Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis

Objective. Rheumatoid arthritis (RA) is characterized by inflammation and joint destruction, with the degree of damage varying greatly among patients. Prediction of disease severity using known clinical and serologic risk factors is inaccurate. This study was undertaken to identify new serologic markers for RA severity using an in silico model of the rheumatic joint.Methods. An in silico model of a prototypical rheumatic joint was used to predict candidate markers associated with erosiveness. The following 4 markers were chosen for validation: tartrate-resistant acid phosphatase 5b (TRAP-5b), N-telopeptide of type I collagen (NTX), angiopoietin 2 (Ang-2), and CXCL13. Serum from 74 RA patients was used to study whether radiologic joint destruction (total erosion score and total Sharp/van der Heijde score [SHS]) after 4 years of disease was associated with serum levels at the time of diagnosis. Serum marker levels were determined using enzyme-linked immunosorbent assays. For confirmation, baseline serum levels were analyzed for an association with progression of joint damage over 7 years of followup in a cohort of 155 patients with early RA.Results. Comparison of high and low quartiles of erosion score and SHS at 4 years showed a difference in baseline serum CXCL13 level (P ‫؍‬ 0.011 and P ‫؍‬ 0.018, respectively). In the confirmation cohort, elevated baseline CXCL13 levels were associated with increased rates of joint destruction during 7 years of followup (P < 0.001 unadjusted and P < 0.004 with adjustment for C-reactive protein level). Analyzing anti-CCP-2-positive and anti-CCP-2-negative RA separately yielded a significant result only in the anti-CCP-2-negative group (P < 0.001).Conclusion. Our findings indicate that CXCL13 is a novel serologic marker predictive of RA severity. This marker was identified with the help of an in silico model of the RA joint.

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“…The mean of the scores assigned by the 2 readers was used for the analysis. The interobserver correlation coefficient was 0.96 (15).…”

Section: Methodsmentioning

confidence: 87%

Identification of CXCL13 as a marker for rheumatoid arthritis outcome using an in silico model of the rheumatic joint

Meeuwisse

Linden

Rullmann

et al. 2011

Arthritis & Rheumatism

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“…It should be pointed out that discontinuing DMARDs, in the attempt to achieve drug-free remission, can be safely implemented only in a small percentage of patients (63)(64)(65)(66)(67)(68)(69). There is no evidence supporting any one DMARD discontinuation method over another; the drug-free remission rate is 12% after five years of follow-up (70). The recommendation was approved by 85.7% of participants.…”

Section: Recommendation 11: Discontinuation Of Methotrexate In the Evmentioning

confidence: 99%

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

et al. 2013

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summaryThe objective of this review is to update the recommendations of the 2010 Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) and other rheumatic diseases. The literature published between 2008 and 2012 was systematically reviewed and updated recommendations on MTX use in rheumatic diseases, particularly RA, were formulated. These recommendations were approved by a panel of expert Italian Rheumatologists. A total of 10,238 references were identified, among which 70 studies were selected for critical evaluation. Sufficient evidence had accumulated to warrant changes to several of the recommendations in the new version. A new recommendation for patients with RA who are in MTX-induced clinical remission was also proposed and approved by the panel. Updated recommendations for the use of MTX in patients with RA or other rheumatologic disease are proposed.

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“…In the past few years, the prognosis for RA has improved enormously since the introduction of intensive combination treatment regimes (23). Complete remission has not been noted, low DAS scores or other activity scores are commonly used to judge disease activity (24;25).…”

Section: Wwwintechopencommentioning

confidence: 99%

Transition of Care in Rheumatology: Managing the Rheumatic Patient from Childhood to Adulthood

Pelt¹,

Wulffraat²

2012

Insights and Perspectives in Rheumatology

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Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis

Abstract: ABSTRACT

Cited by 188 publications

References 35 publications

Identification of CXCL13 as a marker for rheumatoid arthritis outcome using an in silico model of the rheumatic joint

Identification of CXCL13 as a marker for rheumatoid arthritis outcome using an in silico model of the rheumatic joint

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

Transition of Care in Rheumatology: Managing the Rheumatic Patient from Childhood to Adulthood

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