Vitamin D receptor regulates TGF-β signalling in systemic sclerosis Tập 74 Số 3 - Trang e20-e20 - 2015
Pawel Zerr, Stefan Vollath, Katrin Palumbo‐Zerr, Michal Tomčík, Jingang Huang, Alfiya Distler, Christian Beyer, Clara Dees, Kolja Gela, Oliver Distler, Georg Schett, Jörg H. W. Distler
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update Tập 79 Số 6 - Trang 685-699 - 2020
Josef S Smolen, Robert Landewé, J. W. J. Bijlsma, Gerd R Burmester, Maxime Dougados, Andreas Kerschbaumer, Iain B. McInnes, Alexandre Sepriano, Ronald van Vollenhoven, Maarten de Wit, Daniel Aletaha, Martin Aringer, Johan Askling, Alejandro Balsa, Maarten Boers, Alfons A den Broeder, Maya H Buch, Frank Buttgereit, Roberto Caporali, Myrna Cardiel, Diederik De Cock, Cătălin Codreanu, Maurizio Cutolo, Christopher J Edwards, Yvonne van Eijk‐Hustings, Paul Emery, Axel Finckh, Laure Gossec, Jacques‐Eric Gottenberg, Merete Lund Hetland, T. Huizinga, Marios Koloumas, Zhanguo Li, Xavier Mariette, Ulf Müller‐Ladner, Eduardo Mysler, José António Pereira da Silva, Gyula Poór, Janet Pope, Andrea Rubbert‐Roth, Adeline Ruyssen‐Witrand, Kenneth G. Saag, Anja Strangfeld, Tsutomu Takeuchi, Marieke Voshaar, René Westhovens, Désirée van der Heijde
ObjectivesTo provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.MethodsAn international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.ResultsThe task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.ConclusionsThese updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.
Effects of B-cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study Tập 78 Số 2 - Trang 179-185 - 2019
Daniëlle M. Gerlag, M. Safy, Karen I. Maijer, Man Tang, Sander W. Tas, Mirian Starmans‐Kool, Astrid van Tubergen, M. Janssen, M. De Hair, Monika Hansson, Niek de Vries, Aeilko H. Zwinderman, Paul P. Tak
ObjectivesWe explored the effects of B-cell directed therapy in subjects at risk of developing autoantibodypositive rheumatoid arthritis (RA), who never experienced inflammatory arthritis before, and explored biomarkers predictive of arthritis development.MethodsIndividuals positive for both anti-citrullinated peptide antibodies and rheumatoid factor but without arthritis were included in a randomised, double-blind, placebo-controlled study to receive a single infusion of 1000 mg rituximab or placebo.ResultsEighty-one individuals received treatment and were followed up for a mean of 29.0 (0–54) months, during which 30/81 (37%) individuals developed arthritis. The observed risk of developing arthritis in the placebo-treated group was 40%, which was decreased by 55% (HR 0.45, 95% CI 0.154 to 1.322) in the rituximab-treated group at 12 months. Rituximab treatment caused a delay in arthritis development of 12 months compared with placebo treatment at the point when 25% of the subjects had developed arthritis (p<0.0001). Erythrocyte sedimentation rate and the presence of anti-citrullinated α-enolase peptide 1 at baseline were significant predictors of arthritis development.ConclusionsA single infusion of 1000 mg rituximab significantly delays the development of arthritis in subjects at risk of developing RA, providing evidence for the pathogenetic role of B cells in the earliest, prearthritis stage of autoantibody positive RA.
Treating rheumatoid arthritis to target: recommendations of an international task force Tập 69 Số 4 - Trang 631-637 - 2010
Sofía Ramiro, D. Aletaha, José Luís Andreu, F C Breedveld, Dimitrios T. Boumpas, G.-R. Burmester, Bernard Combe, M. Cutolo, Maarten de Wit, M Dougados, Paul Emery, A. Gibofsky, Juan J. Gómez‐Reino, Boulos Haraoui, J. R. Kalden, Edward Keystone, T. K. Kvien, Iain B. McInnes, E. Martín‐Mola, Carlomaurizio Montecucco, M. Schoels, D. van der Heijde
Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial Tập 75 Số 6 - Trang 1043-1050 - 2016
James Dale, A. Stirling, Ruiqi Zhang, David Purves, Jonathan H. Foley, Martin Sambrook, Philip G. Conaghan, Désirée van der Heijde, Alex McConnachie, Iain B. McInnes, Duncan Porter
ObjectiveTo investigate whether an intensive early rheumatoid arthritis (RA) treat-to-target (T2T) strategy could be improved through the use of musculoskeletal ultrasound (MSUS) assessment of disease activity.Methods111 newly diagnosed patients with RA or undifferentiated arthritis (symptom duration <1 year) were randomised to strategies that aimed to attain either DAS28-erythrocyte sedimentation rate (ESR)<3.2 (control) or a total power Doppler joint count≤1 during a combined DAS28-ESR/MSUS assessment (intervention). MSUS examination was indicated if: DAS28-ESR<3.2 or DAS28-ESR≥3.2 with two swollen joints. Step-up disease-modifying antirheumatic drug (DMARD) escalation was standardised: methotrexate monotherapy, triple therapy and then etanercept/triple therapy. American College of Rheumatology (ACR) core-set variables were assessed 3 monthly by a metrologist blinded to group allocation. MRI of dominant hand and wrist, and plain radiographs of hands and feet were undertaken at baseline and 18 months for grading by two readers using the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis MRI Scoring System (RAMRIS) and van der Heijde/Sharp Score, respectively. The coprimary outcomes were mean change from baseline of DAS44 and RAMRIS erosion score.ResultsGroups were matched for baseline clinical, demographic and radiographic features. The intervention group received more intensive DMARD therapy. Both groups demonstrated significant improvements in DAS44 (mean change: control −2.58, intervention −2.69; 95% CI difference between groups −0.70 to 0.48; p=0.72). There were no significant between-group differences for any ACR core-set variables, except DAS44 remission after 18 months (control 43%, intervention 66%; p=0.03). There was minimal progression of MRI and radiographic erosions and no difference in imaging outcomes or serious adverse event rates.ConclusionsIn early RA, a MSUS-driven T2T strategy led to more intensive treatment, but was not associated with significantly better clinical or imaging outcomes than a DAS28-driven strategy.Trial registration numberNCT00920478.