Remission in rheumatoid arthritis: is it all the same?

Gul, Hanna; Ferreira, Joana Moura; Emery, Paul

doi:10.1586/17512433.2015.1061429

Cited by 14 publications

(8 citation statements)

References 76 publications

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“…Disease-modifying antirheumatic drugs (DMARDs) have enabled us to reduce disease activity and halt the progression of RA 2 – 4 ; however, unmet needs persist (such as pain, physical functionality, and fatigue), which have not been resolved even with DMARDs 5 . Additionally, sustained remission without drug treatment, drug-free remission, has not yet been accomplished 6 , implying that DMARDs treat symptoms of RA but may not fully address molecular mechanisms that characterize patients with RA 7 . Indeed, it is unclear whether the achievement of clinical remission (CR) reflects the state in which molecular profiles are closer to those of healthy individuals (healthy controls; HCs) than to those of RA patients, which we refer to as molecular remission (MR).…”

Section: Introductionmentioning

confidence: 99%

Multi-omics monitoring of drug response in rheumatoid arthritis in pursuit of molecular remission

et al. 2018

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Sustained clinical remission (CR) without drug treatment has not been achieved in patients with rheumatoid arthritis (RA). This implies a substantial difference between CR and the healthy state, but it has yet to be quantified. We report a longitudinal monitoring of the drug response at multi-omics levels in the peripheral blood of patients with RA. Our data reveal that drug treatments alter the molecular profile closer to that of HCs at the transcriptome, serum proteome, and immunophenotype level. Patient follow-up suggests that the molecular profile after drug treatments is associated with long-term stable CR. In addition, we identify molecular signatures that are resistant to drug treatments. These signatures are associated with RA independently of known disease severity indexes and are largely explained by the imbalance of neutrophils, monocytes, and lymphocytes. This high-dimensional phenotyping provides a quantitative measure of molecular remission and illustrates a multi-omics approach to understanding drug response.

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Section: Introductionmentioning

confidence: 99%

Multi-omics monitoring of drug response in rheumatoid arthritis in pursuit of molecular remission

et al. 2018

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“…There is agreement concerning the importance of achieving remission, but various remission definitions exist 53. The DAS28 remission criterion, used in BARFOT, identified more patients in sustained remission than did the other applied criteria with no difference in degree of joint damage and disability 9.…”

Section: Discussionmentioning

confidence: 99%

<p>A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis – results of clinical relevance</p>

Hafström¹,

Ajeganova²,

Andersson³

et al. 2019

OARRR

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PurposeAt the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care.Patients and methodsBARFOT is a multicentre observational study of patients with early RA, consecutively included 1992–2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality.ResultsIn all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and co-morbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed.ConclusionA register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.

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“…Disease activity in patients with RA is commonly assessed using clinical instruments, such as DAS28-erythrocyte sedimentation rate (ESR) or Clinical Disease Activity Index (CDAI), both in clinical practice and in trials. These composite measures of disease activity rely on surrogate markers of inflammation, such as tender or swollen joint count and inflammatory markers (i.e., ESR, CRP), with the risk of underor overestimating the disease activity status [59,60].…”

Section: The Utility Of Ultrasound In Rheumatoid Arthritis Patients Imentioning

confidence: 99%

The Role of Musculoskeletal Ultrasound in the Rheumatoid Arthritis Continuum

et al. 2020

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Purpose of Review Rheumatoid arthritis (RA) is no longer considered a fixed phenotype but rather a disease continuum. This review outlines the current and potential value of applying ultrasound (US) along this continuum: from the prediction of progression to RA in at-risk individuals, to confirmation of the early diagnosis of RA, as well as the consideration of differential diagnoses, and the use in disease monitoring and defining remission. Recent Findings In individuals at-risk of RA (i.e., positive autoantibodies with symptoms but without synovitis), US has shown a promising predictive value for the development of clinical arthritis, providing the opportunity to improve risk stratification (and disease prevention) of these individuals. The detection of inflammation on US in patients with early undifferentiated arthritis, in which a definite diagnosis cannot be reached, could predict evolution to persistent arthritis, mostly RA. This, in addition to the US potential ability to identify disease specific patterns for different rheumatic conditions, might facilitate early diagnosis and, therefore, improve the management of patients with RA, or other types of inflammatory arthritides. US has also demonstrated the capability to predict radiographic progression, and relapse risk after treatment discontinuation, in RA patients in remission according to the clinical instruments, raising implications in the management, including therapy discontinuation, of these patients. Summary US has an undeniable value in the management of patients at different stages along the RA continuum. Further research is needed to identify which groups of patients benefit the most from US imaging.

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Remission in rheumatoid arthritis: is it all the same?

Cited by 14 publications

References 76 publications

Multi-omics monitoring of drug response in rheumatoid arthritis in pursuit of molecular remission

Multi-omics monitoring of drug response in rheumatoid arthritis in pursuit of molecular remission

<p>A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis – results of clinical relevance</p>

The Role of Musculoskeletal Ultrasound in the Rheumatoid Arthritis Continuum

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