Common Issues in Pregnancy Management in Lupus & Anti-Phospholipid Syndrome
SLE should be considered a severe risk factor for pregnancy. Main risk factors for adverse pregnancy outcomes in SLE such as active disease within 6 months before conception, active lupus nephritis, chronic hypertension, pre-existing renal disease, antiphospholipid antibody syndrome. Hydroxychloroquine reduces the risk of pregnancy loss, pre-eclampsia in lupus pregnancies.
Off-Label RTX for Systemic Autoimmune Diseases: A Case Series from 3rd Level Hospital
The study analysed patients with SAD treated with RTX in the last 5 years. In 80% of the cases, RTX was used after earlier therapies failed, and in 20% of the cases, it was used as a first-line treatment. 60% of patients had a full response after receiving rituximab, 17% had a partial response, and 20% were nonresponding.
Decrease in Anti-Topoisomerase-1 Antibody Titer in Patients with Systemic Sclerosis on RTX therapy
The study aims to find new treatment options for systemic sclerosis as there are only a few reports on the higher efficiency of Rituximab in patients with SSc positive for anti-topoisomerase-1 antibodies (a-Topo-1). It shows that RTX is highly effective in the a-Topo-1 positive group with the prevalence of Interstitial lung disease. RTX decreases a-Topo-1 titers, mRSS, and disease activity index.
Towards Personalized Treatment Strategies for Psoriatic Arthritis
The selection of the therapy should ideally be linked to the evidence-based treatment for patients. It is essential to know how to choose or sequence DMARDs in PsA both conventional & biological targeted drugs and also need to think beyond step-up care and aim to assess prognosis more accurately in patients with more severe disease from the beginning.
Clinical Heterogeneity of Psoriatic Arthritis in Adults
The objective of the study is to understand heterogeneity of Psoriatic Arthritis. PsA is an inflammatory disease associated with psoriasis. PsA domains include peripheral arthritis, axial disease, dactylitis, enthesitis, skin, and nails diseases. Musculoskeletal manifestations of PsA include peripheral arthritis, dactylitis, enthesitis, and axial disease.
Ten Years of JAKi in RA - Real Life Data from the SCQM Registry
Approximately 70% of Swiss Rheumatologists currently contribute to SCQM. The registry maintains population data on adult RA patients starting therapy with Tofacitinib or TNF inhibitors or other bDMARD. Tofa had higher drug retention compared to TNFi. Tofa had lower discontinuation rate for ineffectiveness than TNFi and higher discontinuation rate for intolerance than bDMARD.
Selective JAKi on the Verve - Implications for Therapy
JAK inhibitors are competitive inhibitors of ATP. The current data indicate that pan-JAK inhibitors & moderately selective JAK inhibitors are comparatively effective in RA and have a similar safety profile (laboratory parameter, herpes zoster, DVT). The concept of JAK-selectivity is based on in vitro assays with limited impact on cellular and clinical aspects of the use of JAKi.
Janus kinase inhibitors (JAKi) in the news - Side effects
Clinical trial data of the safety profiles for Janus kinase inhibitors indicated malignancy. Thrombosis had occurred in patients treated with JAK inhibitors. Rheumatoid Arthritis patients with at least one CV risk factor had a high rate of all-causes mortality and thrombosis with tofacitinib 10mg BD vs 5mg BD or TNF blocker.
Therapeutic Drug Monitoring in RA-Aspirations and Challenges
Opportunities in the TDM landscape are numerous. TDM may be considered to identify those with high drug levels. TDM 3 months treatment is considered to predict future efficacy. Conflicting evidence has been observed regarding switching treatment strategies. There is currently insufficient evidence to recommend routine adoption in rheumatoid arthritis.
Synovial Tissue Heterogeneity and Rheumatoid Arthritis
Disease phenotypes of RA synovitis are extremely heterogeneous. Synovial tissue cellular and molecular signatures define different disease & clinical phenotypes. Fibroid/pauci-immune pathotype is associated with no response to both synthetic and biologic DMARDs. In β-cell rich patients, Rituximab and Tocilizumab appear to be effective, though the study was not powered for non-inferiority.
Role of Comorbidities in Difficult to Treat RA
Comorbidity is common in Rheumatoid Arthritis and may contribute to D2T RA. It may further reduce the effectiveness of medication & hamper proper grading of RA resulting in inappropriate treatment decisions. Future management guidelines for RA should highlight the importance of multimorbidity and advocate appropriate screening and management that should be patient-centred.
Difficult to Treat RA: Definitions and Epidemiology
Outcomes of RA patients have significantly improved by B/tsDMARDs, treat-to-target and tight control strategies. Improvement of management should be based on uniform terminology & definition Concept of D2T RA has now been formalized with the EULAR definition. D2T RA is a heterogenic disease state: one or multiple contributing factors may be present.
Chronic, Low-Grade, Articular and Systemic Inflammation as a Therapeutic Target in OA
The study found that Metabolic Syndrome (MetS), the number of its components & obesity are associated with incident knee Osteoarthritis. Low-grade chronic inflammation is a different process with the classic signs of inflammation. Induction of adipose tissue browning could decrease obesity & metabolic disorders.
Differential Diagnosis in Suspected Axial SpA
Both active and structural MRI lesions are considered typical of axspA. Data-driven definitions for these in the sacroiliac joint in spondyloarthritis have predictive utility. Some specific diagnoses like infections, tumours, degenerative disease, fractures, OCI, and DISH should always be considered. Further research is needed to distinguish what is and what is not sacroiliitis.
Recommendations for Cardiovascular Risk Management in Rheumatic and Mucoskeletal Diseases
Validation of existing generic and modified CVD risk prediction tools in large prospective studies and development of new disease-specific equations is done. Vascular imaging, circulating bio markers, identifying patient subgroups with high risk of CVD, long term effects of current and new drugs and role of antithrombotic agents in overall CVD risk in the patients.
Points to Consider on Therapeutic Drug Monitoring in Inflammatory Arthritis
Points to consider: Measurement of biopharmaceutical blood concentrations and ADAb in a validated lab. Identification of factors that influence these parameters. Routine use of proactive TDM not recommended for inflammatory RMDs. Reactive TDM could be considered in certain clinical situations. Other factors like observational studies/post hoc analyses of RCTs and population-based data.
Secondary Immunodeficiency in Patients with Autoimmune Diseases
The most common secondary immunodeficiencies are antibody or cellular deficiencies. Secondary antibody deficiency is 30 times more common than primary antibody deficiency. Secondary immunodeficiencies are overlooked and undertreated and may be reversible but many are not. Assessment and decision on treatment require clinical context and functional Ab testing.
Autoimmunity and Primary Immunodeficiency
In the future with increasing use of functional genetics, many ill-defined syndromes of immunodeficiency or inflammatory diseases will be dissolved into genetic categories. Leniolisib is a potent and selective oral PI3Kδ inhibitor and also led to significant improvement in the immunological status and clinical presentation of patients with APDS/PASLI. Most common are antibody deficiencies.
Treatment of ILD in Patients with Primary Sjogren's Syndrome: A Single-center Retrospective Analysis
The study determined whether adding cyclophosphamide or rituximab to steroid and oral DMARD therapy improves pulmonary function test results in individuals with primary Sjogren's syndrome-interstitial lung disease (pSS-ILD) who have poor baseline pulmonary function. The study found that FVC improved significantly in patients who received add-on CYC and/or RTX.
Is There an Added Value of Imaging to Composite Index Measurement of Disease Activity in RA Patient?
The study determined whether there is an added value of imaging to the composite index measurement of disease activity in patients with RA. Clinical evaluation of remission alone may be inadequate to capture a persistent lack of inflammation at different joint sites. Imaging can complement the assessment of patients in clinical remission, offering additional data.
