Abstract:
OBJECTIVES:Treat-to-target strategies in the management of patients with rheumatoid arthritis (RA) involve intensifying medication as long as low disease activity or remission is not achieved. Our aim was to discuss reasons and opportunities for tapering and discontinuing medication when the target is achieved, in particular of biological agents. METHODS:Data from the Behandel Strategieën (BeSt) study are presented, a multicentre randomised clinical trial comparing 4 treatment strategies in patients with recent onset active RA (1987 criteria): 1. Sequential monotherapy, 2. Step up to combination therapy (both starting with methotrexate (MTX) monotherapy), 3. Initial combination therapy with MTX, sulfasalazine and prednisone and 4. Initial combination therapy with MTX and infliximab. Treatment adjustments involving dose increases, drug changes or expansion to combination therapy occurred based on three-monthly calculations of the Disease Activity Score (DAS), with a target of ≤2.4. If this was achieved for 2 consecutive evaluations, treatment was tapered (combinations to monotherapy, monotherapy to maintenance dose). Prednisone and infliximab (either as part of initial treatment or as delayed treatment after failure on earlier therapies in arms 1, 2 and -for infliximab- 3) were always tapered and discontinued before other drugs. The outcomes of discontinuation of infliximab are presented. RESULTS:77/120 (64%) of patients who started initial infliximab were able to discontinue infliximab, whereas 27/109 (25%) of patients who started delayed infliximab in arms 1-3 could discontinue infliximab. Discontinuation was independent of previous dose increases in order to achieve low DAS. After discontinuation of infliximab, 16 of 27 patients (59%) in arms 1-3 and 34 of 77 patients (44%) in arm 4 suffered a DAS flare >2.4 and had to restart treatment. Median time without infliximab treatment was 17 (IQR 3-47) months, and 29 of the 61 patients (58%) who needed to restart had been at least 1 year without infliximab. Restarting infliximab resulted in DAS ≤2.4 in all patients, and there was no progression of radiological damage. Presence of shared epitope, smoking, and a long treatment with infliximab were independent predictors of infliximab restart. CONCLUSIONS:Data on infliximab discontinuation in the BeSt study suggest that this possible in 1 in 4 patients, or more if infliximab was the initial treatment, who have had at least 6 consecutive months of low disease activity. While MTX is continued, about 50% of patients can permanently stop infliximab without radiological damage progression, the others regain low disease activity after restarting infliximab. Treat to target strategies using biologic agents should include strategies for discontinuation.
journal_name
Clin Exp Rheumatoljournal_title
Clinical and experimental rheumatologyauthors
Allaart CF,Lems WF,Huizinga TWsubject
Has Abstractpub_date
2013-07-01 00:00:00pages
S14-8issue
4 Suppl 78eissn
0392-856Xissn
1593-098Xpii
7488journal_volume
31pub_type
杂志文章,多中心研究,随机对照试验abstract::In order to study local immunoregulatory mechanisms in patients with seronegative spondylarthropathy and histological evidence of asymptomatic intestinal inflammation, we determined mononuclear cells in distal ileal mucosa with an indirect immunoperoxidase technique using a panel of monoclonal antibodies. The number o...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVES:To establish whether subclinical atherosclerosis is increased in patients with axial spondyloarthritis (ax-SpA). METHODS:A set of 149 consecutive patients with no history of cardiovascular disease that fulfilled the Assessment of SpondyloArthritis International Society classification criteria for ax-SpA was...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2015-05-01 00:00:00
abstract:OBJECTIVE AND METHODS:A large number of studies from the field of "psychorheumatology" have investigated the relationship between critical life events and disease parameters with varying results. In the present study 48 patients with rheumatoid arthritis (RA) (mean age 57.8; range 32-78 years) were questioned about lif...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVES:Cryopyrin-associated periodic syndrome (CAPS), a rare hereditary auto-inflammatory disease, is associated with mutations in the NLRP3 gene resulting in elevated interleukin-1β (IL-1 β) release. CAPS generally occurs in early childhood with most patients presenting with periodic fever, skin rash, osteoarthrop...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To determine the diagnostic and therapeutic approach used in clinical practice for the management of systemic lupus erythematosus (SLE) patients with primary SLE-mediated neuropsychiatric (NP) manifestations. METHODS:A questionnaire was drawn up to assess how clinicians manage various clinical manifestations...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVES:To study the predictive value of coronary calcification score (CCS) for future cardiovascular (CVS) events as detected by multi-detector computed tomography (MDCT) in patients with rheumatoid arthritis(RA) and systemic lupus erythematosus (SLE). METHODS:A total of 152 patients with RA and SLE, and 106 healt...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:To describe steroid-sparing in rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ). METHODS:To evaluate the proportion of RA patients treated with more than 5 mg of prednisone (or equivalent)/day and starting TCZ who can receive less than 5 mg/day after 12 months without intensification of dis...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:TAP2 transporter gene polymorphisms have been ascertained in patients with rheumatoid arthritis (RA) and Felty's syndrome (FS) to determine whether particular alleles of this gene are disease associated. METHODS:TAP2 dimorphisms at amino acid positions 379, 565 and 665 were detected using ARMS-PCR in 89 RA ...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVES:To assess adherence to published guidelines for the treatment of Behçet's syndrome (BS) in two geographic areas. METHODS:We extracted guideline statements from the 2008 EULAR recommendations. Adherence to these statements was evaluated retrospectively in both New York (USA) and Amsterdam (The Netherlands), ...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the effects of anti-TNF-alpha antibody, infliximab, on oxidative stress markers representing DNA damage, lipid peroxidation, and glycoxidation. METHODS:Twenty-three RA patients underwent infliximab treatment and were analyzed for 30 weeks. Six patients who experienced si...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Endothelial dysfunction has been found in patients with rheumatoid arthritis (RA). In this study we aimed to assess whether adalimumab, a fully human monoclonal antibody directed against TNF-alpha, was able to improve endothelial function in RA patients with long-standing disease refractory to infliximab. ME...
journal_title:Clinical and experimental rheumatology
pub_type: 临床试验,杂志文章
doi:
更新日期:2006-05-01 00:00:00
abstract::A young female patient who had documented seropositive rheumatoid arthritis and was treated consecutively with aspirin, diclofenac, and gold salts was admitted years later for severe neutropenia. On examination she had, in addition, fever, positive rheumatoid factor, reversible swan-neck deformity of the fingers but o...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1989-05-01 00:00:00
abstract:OBJECTIVES:Histone H3 lysine 4 trimethylation(H3K4me3) is an important epigenetic modification and associated with active transcription in multiple organisms. In systemic lupus erythematosus (SLE), global and gene-specific DNA methylation changes have been demonstrated to occur. However, to date, our knowledge about th...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2010-03-01 00:00:00
abstract::The lack of successful translation of basic research discoveries into safe and effective treatments for chronic pain patients has led to increased scrutiny of the preclinical models used in pain research, particularly for osteoarthritis, where there is a significant disconnect between the animal models used to study t...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVES:Various cancer studies have suggested that polymorphism of GSTM1 may influence the ability to detoxify chemicals in cigarette smoke. In the present study the effect of smoking on clinical features of Behçet's disease were investigated in patients having GST-M1 and/or -T1 null polymorphisms. METHODS:Ninety-s...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study). METHODS:The MARI study included 1,327 RA patients on MTX treatment for at...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVES:Patients naïve to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and to the Ankylosing Spondylitis Disease Activity Score (ASDAS) have voiced confusion in our clinics over the use of the term "AS" in these instruments. It is unknown whether these tools may be applied to other related forms o...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVES:Adjuvant-induced innate immune responses have been suspected to play a role in the initiation of certain autoimmune disorders. This study investigates the role of alum, an aluminum-based adjuvant in the induction of Sjögren's syndrome-like disorder in mice. METHODS:Inbred, female New Zealand Mixed (NZM) 275...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2014-03-01 00:00:00
abstract::Pain is one of the most frequent clinical symptoms encountered by orthopaedic surgeons and rheumatologists as it is one of the main reasons for patients seeking medical help. Traumas and/or inflammatory rheumatologic diseases give rise to two different types of acute pain, but their chronic evolution is so similar tha...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVES:To validate the diagnostic benefit of dual-energy computed tomography (DECT) and synovial fluid aspiration in suspected gout. METHODS:A total of 43 patients with suspected gout underwent aspiration and DECT (320-row CT; Canon Medical Systems, Japan). The patients were assessed (gout vs. non-gout) based on t...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2018-11-01 00:00:00
abstract::Giant cell arteritis (GCA), a systemic large-vessel vasculitis, is a disease that has been treated with glucocorticoids since 1950. Over the years, several disease-modifying anti-rheumatic drugs have been evaluated as steroid-sparing agents with disappointing results. Tocilizumab, an interleukin-6 inhibitor, has in re...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2020-03-01 00:00:00
abstract::Patient-reported outcomes (PROs) provide intrinsic knowledge about a patient's health, functional status, symptoms, treatment preferences, satisfaction, and quality of life. They have become an established approach for assessing health outcomes. The Health Assessment Questionnaire (HAQ), introduced in 1980, is among t...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVES:To provide a detailed description of the ultrasound (US) scanning protocol to measure the muscle thickness in the forearm and to test its feasibility and interobserver reliability. METHODS:Four rheumatologists trained in musculoskeletal US carried out the examinations in 45 subjects (30 consecutively enroll...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVES:Models for the attribution of neuropsychiatric manifestations to systemic lupus erythematosus (NPSLE) that incorporate timing and type of manifestation, exclusion/confounding or favouring factors have been proposed. We tested their diagnostic performance against expert physician judgment. METHODS:SLE patien...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2016-09-01 00:00:00
abstract::Systemic lupus erythematosus (SLE) is characterized by multiple T and B cell abnormalities. This study was designed to investigate the cell surface membrane characteristics of T cells by using single and double immunofluorescence and examine the role of HLA-DR+ T cells in the production of immunoglobulin by B cells. T...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1988-07-01 00:00:00
abstract::The increased prevalence of osteoporosis and recognition of the importance of subchondral bone marrow inflammation in ankylosing spondylitis, together with in vitro and animal model data indicating that bisphosphonates may possess anti-inflammatory properties, constitute a theoretical rationale for their evaluation in...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVES:The aims of our study were to evaluate serum leptin, resistin, visfatin and adiponectin levels in patients with tumour necrosis factor receptor-associated periodic syndrome (TRAPS), in comparison to healthy controls, and to correlate their levels to parameters of disease activity and/or severity. METHODS:Se...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2012-05-01 00:00:00
abstract::Peak incidences of giant cell arteritis (GCA) following human Parvovirus epidemics were found in 2 previous epidemiological studies. The incidence of GCA [temporal arteritis and polymyalgia rheumatica (TA + PMR)] was studied before and after a major epidemic of human Parvovirus in 1994. Clinical data from the National...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVES:To investigate serum levels of endostatin in a well characterised cohort of patients with primary Sjögren's syndrome (pSS) and healthy controls (HC) and assess associations between these mediators and clinical parameters. METHODS:All patients (n=144) were recruited from the Norwegian systemic connective tis...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:2016-07-01 00:00:00
abstract::Different tools are available for the measurement of functional status; however, only a few of them are based on the evaluation of the joint range of motion (ROM). This study is aimed at the design and evaluation of the measurement properties of a ROM scale to be used as an evaluative instrument in rheumatoid arthriti...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00