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Gladbeck, Germany

Krause D.,Rheumatology private office | Krause D.,Ruhr University Bochum | Gabriel B.,Primary Care Office | Herborn G.,Evangelisches Fachkrankenhaus | And 2 more authors.
Clinical and Experimental Rheumatology

Objective: Methotrexate (MTX) is the anchor drug in the treatment of patients with rheumatoid arthritis (RA). MTX shows effects on disease activity and mortality. However, it is unclear whether the effect of MTX on mortality depends on its effect on disease activity. Methods: In a post-hoc analysis we analysed the data of our cohort established in Ratingen, Germany, and included all patients starting treatment with MTX (n=271) between 1980 and 1987. One year after baseline (BL), response to MTX treatment was assessed using a modified ACR 20 response. Follow-up data of 250 patients were available after 10 and 18 years. Results: After 1 year, there were 66% responders and 20% non-responders; only 14% had discontinued MTX treatment due to side effects or lack of efficacy. Most patients continued MTX treatment irrespective of efficacy. Ten years after BL, 61% of the patients were still treated with MTX. After 18 years, the responder-group showed a standardised mortality ratio of 1.6 compared to 3.2 for the group of non-responders. However, when adjusting for age, gender, response to MTX treatment one year after BL, number of swollen joints and comorbidities after 10 years an independent association of continued MTX treatment with lower mortality was found for the period 10 to 18 years after BL (hazard ratio (HR): 0.63, 95% confidence interval: 0.43-0.92, p=0.015). Conclusion: In this cohort, the mortality lowering effect of continued MTX use was partly independent of its effect on disease activity. This finding may affect treatment decisions concerning RA patients with insufficient response to MTX. © ClinicCal and ExpeErimeEntal RrheEumatology 2014. Source

Krause D.,Rheumatology private office | Gabriel B.,Ruhr University Bochum | Herborn G.,Evangelisches Fachkrankenhaus | Braun J.,Rheumazentrum Ruhrgebiet | Rau R.,Evangelisches Fachkrankenhaus
Clinical and Experimental Rheumatology

Objective: We aimed to assess the association of the degree of radiologic damage at baseline with long-term patient-related outcomes (PRO) in patients with severe rheumatoid arthritis (RA) Methods: This prospective observational single-centre study (Ratingen, Germany) included all RA patients starting treatment with methotrexate (MTX) between 1980 and 1987. Standardised clinical evaluations and radiographs of hands and feet were obtained at baseline and during the following years. About 18 years later, patients were invited for a re-assessment. PRO were assessed in three dimensions according to the International Classification of Functioning and Disability (ICF). Statistical analyses comprised multivariable models using baseline values for radiologic damage of hands and feet, age, gender, disease duration, rheumatoid factor positivity, measures of disease activity, and response to MTX as covariates. Results: At baseline, the mean disease duration was 8.5 years. The disease was active with a mean number of swollen joints of 18 (out of 32) and a mean erythrocyte sedimentation rate of 55 mm/hour. Radiologic damage was present in 95% of the patients. After 18 years, patient-related outcomes could be assessed in 78/271 patients (29%). Among chosen covariates, only the degree of baseline radiologic damage as measured by the Ratingen score was predictive of all long-term PRO (p<0.016). Conclusion: In this cohort including patients with severe RA, baseline radiologic damage was a good long-term predictor of PRO related to all three ICF dimensions. © Clinical and Experimental Rheumatology 2015. Source

Toussirot E.,University Hospital St Jacques | Toussirot E.,University Hospital Jean Minjoz | Toussirot E.,University of Franche Comte | Houvenagel E.,St Philibert Hospital | And 11 more authors.
Joint Bone Spine

Objectives: To describe cases of new onset of inflammatory bowel disease (IBD) in patients with inflammatory rheumatic disease (IRD) receiving anti-TNF-α therapy. Methods: A call for observations of such cases was sent to members of the French "Club rhumatismes et inflammation" Only patients without intestinal symptoms before introduction of anti TNF-α agents were included. Results: During a 2-year period, 16 patients were declared: nine men and seven women, mean age 41.5 ± 17.4 years, 12 patients with ankylosing spondylitis, one with rheumatoid arthritis, one with psoriatic arthritis and two juvenile idiopathic arthritis with enthesitis related arthritis. Overall, 14 patients received etanercept and two had infliximab. The meantime frame between onsets of anti-TNF--α drugs and development of IBD was 29.3 ± 20.1 months. According to endoscopic and histological findings, IBD was classified as typical Crohn's disease in eight cases, Crohn's-like disease in six cases, indeterminate in one case and definite ulcerative colitis in one case. For all cases, each TNF-α blocking agent was discontinued and replaced by another monoclonal anti TNF-α antibody. After a mean follow up period of 23.4 ± 19.5 months, outcome was favorable without recurrent or flaring IBD. Conclusions: Paradoxical IBD may occur during anti TNF-α therapy for inflammatory rheumatic disease, mostly in patients with spondylarthropathies while receiving etanercept, at a frequency estimated to 0.15% in the French patients with spondylarthropathies exposed to TNF-α antagonists. The IBD mainly corresponded to Crohn's or Crohn's-like disease. On the contrary, new onset IBD is less frequently observed in other cases of IRD and with other TNF--α blockers. © 2011 Société française de rhumatologie. Source

Kiltz U.,Rheumazentrum Ruhrgebiet | Baraliakos X.,Rheumazentrum Ruhrgebiet | Karakostas P.,Rheumazentrum Ruhrgebiet | Igelmann M.,Rheumatology private office | And 7 more authors.
Annals of the Rheumatic Diseases

Background: The threshold for disease activity required to start antitumour necrosis factor (TNF) therapy has been arbitrarily set in patients with axial spondyloarthritis (axSpA) at Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4. How this relates to spinal inflammation is unknown. Objective: To systematically compare the clinical, laboratory and imaging data of patients with axSpA with respect to their BASDAI level. Methods: A total of 100 consecutive patients with axSpA who had never been treated with TNF blockers were included. Laboratory parameters, spinal MRI and x-rays were quantified. Data were stratified according to BASDAI ≥4. Results: 44 patients were diagnosed as non-radiographic axSpA (nraxSpA) and 56 patients as ankylosing spondylitis (AS): median age 40.3±10.4 years; 57% male, mean disease duration since diagnosis 6.4±8.4 years, 88% HLA-B27+, mean modified Stokes Ankylosing Spondylitis Spinal Score 8.3±16.4. 60% of patients had spinal inflammation by MRI. The stratification based on BASDAI e4 disclosed significant differences in most clinical parameters but not for inflammation: patients with nraxSpA and BASDAI <4 versus e4 had 0.9±1.4 and 0.5±0.6 inflammatory lesions/patient, respectively (p=0.6), while patients with AS had 3.6±3.7 and 2.7±3.0 inflammatory lesions/patient, respectively (p=0.4). Conclusion: The burden of inflammation is quite comparable in patients with axSpA - regardless of disease activity. These data clearly challenge the concept of the recommended cut-off point of BASDAI ≥4. Source

Kiltz U.,Rheumazentrum Ruhrgebiet | Baraliakos X.,Rheumazentrum Ruhrgebiet | Karakostas P.,Rheumazentrum Ruhrgebiet | Igelmann M.,Rheumatology private office | And 7 more authors.
Arthritis Care and Research

Objective Patients with axial spondylarthritis (SpA) who have structural changes in the sacroiliac joints and/or the spine have been classified as having ankylosing spondylitis (AS), while those without such changes are now classified as having nonradiographic axial SpA (nr-axSpA). The differentiating features are incompletely understood. Methods Data from 100 consecutive patients with axial SpA not treated with tumor necrosis factor antagonists were compared clinically and with laboratory parameters, spinal radiographs, and magnetic resonance imaging (MRI) of the spine. Standardized clinical assessment tools were used to assess health status. Results AS was diagnosed in 56 patients and nr-axSpA in 44 patients. Signs of inflammation were significantly higher in patients with AS than in patients with nr-axSpA, with a median C-reactive protein level of 8.0 versus 3.8 mg/liter, a median Ankylosing Spondylitis Disease Activity Score of 2.2 versus 2.8, respectively, and a median amount of spinal inflammatory lesions on MRI of 2.0 versus 0.0, respectively. Significant differences between these 2 groups were seen in sex (76.8% male AS patients versus 31.8% male nr-axSpA patients). Clinical variables did not differ between patients with AS and nr-axSpA (Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life questionnaire, Short Form 36 health survey). Conclusion Patients with nr-axSpA were characterized by the low proportion of male patients and the low burden of inflammation compared to patients with AS. While both groups did not differ regarding health status, disease activity, and physical function, they did differ in signs of inflammation; all were higher in patients with AS. Since many patients with nr-axSpA had not developed structural changes after years of symptoms, we propose that those patients should not be regarded as having preradiographic AS but rather as having nr-axSpA. Copyright © 2012 by the American College of Rheumatology. Source

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