Non–TNF-Targeted Biologic vs a Second Anti-TNF Drug to Treat #Rheumatoid Arthritis in Patients With Insufficient Response to a First Anti-#TNF Drug A Randomized Clinical Trial

http://jama.jamanetwork.com/mobile/article.aspx?articleid=2553449

Conclusions and Relevance Among patients with rheumatoid arthritis previously treated with anti-TNF drugs but with inadequate primary response, a non-TNF biologic agent was more effective in achieving a good or moderate disease activity response at 24 weeks than was the second anti-TNF medication.

Phenome-Wide Association Study of #Rheumatoid Arthritis Subgroups Identifies Association between Seronegative Disease and #Fibromyalgia

http://onlinelibrary.wiley.com/wol1/doi/10.1002/art.39851/abstract

Conclusion: This PheWAS in RA patients identifies a strong association between seronegativity and fibromyalgia. It also affirms relationships between seropositivity with chronic airway obstruction and seropositivity with tobacco use. These findings demonstrate the utility of the PheWAS approach to discover novel phenotype associations within different subgroups of a disease.

The effect of #rheumatoid arthritis–associated autoantibodies on the incidence of #cardiovascular events in a large inception cohort of early inflammatory arthritis

http://m.rheumatology.oxfordjournals.org/content/early/2017/01/09/rheumatology.kew474.abstract

The rate of CVEs early in the course of inflammatory arthritis was low; however, delays in the diagnosis of arthritis increased the rate of CVEs. Hypertension was the strongest independent risk factor for CVEs. Results support early aggressive management of RA disease activity and co-morbidities to prevent severe complications.

#Fibromyalgia Predicts Two-Year Changes in Functional Status in #Rheumatoid Arthritis Patients

http://onlinelibrary.wiley.com/doi/10.1002/acr.23216/abstract

Both the presence of FM and increasing number of FM symptoms predicted worsening of functional status among individuals with RA. Among individuals with RA and FM, the magnitude of the difference in changes in MDHAQ was 4 to 7-fold higher than typical changes in MDHAQ score among individuals with established RA.

Multi-Dimensional Health Assessment Questionnaire (MDHAQ)

#Pain Sensitization is Associated with Disease #Activity in #Rheumatoid Arthritis Patients: A Cross-Sectional Study
http://onlinelibrary.wiley.com/doi/10.1002/acr.23266/abstract

Pain sensitization may contribute to pain severity in rheumatoid arthritis (RA), impacting assessment of disease activity. We examined whether pain processing mechanisms were associated with disease activity among RA patients with active disease.

Conclusion. High pain sensitization is associated with elevations in disease activity measures. Longitudinal studies are underway to elucidate the cause-effect relationships between pain sensitization and inflammatory disease activity in RA.

The relationship between #fish consumption and disease activity in #rheumatoid arthritis
http://onlinelibrary.wiley.com/doi/10.1002/acr.23295/abstract

In an adjusted linear regression model, subjects consuming fish ≥2 times/week had a significantly lower DAS28-CRP compared with subjects who ate fish never to <1/month (difference -0.49 [95% CI -0.97, -0.02]). For each additional serving of fish per week, DAS28-CRP was significantly reduced by 0.18 (95% CI -0.35, -0.004).

Conclusions: Our findings suggest that higher intake of fish may be associated with lower disease activity in RA patients. Multivariable, total energy-adjusted linear regression models provided effect estimates and 95% confidence intervals (CI) for frequency of fish consumption (never to <1/month, 1/month to <1/week, 1/week, and ≥2/week) on baseline DAS28-CRP. We also estimated the difference in DAS28-CRP associated with increasing fish consumption by one serving per week.

Patient-reported outcomes from a phase 3 study of #baricitinib versus placebo or adalimumab in #rheumatoid arthritis: secondary analyses from the RA-BEAM study

http://ard.bmj.com/node/236598.full

To assess the effect of baricitinib on patient-reported outcomes (PROs) in patients with active rheumatoid arthritis and an inadequate response to methotrexate (MTX)

Compared with placebo and adalimumab, baricitinib showed statistically significant improvements (p≤0.05) in HAQ-DI, PtGA, pain, FACIT-F, SF-36 physical component score, EQ-5D index scores and WPAI-RA daily activity at week 12. Improvements were maintained for measures assessed to week 52. Statistically significant improvement in patient diary measures (MJS duration and severity), worst tiredness and worst joint pain were observed for baricitinib versus placebo and adalimumab at week 12 (p≤0.05).

Conclusions Baricitinib provided significantly greater improvement in most PROs compared with placebo and adalimumab, including physical function MJS, pain, fatigue and quality of life. Improvement was maintained to the end of the study (week 52)

#Fibromyalgia and the Prediction of Two-Year Changes in Functional Status in #Rheumatoid Arthritis Patients
http://onlinelibrary.wiley.com/doi/10.1002/acr.23216/full

Of the 156 included RA subjects, 16.7% had FM, while 83.3% did not. In a multivariable linear regression model adjusted for age, sex, race, baseline MDHAQ score, disease duration, rheumatoid factor/cyclic citrullinated peptide antibody seropositivity, disease activity, and psychological distress, RA patients with FM had a 0.14 greater 2-year increase in MDHAQ score than RA patients without FM (P = 0.021). In secondary analyses examining the association between continuous PSD scale score and change in MDHAQ, higher PSD scale scores were significantly associated with greater 2-year increases in MDHAQ score (β coefficient 0.013, P = 0.011).
Conclusion

Both the presence of FM and increasing number of FM symptoms predicted worsening of functional status among individuals with RA. Among individuals with RA and FM, the magnitude of the difference in changes in MDHAQ was 4- to 7-fold higher than typical changes in MDHAQ score among individuals with established RA

Testing treat-to-target outcomes with initial #methotrexate monotherapy compared with initial tumour necrosis factor inhibitor (#adalimumab) plus methotrexate in early #rheumatoid arthritis
http://ard.bmj.com/content/early/2017/12/04/annrheumdis-2017-211871

Significantly greater proportions of patients initially treated with adalimumab+MTX (n=466) compared with MTX monotherapy (n=460) achieved good clinical (53% vs 30%), functional (45% vs 33%) and radiographic (87% vs 72%) outcomes at week 26. From weeks 26 to 78, adalimumab rescue patients achieved similar clinical and functional outcomes versus patients initially treated with adalimumab+MTX. However, significantly more patients initially treated with adalimumab+MTX had no radiographic progression at weeks 52 and 78 versus patients initially treated with MTX (both timepoints: 86% vs 72%).

Conclusions In early RA, starting with MTX monotherapy and adding TNFi after 26 weeks yields similar longer term clinical results as starting with TNFi+MTX combination therapy but allows a small but significant accrual of radiographic damage

Causes of death in #rheumatoid #arthritis: How do they compare to the general population?

http://onlinelibrary.wiley.com/doi/10.1002/acr.23548/full

A total of 11,778 (14% of) RA patients and 32,472 (9% of) comparators died during 508,385 and 1,769,365 person-years (PY) of follow-up, respectively, for corresponding mortality rates of 232 (95% CI 228, 236) and 184 (95% CI 182, 186) per 10,000 PYs. Leading causes of death in both groups were diseases of the circulatory system, cancer, and respiratory conditions. Increased mortality for all-cause and specific causes was observed in RA relative to the general population. MRRs were elevated for most causes of death. Age-specific mortality ratios illustrated a high excess mortality among RA patients under 45 years of age for respiratory disease and circulatory disease. RA patients lost 7,436 potential years of life per 10,000 persons, compared with 4,083 YPLL among those without RA.

Conclusion
Mortality rates were increased in RA patients relative to the general population across most causes of death. The potential life years lost (before the age of 75) among RA patients was roughly double that among those without RA, reflecting higher rate ratios for most causes of death and RA patients dying at earlier ages.

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Frequency and Predictors of Communication About High Blood #Pressure in #Rheumatoid Arthritis Visits


https://journals.lww.com/jclinrheum/Fulltext/2018/06000/Frequency_and_Predictors_of_Communication_About.8.aspx

Compared with peers, patients with rheumatoid arthritis (RA) have higher rates of cardiovascular disease (CVD) events including myocardial infarction, stroke, and heart failure,1 conditions causally linked to hypertension. Hypertension (HTN) affects 50% of people older than 55 years, yet nearly half of adults with known HTN do not have it under control.2 Hypertension is the most frequent comorbidity in RA3,4 and is a major determinant of organ damage and mortality

Among 1267 RA patients, 40% experienced BP elevations meeting the definition of uncontrolled HTN. Of 2677 eligible RA visits, 22% contained any documented BP communication. After adjustment, models predicted only 31% of visits with markedly high BPs 160/100 mm Hg or greater would contain BP communication. Compared with stage I, stage II elevation did not significantly increase communication (odds ratio, 2.0 95% confidence interval, 1.4–2.8 vs. 1.5 1.2–2.2), although both groups' odds exceeded pre-HTN and normotension. Less than 10% of eligible visits resulted in documented action steps recommending follow-up of high BP.

Conclusions Regardless of BP magnitude, most RA clinic visits lacked documented communication about BP despite compounded CVD risk. Future work should study how rheumatology clinics can facilitate follow-up of high BPs to address HTN as the most common and reversible CVD risk factor.

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The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study

https://onlinelibrary.wiley.com/doi/10.1002/acr.23764

To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.

During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.

Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.

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Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to #Rheumatoid Arthritis in Clinically Tested #CCP‐Positive Patients Without RA

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23820

We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1047 person‐years of follow‐up, 73 (21.5%) patients developed RA. Risk of progression to RA increased with CCP level, with 46.0% (95%CI 34.7‐55.3) of high level CCP patients progressing to RA by 5 years. Compared to low CCP, medium (HR 3.00, 95%CI 1.32‐6.81) and high (HR 4.83, 95%CI 2.51‐9.31) CCP levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level.

Conclusion
Among CCP+ patients without RA, risk for progression to RA increased substantially with increasing CCP level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk

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Cost‐effectiveness of combination disease‐modifying antirheumatics vs. tumour necrosis factor inhibitors in active #rheumatoid arthritis: TACIT trial

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23830

205 participants were recruited, 104 in the #cDMARDs arm, 101 in the TNFis arm. cDMARD arm participants with poor response at 6 months were offered TNFis; 46 (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6 month follow‐up and 91‐92% at 12 month follow‐up. The cDMARDs arm had significantly lower total costs from all perspectives (6 month H&SC adjusted mean difference ‐£3615 (95% confidence interval ‐£4104 to ‐£3182); 12 month H&SC adjusted mean difference ‐£1930 (95% confidence interval ‐£2599 to ‐£1301)). The HAQ showed benefit to the cDMARDs arm at 12 months (‐0.16; 95% CI‐0.32 to ‐0.01); other outcomes/follow‐ups showed no differences.

Conclusion
Starting treatment with cDMARDs, rather than TNFis, achieves similar outcomes at significantly lower costs. Patients with active rheumatoid arthritis and meeting NICE criteria for expensive biologics can cost‐effectively be treated with combinations of intensive synthetic disease modifying drugs.

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Impact and timing of #smoking cessation on reducing risk for #rheumatoid arthritis among women in the Nurses’ Health Studies

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23837

Compared to never smoking, current smoking increased risk for all RA (multivariable HR 1.47, 95%CI 1.27‐1.72) and seropositive RA (HR 1.67, 95%CI 1.38‐2.01), but not seronegative RA (HR 1.20, 95%CI 0.93‐1.55). Increasing smoking pack‐years was associated with increased trend of risk for all RA (p<0.0001) and seropositive RA (p<0.0001). With increasing duration of smoking cessation, a decreased trend was observed in risk for all RA (p=0.009) and seropositive RA (p=0.002). Compared to recent quitters (<5 years), those who quit ≥30 years ago had HR of 0.63 (95%CI 0.44‐0.90) for seropositive RA. However, a modestly elevated RA risk was still detectable 30 years after quitting smoking (all RA: HR 1.25, 95%CI 1.02‐1.53; seropositive RA: HR 1.30, 95%CI 1.01‐1.68; reference: never smoking).

Conclusions
These results confirm smoking as a strong risk factor for seropositive RA and demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.

Risk for Serious #Infection With Low-Dose #Glucocorticoids in Patients With #Rheumatoid Arthritis
https://2medical.news/2020/09/26/risk-for-serious-infection-with-low-dose-glucocorticoids-in-patients-with-rheumatoid-arthritis/

Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain.. ..Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability–weighted analyses, with 1-year cumulative incidence predicted from weighted models. Results: 247 297 observations were identified among 172 041 patients …

Finger Joint #Cartilage Evaluated by Semiquantitative #Ultrasound Score in Patients With #Rheumatoid Arthritis
https://2medical.news/2021/02/09/finger-joint-cartilage-evaluated-by-semiquantitative-ultrasound-score-in-patients-with-rheumatoid-arthritis/

Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. Methods We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. …

#Pain and fatigue are longitudinally and bi-directionally associated with more #sedentary time and less standing time in #rheumatoid arthritis
https://2medical.news/2021/02/19/pain-and-fatigue-are-longitudinally-and-bi-directionally-associated-with-more-sedentary-time-and-less-standing-time-in-rheumatoid-arthritis/

The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. Methods People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to …

The oral #microbiome in early #rheumatoid arthritis patients and individuals at risk differs from healthy controls

https://2medical.news/2021/05/09/the-oral-microbiome-in-early-rheumatoid-arthritis-patients-and-individuals-at-risk-differs-from-healthy-controls/

OP0012 ASSOCIATION BETWEEN PASSIVE #SMOKING IN CHILDHOOD AND ADULTHOOD, AND #RHEUMATOID ARTHRITIS: RESULTS FROM THE FRENCH E3N-EPIC COHORT STUDY

https://2medical.news/2021/06/07/op0012%E2%80%85association-between-passive-smoking-in-childhood-and-adulthood-and-rheumatoid-arthritis-results-from-the-french-e3n-epic-cohort-study/