College of Rheumatology (ACR) Responder Index (ACR20) [21,22]. But, the difference in the pattern of joint involvement between PsA and RA has raised serious questions about the ability of ACR20 and DAS28 to quantify the disease activity of PsA. For example, compared with RA in PsA, there is a greater tendency for asymmetric and oligoarticular joint involvement. Moreover, the distal interphalangeal (DIP) joints are frequently involved in PsA but not in RA—a remarkable feature because the 28-joint count comprising the DAS28 excludes the finger (DIP) joints, as well as the ankles and feet, which are commonly affected in PsA [21]. So, in patients with oligoarthritis, use of the DAS28 can misclassify 20% of PsA patients and application of DAS28 will simply mismeasure disease activity in these patients [23]. As a result of this fallacy for PsA clinical trials, it has been recommended to do a count of 68 tender and 66 swollen joints, including the DIP joints of the hands [24].
Mechanisms of Fibril Formation and Cellular Response
Published in Martha Skinner, John L. Berk, Lawreen H. Connors, David C. Seldin, XIth International Symposium on Amyloidosis, 2007
Martha Skinner, John L. Berk, Lawreen H. Connors, David C. Seldin
The DAS28 is a well validated score relating to outcome in rheumatoid arthritis. All 76 patients who were assessed by this had an established diagnosis of rheumatoid arthritis. The laboratory results which correlate best should perhaps be paramount in any conclusion. The patient global score, on the other hand, while widely used can have two disadvantages: first it may reflect the patient’s view of their condition in respect of symptoms related to joint damage rather than inflammation; second, it is recognised that some patients don’t cope well with the concept of visual analogue scores. The physician’s assessment was specifically designed to reflect clinically evident inflammation and, though not validated, should give a good guide as to the most relevant laboratory marker for inflammation. The correlation of patient global solely with CRP, the DAS28 best with CRP, and better correlations of the physician’s score with CRP and ESR taken together suggest that CRP is the best routine objective measurement that is likely to be available in patients’ records. These results suggest that identifying those patients who have high CRP levels over prolonged periods (CRP x time) is the best means of identifying those who are most at risk of AA amyloid because of chronic inflammatory disease.
Anticytokine therapies in rheumatic diseases: an update
Published in Rajan Madhok, Hilary Capell, The Year in Rheumatic Disorders Volume 4, 2004
RA runs a variable course but in most patients it has a poor long-term outcome, with significant disability and increased mortality. DMARDs prevent articular damage and functional deterioration; however, a sizeable proportion of patients have an incomplete clinical response, while about 10% of all RA patients are DMARD- resistant. Therefore, it is important to consider therapy with biological agents in all patients with highly active, refractory disease, not only to control the symptoms but also to improve the disease outcome. To ensure consistency across different centres, it has been agreed that severe disease activity should be properly defined using an appropriate index. To this end, in Europe the disease activity score based on a 28-joint count (DAS28) has been chosen. The DAS28 is a composite index that takes into account four variables: tender joint count, swollen joint count, erythrocyte sedimentation rate and the patient's global assessment of disease activity. In the UK, a DAS28 higher than 5.1 denotes highly active disease and is an indication for anti- TNF-a therapy if at least two DMARDs, including MTX, have been ineffective or poorly tolerated.
Heterogenous bone response to biologic DMARD therapies in rheumatoid arthritis patients and their relationship to functional indices
Published in Scandinavian Journal of Rheumatology, 2021
SC Brunet, JJ Tse, MT Kuczynski, K Engelke, SK Boyd, C Barnabe, SL Manske
Of the 90 patients who were recruited, 27 were lost to follow-up (change of address, did not attend hand function or hand scan appointment), six withdrew because they discontinued bDMARD therapy, and a further nine were excluded owing to motion artefacts at baseline or follow-up scans. The mean age of the remaining 48 patients included in this analysis was 55.9 ± 12.6 years, with a mean diagnosis duration of 9.5 ± 8.2 years. Thirty-nine patients were female (81%). The mean DAS28 score at baseline was 2.6 ± 1.1 (Table 1). Thirty-three patients were on an anti-tumour necrosis factor (anti-TNF) therapy, nine were on a T-cell co-stimulatory inhibitor therapy, and six were on an anti-interleukin-6 (anti-IL-6) therapy. Eight patients had past bDMARD exposure and were switching therapies to a new therapeutic class. Of these eight, three patients changed from an anti-TNF therapy to a new anti-TNF therapy, and one switched from an anti-TNF to an anti-IL-6 therapy. Four patients had tried more than one bDMARD before this study, two of whom initiated a new T-cell co-stimulatory inhibitor, and two whom initiated a new anti-IL-6 therapy.
Evaluation of retinal vascularization by optical coherence tomography angiography (OCTA) in rheumatoid arthritis, and its relationship with disease activity
Published in Modern Rheumatology, 2021
Koray Ayar, Mehmet Erol Can, Nizameddin Koca, Direnç Şerif Çelik
The disease activity of RA patients was measured using the DAS28 (Disease Activity Score). DAS28 is calculated using the number of tender and swollen joints, patient global health assessment (PGHA), and erythrocyte sedimentation rate (ESR). Physical examinations of the small joints of the hands and joints of the wrist, knee, shoulder, and elbow (28 joints) were performed by a single experienced rheumatologist to see if the joints were tender or swollen. PGHA was assessed by asking patients to respond to the question, ‘Considering all the ways your arthritis has affected you how do you feel today?’ using a visual analog scale (VAS). DAS28-ESR was calculated according to this formula; DAS28-ESR = (0.56 × square (tender joint count))+(0.28 × square (swollen joint count))+(0.7 × ln (ESR))+(0.014 × PGHA).
Effectiveness of golimumab in rheumatoid arthritis patients with inadequate response to first-line biologic therapy: Results from a Japanese post-marketing surveillance study
Published in Modern Rheumatology, 2021
Hirohito Shimizu, Hisanori Kobayashi, Masayoshi Kanbori, Yutaka Ishii
Demographic and baseline characteristics of the ITT/effectiveness analysis set are summarized by prior bDMARD therapy in Table 1. Generally, these characteristics were comparable across the subgroups except that the baseline disease activity was slightly higher in patients who had previously received TCZ. The overall mean age was 63.9 ± 12.5 years and 82.8% of the patients were women. As expected for the current study population (i.e. biologic-experienced), most patients had long-standing RA and the mean disease duration was 12.0 ± 10.3 years. All patients had active disease at baseline, with a mean DAS28-CRP score of 4.52 ± 0.94, DAS28-ESR score of 5.16 ± 1.07, SDAI score of 25.00 ± 11.31, and CDAI score of 23.18 ± 10.95. Based on the DAS28-CRP and DAS28-ESR scores, 25.0% and 48.3% were classified as having high disease activity, and 75.0% and 49.1% had moderate disease activity, respectively. Over 80% of the patients previously treated with IFX and ADA were concomitantly prescribed MTX (94.3% and 82.3%, respectively), while this rate was lower for patients with prior ETN, TCZ and ABT therapy (71.4%, 68.3%, and 76.2%, respectively). In contrast, concomitant glucocorticoid use was more frequent among the patients with prior ETN, TCZ or ABT therapy (62.0%, 70.7%, and 57.1%, respectively) than in the other two subgroups (45.5% and 53.9% for the IFX and ADA subgroups, respectively). In each subgroup, the majority of patients received 50 mg of GLM rather than 100 mg at baseline (Table 1).