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Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy?

To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. As part of a real-world approach, patients with RA receiving anti-TNF therapies w... Full description

Journal Title: Arthritis care & research May 2015, Vol.67(6), pp.746-53
Main Author: Marks, Jonathan L
Other Authors: Holroyd, Christopher R , Dimitrov, Borislav D , Armstrong, Ray D , Calogeras, Antonia , Cooper, Cyrus , Davidson, Brian K , Dennison, Elaine M , Harvey, Nicholas C , Edwards, Christopher J
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 2151-4658 ; PMID: 25605045 Version:1 ; DOI: 10.1002/acr.22552
Link: http://pubmed.gov/25605045
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recordid: medline25605045
title: Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy?
format: Article
creator:
  • Marks, Jonathan L
  • Holroyd, Christopher R
  • Dimitrov, Borislav D
  • Armstrong, Ray D
  • Calogeras, Antonia
  • Cooper, Cyrus
  • Davidson, Brian K
  • Dennison, Elaine M
  • Harvey, Nicholas C
  • Edwards, Christopher J
subjects:
  • Ultrasonography, Doppler
  • Antirheumatic Agents -- Administration & Dosage
  • Arthritis, Rheumatoid -- Diagnostic Imaging
  • Biological Products -- Administration & Dosage
  • Joints -- Diagnostic Imaging
  • Tumor Necrosis Factor-Alpha -- Antagonists & Inhibitors
ispartof: Arthritis care & research, May 2015, Vol.67(6), pp.746-53
description: To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third. Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28
language: eng
source:
identifier: E-ISSN: 2151-4658 ; PMID: 25605045 Version:1 ; DOI: 10.1002/acr.22552
fulltext: fulltext
issn:
  • 21514658
  • 2151-4658
url: Link


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titleDoes combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy?
creatorMarks, Jonathan L ; Holroyd, Christopher R ; Dimitrov, Borislav D ; Armstrong, Ray D ; Calogeras, Antonia ; Cooper, Cyrus ; Davidson, Brian K ; Dennison, Elaine M ; Harvey, Nicholas C ; Edwards, Christopher J
ispartofArthritis care & research, May 2015, Vol.67(6), pp.746-53
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subjectUltrasonography, Doppler ; Antirheumatic Agents -- Administration & Dosage ; Arthritis, Rheumatoid -- Diagnostic Imaging ; Biological Products -- Administration & Dosage ; Joints -- Diagnostic Imaging ; Tumor Necrosis Factor-Alpha -- Antagonists & Inhibitors
descriptionTo investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third. Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038). Combined clinical and US assessment identifies individuals in remission who may be suitable for anti-TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.
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8Harvey, Nicholas C
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titleDoes combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy?
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0To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies.
1As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third.
2Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038).
3Combined clinical and US assessment identifies individuals in remission who may be suitable for anti-TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.
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abstractTo investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies.
doi10.1002/acr.22552
pmid25605045
date2015-05