Mediterranean Journal of Rheumatology最新文献

Psoriatic Arthritis (PsA) is a multifaceted, immune-mediated disease marked by chronic musculoskeletal inflammation (peripheral arthritis and axial disease, dactylitis, and enthesitis), extra-musculoskeletal manifestations (psoriasis, nail involvement, Inflammatory Bowel Disease [IBD], and uveitis) and multi-comorbidity (cardiovascular disease, metabolic syndrome, mental health disorders, and fibromyalgia). Immunological and non-immunological factors have led, despite the progress made in the understanding, treatment and management of PsA, to a minority of patients being able to achieve satisfactory outcomes. Following the establishment of the definition for difficult to treat rheumatoid arthritis, efforts are underway for difficult to treat PsA (D2T PsA). Defining D2T PsA and its predictors is crucial for advancing clinical trials, treatment strategies, and patient care. Proposed definitions and criteria for D2T PsA vary, but the few available data indicate that extensive psoriasis, axial involvement, obesity, female gender, and comorbidities like IBD, depression, and fibromyalgia are involved. Concerns are also raised for the lack of a universally accepted index for disease activity measurement and for the inclusion of a time-related criterion in the definition of D2T. Moreover, the potential need for distinction between D2T and refractory-to-treatment PsA has also been suggested. In this narrative review, we summarise the current knowledge on the D2T PsA field, highlighting the gaps and the necessity of the "D2T" concept, providing further considerations on the matter.

As the field of rheumatology continues to advance, the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR) annual meetings stand as pivotal events, showcasing the latest research, treatments, and insights into various rheumatic diseases. Among these, Inflammatory Spondyloarthritis presents a unique challenge, characterised by its elusive diagnostic markers and diverse clinical manifestations. In this article, we delve into the highlights and findings from EULAR 2023 and ACR 2023, shedding light on the latest advancements in understanding and managing these complex rheumatic conditions.

Objectives: The aim of the present analysis was to describe the clinical and demographic characteristics of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) patients from Greece who were enrolled in the global PROOF study, and their longitudinal follow-up over 5 years to determine the impact of the disease on quality of life and patient-reported outcomes.

Methods: PROOF was an observational study that enrolled recently diagnosed (<1 year) patients fulfilling the Assessment of SpondyloArthritis International Society classification criteria from rheumatology clinical practices from 29 countries across 6 different geographical regions.

Results: Of the 100 Greek patients enrolled, 85 were classified based on local (investigator) evaluation of sacroiliac radiographs [AS: 56 (65.88%); nr-axSpA: 29 (34.12%)]. Higher prevalence of males in the AS (approximately 70%) and equal gender representation in the nr-axSpA patients were observed. There were variations in the clinical presentation, symptom duration, mean age at baseline, and HLA-B27 positivity between male and female patients. The majority of the patients were treated with TNF inhibitors from baseline to study end. Disease activity as well as patient-reported outcomes (functional index, quality of life, patient assessment of disease, and work productivity for employed patients) improved compared to baseline. Only 4 patients progressed to AS during the study.

Conclusions: This analysis provides longitudinal data from the patients enrolled in the global PROOF study from Greece for comparative purposes. The data from the Greek cohort can highlight challenges in the management of the SpA patients.

Purpose: To investigate the impact of beliefs in adherence to biologic drugs among patients with rheumatoid arthritis (RA).

Methods: This was a cross-sectional study, including RA patients who were on biologic disease-modifying antirheumatic drugs (bDMARDs). Therapeutic adherence was evaluated arbitrarily using a self-reported method by asking them the following question: "Do you regul arly take your biologic drug as prescribed by your doctor?". The Beliefs about Medicines Questionnaire (BMQ) was used to evaluate medication beliefs [general overuse, general harm, specific necessity, specific concerns].

Results: Seventy-five RA patients were included (80.0% females, 33.3% illiterate, and 68.0% unemployed, mean age: 57±9 years, mean disease activity score: 3.94±1.32). Adherence to the current biologic drug was reported by 71 patients (94.7%). The means ± standard deviation scores for general overuse, general harm, specific necessity, and specific concerns were 14.0±2.4, 10.8±4.4, 20.6±5.7, and 10.3±3.3, respectively. Compared to the adherent group (n=71), the non-adherent group (n=4) had a lower specific necessity score (21.0±5.4 vs. 13.5±7.5, respectively, p=0.009), a higher specific concern score (10.1±3.13 vs. 15.0±2.8, respectively, p=0.036), and similar scores for general overuse and general harm (10.0±2.3 vs. 9.5±1.9, p=0600; 13.3±4.4 vs. 11.5±4.1, p=0.400, respectively). In logistic regression, specific necessity and specific concerns scores were significantly associated with adherence (Odds-ratio (OR)= 0.855, 95% confidence interval (CI) [0.726-1.006], and 1.438, 95% CI [1.004-1.980], respectively).

Conclusion: Our study showed that RA patients have strong beliefs about the necessity to take biologic drugs which significantly influence the adherent behaviour therapy.

Objectives: The aim of this study was to study the therapeutic maintenance of tumour necrosis factor α inhibitors (TNFα-I) for spondyloarthritis patients enrolled in the Moroccan biotherapy registry and to analyse the reason and the predictive factors of stopping TNFα-I.

Methods: Data were collected from a historical-prospective multicentre registry of adult patients with spondyloarthritis, treated with biological treatment, in the 10 rheumatology departments in Morocco. Maintenance was defined as the interval between the introduction and the suspension of the same TNFα-I.

Results: 190 patients under TNFα-I were included, their average age was 40.2 +/-13.6 years. The male gender predominated. On average, the duration of the disease was 11.7 years +/-6.7 years. The ongoing therapeutic maintenance of all TNFα-I drugs in our study was relatively high and exhibited a decline over time, decreasing from 63.8% at 1 year to 45% at 3 years. At the 36-month follow-up, 27.7% had stopped their treatment. It was found that taking nonsteroidal anti-inflammatory drugs (NSAIDs) between visits and having a high average Ankylosing Spondylitis Disease Activity Score with C-reactive protein on the day of the visit were identified as predictive factors for therapeutic discontinuation in multivariate analysis.

Conclusion: The therapeutic maintenance level of TNFα-I in our study was satisfactory and comparable to other series. our study provides a more comprehensive understanding of the factors that contribute to the improved maintenance of treatment with TNFα-I. It delves into the reasons influencing treatment continuity and identifies predictive factors of discontinuation.

Axial spondyloarthritis (axSpA) is a multifaceted disease with a wide range of manifestations and associated comorbidities. Despite an expanding arsenal of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment landscape of axSpA, a substantial number of patients remains resistant to multiple therapeutic interventions, posing a clinical challenge. This resistance may originate from both inflammatory and non-inflammatory factors. The term "difficult-to-manage" (D2M) axSpA, which was recently proposed by the Assessment of Spondyloarthritis international Society (ASAS), indicates the persistence of symptoms and/or signs despite treatment with ≥2 different classes of biologic/targeted synthetic DMARDs and requires a variety of factors leading to inadequate treatment response. Meanwhile, the term "treatment refractory" disease, implying a frank biologically active inflammatory process, was also defined as a subtype of the D2M group. Literature in this field is restricted, while definitions applied are diverse and often used interchangeably. Medline/PubMed, Scopus, and Google Scholar databases were searched for relevant full-text articles. This short review overviews the current concept and evidence regarding D2M axSpA, including its definition, prevalence, and associated key factors. Furthermore, current management is discussed, and possible therapeutic strategies are suggested for this special subgroup of axSpA patients.

Objectives: High biologic requirement in inflammatory rheumatic diseases (IRD) may indicate a difficult to treat (D2T) condition. In axial spondyloarthritis (axSpA), a consensual definition for this concept is still lacking. Our objectives are to identify the prevalence and characteristics of multiswitcher patients with axSpA, and to analyse the number and reasons for switches.

Methods: This is a longitudinal observational study including patients treated with biologic agents for axSpA. We propose to define D2T patients as those who required more than 2 b/tsDMARD. Patients who did not fulfil this definition were used as controls. The prevalence of multiswitchers was calculated, and characteristics were compared between the two groups. The number and reasons for switches were analysed in the D2T group.

Results: 124 patients were included. The prevalence of multiswitchers was 24.19%. There were no significant differences between the two groups in the age, sex, and comorbidities. D2T patients have more arthritis (p=0.01), and fibromyalgia (p=0.04), and higher disease activity before initiating biotherapy, (BASDAI:p=0.04), (ASDAS:p=0.04). Additionally, the time from diagnosis to the first use of biologic was longer (p=0.04). In the multivariate analysis, the D2T condition was found to be associated with fibromyalgia (p=0.01). Among this group, the prevalence of those treated with 3, 4, and 5 b/tsDMARD was 86%, 9%, and 5%, respectively, the primary and secondary failures were the most common reasons for switching.

Conclusion: We suggest that D2T-axSpA present several characteristics. Identification of this category in large studies is necessary to establish a consensus definition.

Objective: To assess patients' understanding and attitudes towards biosimilars in rheumatoid diseases in Greece.

Methods: A convenience sample of patients with rheumatoid diseases who were members of the largest rheumatoid patient association (RHEUMAZIN) in Greece was selected for this survey. Data on patients' knowledge and attitudes towards biosimilars were collected with a web-based questionnaire.

Results: Among the 309 patients, 60.2% were being treated with bio-originator products, 11% with biosimilars and another 28.8% did not know the type of their biologic therapy. Only 43.7% of the respondents reported they had adequate information about biologic treatments. About 47.9% knew what biosimilars are exactly and 81.2% stated that they need more information about them. The most influential patient information sources about biologics were rheumatologists (88.3%), the Internet (45%), and patient associations (40.5%). Only about 55-60% of the participants thought that biosimilars are comparable to their reference products in terms of safety, effectiveness, quality and regulatory requirements. Patients with adequate knowledge about biosimilars were significantly less concerned about switching from their reference products. A higher education level, previous biosimilar treatment experience, having rheumatologists, patient associations, regulatory bodies and the internet as main information sources, being better informed about the disease, biologic therapies and biosimilars, working and having adequate information about biosimilars were univariately associated with a significantly higher likelihood of having a positive attitude towards biosimilars.

Conclusions: There is an urgent need for patient education about biosimilars in rheumatic diseases in Greece to enhance patient knowledge and ensure informed decisions on biosimilar use.