Relationship between different IGG and IGA Anti-Modified Protein Autoantibodies in RA
The study analyzes 30 different IgG and IgA AMPA reactivities to Cit, Carb, KAc, and MAA antigens. It concludes that autoantibodies exhibiting different patterns of ACPA fine-specificities as well as Carb & KAc reactivity are present in RA. MAA is not related to citrulline reactivity. While Carb & KAc reactivities could belong to same autoreactivity family as ACPA fine-specificities.
Eular Recommendations for Implementation of Self-Management Strategies in Patients with IA
The recommendations include: patient education should be the start point; HCPs should promote physical activity; emotional and mental health should be assessed; encourage self-management interventions into the daily routine including problem solving, goal setting, and cognitive behavioural therapy. These should be used alongside the medical management guidelines to support patients in their care.
Multisystem Inflammatory Syndrome in Children following SARS-CoV-2
Multisystem Inflammatory Syndrome in Children (MIS-C) appears one month after the COVID-19 peak in populations. Neutrophildamage seems to be prominent in MIS-C. It has higher level of inflammatory cytokines than uncomplicated childhood COVID-19 infection. Children have higher IL17 and INGF levels than adults. MIS-C has a higher immunoglobulin response than COVID-19 and higher IgG1.
Success and Failures of Therapies for Hyperinflammation in COVID-19
Immunomodulators should not be given early in COVID-19 infection. Corticosteroid (dexamethasone 6-10mg/day) should be given in patients requiring oxygen, high flow oxygen or mechanical ventilation. A recent meta-analysis shows efficacy of Tocilizumab if associated with DXM in patients requiring oxygen. Combination of immunomodulators & antivirals with interferon can be explored further.
Mechanisms of Hyperinflammation in COVID-19 and Beyond
Hyperinflammatory syndrome & MAS contribute to disease severity and mortality in COVID-19. Viral escape & dysregulated host innate immune response contribute to this complication. Cytokine storm is promoted by pyroptosis, activation of pattern recognition receptors, immune cell infiltration & macrophage activation (Th1 and M1 polarized response).
Shared Decision-Making Improves Treatment Adherence
International recommendations and T2T concept strongly recommend treatment based on shared decisions in daily practice. Shared decisions and appropriate drug profiles are the factors for treatment adherence. Treatment adherence leads to disease modification & treatment adaptation with good long-term responses, and better patient monitoring.
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.
