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Preview: Rheumatology - Advance Access

Rheumatology Advance Access





Published: Fri, 20 Apr 2018 00:00:00 GMT

Last Build Date: Sat, 21 Apr 2018 03:50:22 GMT

 



The potential benefits of aspirin for primary cardiovascular prevention in rheumatoid arthritis: a secondary analysis of the PRECISION Trial

Fri, 20 Apr 2018 00:00:00 GMT

Abstract
Objective
Guidelines exist for the use of low-dose aspirin in the general population for primary cardiovascular (CV) prevention, but the risk-benefit considerations may differ in RA. While RA confers an increased CV risk, such patients more likely use NSAIDs and corticosteroids.
Methods
We conducted a cohort study to assess potential risks and benefits of low-dose aspirin. We estimated incidence rates and hazard ratios (HRs) using Cox regression among subjects with RA but no known CV disease in the Prospective Randomized Evaluation of Celecoxib Integrated Safety Vs Ibuprofen Or Naproxen trial. The primary exposure of interest was low-dose aspirin, and all enrolled patients were provided open-label esomeprazole. The primary composite outcome was major NSAID toxicity, including major adverse CV event (MACE), clinically significant gastrointestinal events, renal events and all-cause mortality.
Results
We found 1852 subjects with RA in Prospective Randomized Evaluation of Celecoxib Integrated Safety Vs Ibuprofen Or Naproxen without known CV disease; 540 reported using low-dose aspirin for CV prevention and 1312 did not. Any major NSAID toxicity was observed in 79 (6.0%) non-aspirin users and 37 (6.9%) aspirin users (P = 0.50). Aspirin users experienced all components of the primary outcome at a similar rate to non-users. In fully adjusted models, the risk for major NSAID toxicity was similar between aspirin exposure groups (HR = 1.08, 95% CI: 0.69, 1.69). The risk for MACE was also similar between exposure groups in age- and gender-adjusted models (HR = 1.23, 95% CI: 0.72, 2.10).
Conclusion
RA patients using low-dose aspirin with chronic NSAIDs and esomeprazole had a similar risk of major NSAID toxicity and MACE as patients who did not.



Is remission achievable in most patients with rheumatoid arthritis? Results suggest not

Fri, 20 Apr 2018 00:00:00 GMT

This editorial refers to ‘Prevalence of sustained remission in rheumatoid arthritis. Impact of criteria sets and disease duration, a nationwide study in Sweden’ by Einarrson J et al.



A novel lupus activity index accounting for glucocorticoids: SLEDAI-2K glucocorticoid index

Fri, 20 Apr 2018 00:00:00 GMT

Abstract
Objective
To develop and validate a modification of SLEDAI-2K to accurately describe disease activity while accounting for glucocorticoid (GC) doses.
Methods
The first two phases focused on the development of the index. Phase 1: identification of scenarios of real patients seen prospectively in a longitudinal cohort. Phase 2: derivation of an equation that explains the association between SLEDAI-2K and GC doses using physician global assessment as the external construct. Phase 3: comparison of SLEDAI-2K and SLEDAI-2K GC (SLEDAI-2KG), using different cut-off points (4–7), in identifying responders in response to therapy.
Results
In phase 1, 150 scenarios with different organ involvement and a range of GC doses were identified. In phase 2, three rheumatologists ranked disease activity using physician global assessment. A quadratic linear regression model relating GC doses and SLEDAI-2K resulted in the following equation: SLEDAI-2KG score = SLEDAI-2K score + [0.32 × GC – 0.0031 × GC2]. The weighted score of different GC doses was derived. In phase 3, SLEDAI-2KG identified more responders in a total of 111 patients at 6 months (84 vs 93%) and at 12 months (76 vs 92%) compared with SLEDAI-2K. SLEDAI-2KG performances were superior to SLEDAI-2K with all cut-off points (5–7).
Conclusion
We developed a modification of SLEDAI-2K, SLEDAI-2KG, that describes disease activity while accounting for GC dose category. SLEDAI-2KG identifies more responders compared with SLEDAI-2K.



Are we failing patients in our assessment of treatment failure?

Thu, 19 Apr 2018 00:00:00 GMT

Treat-to-target principles of managing rheumatic and musculoskeletal diseases (RMDs) such as RA [1] are now widely accepted as effective strategies for achieving optimal disease outcomes. Despite this, a proportion of patients continue to have poor disease outcomes, regardless of the use of highly effective treatments that are currently available. The term ‘treatment failure’ is becoming increasingly replaced by ‘treatment success’, the latter capturing headlines in the news and declaring the power of newer treatments to achieve disease control and states of disease remission. Yet, the meaning of treatment failure or treatment success can be vastly different from the patient’s perspective, compared with that of their treating rheumatologist. It is therefore perhaps not surprising to see discordance in the perception of disease severity between patients and physicians [2].