To describe comorbid conditions in patients with rheumatoid arthritis–associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity.
Nested case-cohort study of ...2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD.
The final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 72.7 vs 60 57.7; p = 0.021). In both groups, multimorbidity was associated with ILD (OR 95% CI 1.92 1.03–3.59; p = 0.039), age (OR 95% CI 1.05 1.01–1.08; p = 0.004), CRP (OR 95% CI 1.16 1.05–1.29; p = 0.003), and erosions (OR 95% CI 1.05 1.01–1.08; p = 0.004); in the cases, it was associated with CRP (OR 95% CI 1.17 1.01–1.35; p = 0.027), anti–citrullinated peptide antibody (OR 95% CI 1.23 1.14–13.02; p = 0.049), and forced vital capacity (OR 95% CI 0.79 0.96–0.99; p = 0.036).
In patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.
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•Comorbid conditions are a major cause of morbidity and mortality in patients with rheumatoid arthritis (RA) and patients with interstitial lung disease (ILD).•ILD was independently associated with multimorbidity in patients with RA.•The most frequent comorbid conditions associated with RA-ILD were traditional cardiovascular risk factors, depression, and osteoporosis.•Other factors, such as ACPA titers and elevated CRP levels, were also associated with multimorbidity in cases with RA-ILD.
To describe severe infection, foci of infection, microorganisms, associated factors, and impact on mortality in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
The ...study was based on a multicenter prospective cohort of patients with RA-ILD followed up from 2015 to 2023. The main outcome measures were incident severe infection and fatal infection. We evaluated infectious foci, etiologic agents, vaccination status, variables associated with lung function, and clinical-therapeutic variables in RA. The incidence rate (IR) for infection and mortality was calculated per 100 person-years, and 3 multivariate models were constructed to explore factors associated with infection.
We followed up 148 patients with RA-ILD for a median 56.7 months (699.3 person-years). During this period, 142 patients (96%) had at least 1 infection. A total of 368 infectious episodes were recorded, with an IR of 52.6 per 100 person-years. Of the 48 patients who died, 65% did so from infection. Respiratory infections were the most common first infection (74%), infection overall (74%), and fatal infection (80%) and were caused mostly by SARS CoV-2
, and influenza A virus. The factors associated with an increased risk of infection and death in patients with RA-ILD were age, inflammatory activity, and therapy with corticosteroids and immunosuppressants.
Patients with RA-ILD have a high risk of serious infection, especially respiratory infection. Infection develops early, is recurrent, and is frequently fatal. The presence of associated factors such as advanced age, joint inflammation, and treatment highlight the importance of integrated and preventive medical care.
Objective: To prospectively evaluate the safety and efficacy profile of abatacept in patients with rheumatoid arthritis–associated interstitial lung disease (RA-ILD). Methods: We performed a ...prospective observational multicenter study of a cohort of patients with RA-ILD treated with abatacept between 2015 and 2021. Patients were evaluated using high-resolution computed tomography and pulmonary function tests at initiation, 12 months, and the end of follow-up. The effectiveness of abatacept was evaluated based on whether ILD improved, stabilized, progressed, or was fatal. We also evaluated factors such as infection, hospitalization, and inflammatory activity using the 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR). Cox regression analysis was performed to identify factors associated with progression of lung disease. Results: The study population comprised 57 patients with RA-ILD treated with abatacept for a median (IQR) of 27.3 (12.2–42.8) months. Lung disease had progressed before starting abatacept in 45.6% of patients. At the end of follow-up, lung disease had improved or stabilized in 41 patients (71.9%) and worsened in 13 (22.8%); 3 patients (5.3%) died. No significant decreases were observed in forced vital capacity (FVC) or in the diffusing capacity of the lung for carbon monoxide (DLCO).The factors associated with progression of RA-ILD were baseline DAS28-ESR (OR 95% CI, 2.52 1.03–3.12; p = 0.041), FVC (OR 95% CI, 0.82 0.70–0.96; p = 0.019), and DLCO (OR 95% CI, 0.83 0.72–0.96; p = 0.018). Only 10.5% of patients experienced severe adverse effects. Conclusion: Pulmonary function and joint inflammation stabilized in 71% of patients with RA-ILD treated with abatacept. Abatacept had a favorable safety profile.
Background Baseline profile of systemic lupus erythematosus patients on treatment with Belimumab of a Spanish multicenter cohort. Methods Multicenter retrospective and longitudinal cohort study. Data ...was collected at baseline, 6, 12 months and in the last visit available. Different periods (2010–2015/2016–2021) were compared. Results 324 patients (91% female) were enrolled. Mean (±SD) age at diagnosis: 31.8 years (±11.9); mean disease duration of 8.7 years (±9.07). At baseline, mean SLEDAI-2K score was 10.4 (±5.25); 152 (47.5%) patients had damage with a mean SDI score of 0.83 (±1.2). 289 patients (89.2%) had received DMARDs before BLM: cDMARDS in 282 (87%) and bDMARDs in 74 patients (22.8%); 164 (51.9%) had received more than one cDMARDs, methotrexate being the most frequently used (44.4%) and Rituximab the most frequent bDMARDs used (80%). Antimalarials were used in 83,2% and glucocorticoids (GC) in 91.2%, with a mean dose of 12.3 mg/day. 67.9% of patients were receiving more than 5 mg/day and 58.4% more than 7.5 mg/day of prednisone. BLM was used in monotherapy in 30.5% of subjects. Reasons of prescription: disease activity in 95% of patients and/or as a GC sparing agent in 59%. Only a few patients received BLM just for maintenance (4/322) or save GC (8/322). At baseline, 6 patients (1.9%) were in DORIS-21-remission and LLDAS. The main reasons of prescription for ongoing activity were arthritis (65.4%), cutaneous (40.7%) or both (81%). No differences were observed in prescription reasons between periods. Conclusions Belimumab was mainly prescribed after the use of other DMARDs and more than 50% had received at least 2 DMARDs and were receiving GC at medium doses. Most patients received BLM due to active disease and/or as GC sparing agent. Activity in articular and cutaneous domains were the main reasons of indication. No changes in prescription habits were identified.
To compare the efficacy of TNF inhibitors (adalimumab (ADA) and infliximab (IFX)) vs tocilizumab (TCZ) in patients with refractory cystoid macular edema (CME) due to Behçet's disease (BD).
...Multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. We analyzed the evolution of macular thickness (main outcome), best-corrected visual acuity (BCVA) and intraocular inflammation (Tyndall and vitritis) from baseline up to 4 years in the 3 groups mentioned.
49 patients and 72 eyes with CME were included. ADA was used in 25 patients (40 eyes), IFX in 15 (21 eyes) and TCZ in 9 (11 eyes). No statistically significant baseline differences were observed between the 3 groups except for a lower basal BCVA in TCZ group and a higher basal degree of intraocular inflammation in ADA group. Most patients from all groups had received several conventional immunosuppressive drugs. In addition, most patients in the group of TCZ had also received anti-TNF agents. Biological therapy was used in monotherapy (n=8) or combined with conventional immunosuppressive drugs (n=41). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory intraocular remission was achieved in all groups.
Refractory CME associated with BD uveitis can be effectively treated either with ADA, IFX or TCZ. Furthermore, TCZ is effective in patients resistant to anti-TNF therapy.
ObjectivesBelimumab (BLM) had been shown to be consistently effective in patients with systemic lupus erythematosus (SLE) and is increasingly being used. Although it comes a biologic agent with a ...good safety profile, limited data are available regarding serious infection in real world, particularly concerning to COVID19.We aimed to assess the incidence of serious infection and COVID19 in patients with SLE, undergoing treatment with BLM and explore associated factors.MethodsMulticentre retrospective and longitudinal study of SLE patients treated with BLM, in Spanish rheumatology services. We collected activity status (AM-SLEDAI), organ damage (SLICC/ACR/DI) (SDI), treatments, outcomes and adverse effects, with special focus on serious infectious events. The data were collected at baseline, 6, 12 months and at the last available visit. A bivariate analysis of factors associated with serious infection was performed (Chi2 or Fisher’s test).ResultsA total of 324 patients with SLE (ACR-97 or SLICC-12 criteria) were included; 91% women; mean age (± SD): 42.4 (±12.9) years. Median follow-up: 3.2 years (1.4–5.9). Median time on BLM treatment: 2.7 (±2.4) years; 106 patients (32.7%) discontinued BLM, 22 (6.8%) due to adverse effects, of which 4/22 (18.2%) suffered serious infections, none of them opportunistic.A total of 51/324 patients (15.7%) had > 1 serious infection (up to 53 serious infections recorded.). Incidence density: 7.9 per 100 patient-years (for the first year); 94 out of 297 patients (31%) suffered from COVID19, of whom only 4 were severe, remarkably none of them being under treatment with BLM at the time of SARS-CoV2 infection. There were no deaths due to infection. Serious infection was associated with damage (median SDI (1 (0–2) vs 0 (0–1) (p = 0.023;95%CI: 0.10–1.33) and use of glucocorticoids (GC) (p=0.035; OR 2.25, 95%CI:1.04–5.17)Conclusions1° Incidence rate of serious infection in SLE patients treated with BLM does not differ from that reported in the clinical assays and only a few patients stopping BLM due to infection.2° Organ damage and the use of glucocorticoids were both associated with serious infection.3° Remarkably, no patient presented severe COVID19 or died as a result of an infection.
ObjectiveTo assess the prevalence of dose optimization in patients with SLE treated with BLM, its modalities and its impact on disease activity control.MethodsRetrospective longitudinal and ...multicenter study of SLE patients treated with BLM in Spain. Activity (SLEDAI), treatments and outcomes (remission (DORIS-2021) and low disease activity (LLDAS) were collected at baseline (pre-optimization) (VB), at 6 (V6M) and at 12 months (V12M) post optimization. A comparative analysis was performed pre- and post-optimization.Results324 patients were included; mean age (±DS): 42.4 (±12.9) years. A total of 29 patients (8.9%) were optimized. Median time to optimization 2.7 (1.77–4.48) years. Mean time on optimization: 11.36 (±2.5) months. BLM was administrated intravenously (iv) in 20 patients and 9 used the subcutaneous route (sc). A total of 15/20 iv BLM patients had their dose reduced (from 10mg/kg to 5–9 mg/Kg). Other 5/20 iv BLM patients, had their administration interval increased (from 4 weeks to 5–6 weeks). All sc BLM patients increased the interval of administration (from 7 to 10–21 days). Pre-optimization status (VB): 15/26 (57.7%) in DORIS-21 and 23/26 (88.5%) in LLDAS. Post-optimization: 2/24 (8.3%) and 3/22 (13.6%) patients lost DORIS-21 in V6M and V12M, respectively (no statistically significant differences). Regarding to LLDAS, 2/23(8.7%) and 2/21(9.5%) did so in V6M and V12M, respectively (no statistically significant differences). Out of 11/23(47.8%) and 9/21(42.9%) moved from SLEDAI 0 to SLEDAI >0 in V6M and V12M, respectively. In terms of disease activity, no significant differences were found pre- and post-optimization in any of the measures, except for hypocomplementemia (p = 0.0276). Changes in activity did not lead to relevant changes in treatment. Significantly fewer patients received GC in V12M, even though the median dose of GC was higher in V12M (5 (0.62–8.75) vs. 2.5 (0–5) in (VB) (table 1).ConclusionsIt is possible to optimize doses of BLM without relevant changes in disease activity, at least in the short term, in a significant percentage of patients, and the most of them maintain the optimized dose. However, the increased clinical or serologic activity is possible in some patients. This makes a tighter post-optimization follow-up advisable.Abstract P147 Table 1Clinical, serological and treatment differences between pre and post BLM treatment VB (pre opBLM) V6M (post opBLM) V12M (post opBLM) SLEDAI, median (p25-p75) 0 (0–2) 2 (0–49) 0 (0–2) PGA (0–3), median (p25-p75) 0.33 (0–0,5) 0.28 (0–0,48) 0.2 (0–0.4) Remission DORIS, N/total (%) 15/26 (57.7%) 14/22 (63.6%) 12/19 (63.2%) LLDAS, N/total (%) 23/26 (88.5%) 20/22(90.9%) 17/19(89.5%) CRP, median (p25-p75) 1.65 (0.4–5.5) 1.63(0.46–4.14) 0.7(0.25–3.9) C3 or C4 low, N/total (%) 5/26(19.2%) 11/25(44%) # 7/20(35%) # Anti-DNA antibodies, N/total (%) 5/26(19.2%) 2/24(8.3%) 0/20(0%) Active serology *, N/total (%) 8/29(27.6%) 13/24(54.2%) 7/20(35%) DMARDs, N/total (%) 17/26(65.4%) 14/25(56%) 10/20(50%) Patients on GC, N/total (%) 15/26(57.7%) 12/24(50%) 8/20(40%) # GC dose, median (p25-p75) 2.5 (0–5) 2.5 (0–5) # 1.25 (0–5) # SLEDAI: Systemic Lupus Erythematosus Disease Activity IndexPGA: Physician Global AssessmentLLDAS: Lupus Low Disease Activity StateDMARDs: Disease-modifying anti-rheumatic drugsGC: Glucocorticoids. CRP: C Reactive Protein. * Active serology means complements and or anti-DNA
To analyse the risk of fracture calculated by FRAX® and the frequency of high risk of fracture in the general population in Spain.
EPISER2016 is a multicentre cross-sectional population-based study ...of the prevalence of rheumatic diseases in the adult population in Spain. 3,154 subjects aged ≥40 years (1,184 men and 1,970 women) were selected by stratified random sampling. The questions related to fracture risk factors were asked by telephone survey. The risk of major osteoporotic fracture (MOFR) and hip fracture (HFR) were calculated with the Spanish version of the FRAX® tool, without the inclusion of bone mineral density. To define high fracture risk, the MOFR≥20%, MOFR≥10%, MOFR≥7.5% and HFR≥3% thresholds were used.
The median (interquartile range) of the MOFR was 2.61% (1.55-6.34%) in women and 1.67% (1.15-2.87%) in men, whereas that of the HFR was 0.39% (0.14-1.86%) and 0.18% (0.07-0.77%); 3.83% of women and no men had a MOFR≥20%; 15.71% and 1.14% had a MOFR≥10%; 20.62% and 2.21%, a MOFR≥7.5%; and 19.27% and 8.05%, an HFR≥3%. In women aged 65 and over, the HFR was high in 58.09%.
EPISER2016 enabled us to establish the risk of fracture calculated by FRAX® and the prevalence of high risk of fracture in the general population according to the different thresholds used in Spain.
Objective
To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first‐line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to ...Behçet's disease (BD).
Methods
We conducted an open‐label multicenter study of IFX versus ADA for BD‐related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first‐line biologic agent based on physician and patient agreement. Patients received 3–5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4–8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups.
Results
The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best‐corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042).
Conclusion
Although both IFX and ADA are efficacious in refractory BD‐related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow‐up.
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