Background Evidence suggests rheumatoid arthritis (RA) confers an increased risk of psychological morbidity, particularly anxiety and depression, which may affect the subsequent management and treatment adherence.1,2 Few studies have studied psychological factors over time in RA patients.3 Objectives We aimed to evaluate the prevalence of anxiety and depression in RA patients following rituximab treatment initiation and prolongation. Methods Biologics-naïve RA patients were followed up for 27 months after commencing and continuing rituximab therapy (1, 2, 3 standard courses). Anxiety and depression, and health-related quality of life (HRQoL) were assessed at baseline, 3, 15 and 27 months using the Hospital Anxiety and Depression Scale (HADS) and the Short Form (SF-36 v.1) Health Survey questionnaire, respectively. Results 86 patients [mean (SD) age 49.2 (9.3) years, 76 women; median (IQR) DAS28 5.64 (3.92–8.42); median (IQR) HAQ 1.85 (1.0–3.5)] were recruited. Median anxiety and depression scores decreased significantly between baseline and 3 months (p<0.001) and remained decreased over the 27-month period. The prevalence of depression cases decreased twice from baseline to 27 months (66.3% to 30.0%), as did the prevalence of anxiety (79.1% to 40.0%). Patients reported poor baseline HRQoL. SF-36 v.1 domain scores substantially raised after 15 months. Conclusions Anxiety and depression levels decrease significantly following commencement and continuity of rituximab. B cell-directed therapy for patients with RA helps achieve remission of both anxiety and depression, and improves health-related quality of life. References McWilliams LA, Goodvin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 2004;111:77–83. Garcia-Cebrian A, Gandhi P, Demyttenaere K et al. The association of depression and painful physical symptoms: a review of the European literature. Eur Psychiatry 2006;21:379–388. Overman CL, Bossema ER, van Middendorp H et al. The prospective association between psychological distress and disease activity in rheumatoid arthritis: a multilevel regression analysis. Ann Rheum Dis 2012;71:192–197. Disclosure of Interest: None Declared
Background:Similarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (ACVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum.1ACVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients.2,3Objectives:To evaluate the effects of rituximab (RTM) therapy on cardiorenal continuum of RA patients.Methods:Biologics-naïve RA patients (n=92; age 49.5±9.9) were followed up for 72 months after commencing and continuing RTM therapy (1–10 standard courses) compared with 50 control RA patients (age 49.2±9.8). All control and 63% of RTM patients received methotrexate or leflunomide.Results:There were no baseline differences between two groups – Table. At year 6, RTM patients have fewer incidences of hypertension, anxiety/depression, atherosclerosis and diastolic dysfunction than controls. RTM decreased prevalence of albuminuria and CKD.Table.Cardiorenal continuum of rheumatoid arthritis patients (%)FeaturesRituximab groupControl grouppRTM–C1 year n=923 years n=476 years n=311 yearn=503 years n=266 years n=16Risk factorsHypertension52.238.325.8p6–1=0.02250.038.550.0p6=0.032Dyslipidaemia44.636.238.748.046.250.0>0.05Pre-diabetes41.336.241.944.034.656.3>0.05Metabolic syndrome12.06.43.210.07.712.5>0.05Diabetes mellitus3.2002.000>0.05Anxiety/depression78.341.5p3–1=0.00535.3p6–1<0.00176.073.168.8p3=0.009p6=0.008Initial stages (asymptomatic organ damage)Atherosclerosis34.821.312.9p6–1=0.04536.034.637.5p6=0.02Left ventricular hypertrophy8.74.308.07.70>0.05Diastolic dysfunction57.638.322.6p6–1=0.01856.050.056.3p6=0.04Albuminuria19.600p6–1=0.03812.006.3>0.05Kidney impairment6.52.106.000>0.05ProgressionAngina6.5004.000>0.05Chronic kidney disease26.18.59.7p6–1=0.04212.000>0.05End stageMyocardial infarction000000>0.05Stroke000000>0.05Heart failure4.400000>0.05Acute/chronic renal failure000000>0.05Death000000>0.05There were no significant differences in frequencies of other risk factors, signs of organ damage and cases of established heart, cerebrovascular and renal diseases/complications.Conclusion:RTM may be effective in delay of the movement of RA patients on cardiorenal continuum. The clinical implications of RTM for cardiorenal correlations in RA patients need to be confirmed in large-scale clinical outcome trials.References:[1]Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm.Am J Kidney Dis2000;35(4, Suppl. 1):117–31.[2]Avina-Zubieta JA, Choi HK, Sadatsafarvi M,et al.Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies.Arthritis Rheum2008;59:1690–7.[3]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis.Best Pract Res Clin Rheumatol2011;25:469–83.Disclosure of Interests:Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Larisa Ivanova Speakers bureau: Bayer, Novartis, KRKA, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Rosa Valeeva: None declared, Dilara Yurk: None declared, Anastasia Vedekhina: None declared, Nuriya Garaeva: None declared, Irina Sabelnikova: None declared
BackgroundRaynaud's phenomenon (RP) secondary to rheumatic diseases (RD) is associated with significant morbidity (e.g., ulcerations and gangrene).1 Three groups of specific drugs have been marketed for RP (prostanoids, ERAs and PDE-5 inhibitors).2ObjectivesTo evaluate the comparative efficacy and safety of two prostanoids (intravenous iloprost and alprostadil) in treatment of secondary RP.MethodsIn 2013 and 2014, all 25 inpatients at the regional clinic with secondary RP were treated with prostanoids [23 females; mean (SD) age 47.5 (10.2) yrs]. 20 (80%) pts had systemic sclerosis (SSc),3 by 1 (4%) – RA, SLE, dermatomyositis, cryoglobulinaemic vasculitis and overlap-syndrome. Duration of RD was 19.1±9.5 yrs, time since onset of RP 13.2±6.4 yrs. Limited cutaneous SSc (13 pts) manifestated with RP in 54%, diffuse SSc (7 pts) - in 57%. 80% of pts had activity of both RD and RP.6 pts was treated by intravenous iloprost 25 μg for 3–5 days every 3 months. 10 pts received intravenous alprostadil 20 μg for 10 days every 6 months. III group had alprostadil-switched-to-iloprost (due to alprostadil ineffectiveness; 7 pts) or iloprost-switched-to-alprostadil (due to iloprost side effects; 2 pts) therapy. There were no significant differences between three groups at baseline in Raynaud's Condition Score (RCS), SSc activity and Health Assessment Questionnaire Disability Index (HAQ-DI). All pts were treated with conventional synthetic DMARDs.ResultsAt baseline, the incidence of finger pallor and numbing was 80%, digital pain – 68%, fingertip clefts – 44%, digital tip ulcers – 40%, fingertip pitting scars – 16%. 56% of pts had constant RP symptoms and signs. Joint and muscle involvement had 76% of pts, pulmonary involvement – 68%, heart diseases – 56%.All treatments allowed reducing or stopping digital numbness and pain. About six-sevenths of pts with RP could be classified as good responders to iloprost and two-thirds – to alprostadil. Iloprost reduced the frequency of RP attacks by ∼1.2/day compared with alprostadil (p=0.024) and daily duration of RP attacks by ∼45.3 min in comparison (p=0.015). Treatment with iloprost showed significant benefit on RCS with ∼2.8 difference with alprostadil (p=0.032). After a 24-month follow-up all iloprost pts had healed up digital clefts and ulcers. A trend towards a decrease in HAQ-DI was seen in alprostadil groups, and significant HAQ-DI reduction – in iloprost. Treatment with iloprost was associated with a trend towards improvements in pulmonary hypertension and functions. Both prostanoids were well tolerated, except for incidents of tachycardia and hypotension in 2 iloprost pts.ConclusionsAlprostadil has significant but moderate efficacy in secondary RP. Iloprost is superior to alprostadil and might be recommended not only for severe RP but for preventing digital ulcers.ReferencesWigley FM. Clinical practice. Raynaud's phenomenon. N Engl J Med 2002;347:1001–1008.Kowal-Bielecka O, Landewé R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EU...
BackgroundSimilarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum.1 CVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients.2,3ObjectivesWe aimed to evaluate the effects of rituximab biologic therapy on cardiorenal continuum of RA patients.MethodsBiologics-naïve RA patients (n=50; age 55.1±10.3) were followed up for 72 months after commencing and continuing rituximab therapy (1–10 standard courses) compared with 30 control RA patients (age 53.2±9.8).ResultsAt year 6, rituximab patients have fewer incidences of hypertension, anxiety/depression, atherosclerosis and diastolic dysfunction than control patients (Table).Table 1.Cardiorenal continuum features of rheumatoid arthritis patients (%)FeaturesRituximab groupControl groupPR-C 1 year, n=503 years, n=476 years, n=311 year, n=303 years, n=266 years, n=16 Risk factorsHypertension50.038.325.840.038.550.0p6=0.032p6–1=0.028Dyslipidaemia44.036.238.740.046.250.0>0.05Pre-diabetes52.036.241.933.334.656.3>0.05Metabolic syndrome12.06.43.210.07.712.5>0.05Diabetes mellitus4.000000>0.05Anxiety/depression83.241.535.380.073.168.8p3=0.009p3–1=0.006p6–1<0.001p6=0.008Initial stagesAtherosclerosis32.021.312.940.034.637.5p6=0.02p6–1=0.048Left ventricular hypertrophy8.04.306.77.70>0.05Diastolic dysfunction48.038.322.646.750.056.3p6=0.04p6–1=0.022Albuminuria8.000006.3>0.05Kidney impairment6.02.1013.300>0.05ProgressionAngina6.0003.300>0.05Chronic kidney disease16.08.59.713.400>0.05End stageMyocardial infarction/stroke000000>0.05Heart failure2.000000>0.05Acute/chronic renal failure000000>0.05Death0012.9000>0.05There were no significant differences in frequencies of other risk factors, signs of asymptomatic multiorgan damage and cases of established heart, cerebrovascular and renal diseases/complications.ConclusionsRituximab may be effective in delay of the movement of RA patients on cardiorenal continuum. The clinical implications of rituximab for cardiorenal correlations in RA patients need to be confirmed in large-scale clinical outcome trials.References Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000;35(4, Suppl. 1):117–31.Avina-Zubieta JA, Choi HK, Sadatsafarvi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008;59:1690–7.Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2011;25:469–83. Disclosure of InterestNone declared
Aim. On the basis of clinical manifestations of Raynaud’s phenomenon (RP) to determine the RP expression level and to evaluate the long-term efficacy of treatment of RP in patients with rheumatic diseases (RD) with iloprost and alprostadil. Methods. Treatment for indications with prostanoids (intravenous iloprost, alprostadil or their combinations) was administered to 40 patients with secondary RP in RD. During 3-year follow up, clinical instrumental parameters (frequency of attacks of Raynaud's, digital ulcers (DU) formation, pain intensity on visual analogue scale (VAS) were evaluated. The control group included 30 patients with RP in RD who did not receive prostanoid therapy. The method of factor analysis was used to determine the index of generalized expression of RP, on the basis of which the expression levels of the RP were determined. Results. The “expression of RP” scale revealed in the course of factor analysis as an indicator of generalized manifestation of RP, is the average value of two subscales, the first one of which consisted of four indices - “digital ulcer”, “digital pitting scars”, “phalange amputation” and “Raynaud's attack frequency”, and the second one included “intensity of pain”, “duration of illness”, “whitening of fingers”. Verification of the correlation revealed during the study of subscales, showed its reliability (r = 0.294, p = 0.053). The final expression of RP was 1.51 ± 0.86. The low level of RP expression had values up to 0.65, high - over 2.37. When included in the study, a high level of RP expression was defined in 16 (22.9 %) patients, medium - in 43 (61.4 %), low - in 11 (15.7 %). The use of iloprost in the treatment of RP was effective for healing of DU and a statistically significant decrease of the generalized expression of RP from 2.25 [1; 3] to 1.75 [1; 2] (p = 0.012) was observed. On alprostadil treatment, statistically significantly decreased frequency of attacks from multiple daily (more than once a day) to once a month and reduced numbness during RP attack were observed as well as a decrease of the level of generalized index of RP expression from 1.26 ± 0.71 to 0.97 ± 0.57 (р = 0.038). The combination of prostanoids had a contradictory clinical effect: the pain and frequency of RP attacks decreased, but the formation of DU and new cases of amputations of phalanges were registered, the treatment had no effect on the value of RP expression. Conclusion. Based on the clinical manifestations of RP, a generalized index of RP severity was identified and the levels of RP severity were determined. Treatment with iloprost and alprostadil has a significant effect on reducing the clinical manifestations of RP with a corresponding decrease in its severity.
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