Friday, 20 Sep 2019

You are here

Seronegative and Seropositive Rheumatoids Respond Equally Well

A cohort study of 241 DMARD-naive rheumatoid arthritis (RA) patients, meeting either 1987 ACR or the 2010 ACR/EULAR  classification criteria for RA, compared the baseline status and long term outcomes of seronegative (SNRA) and seropositive (SPRA).

While it is well-known that RA patients seropositive for either rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) may have more aggressive disease and poorer radiologic outcomes, the fate of SNRA patients is less well characterized.

They compared 40 patients with SNRA and 201 with SPRA and looked at clinical and X-ray findings at baseline and after 1 and 2 years of conventional DMARD treatment.

While age, sex and disease duration were similar between SNRA and SPRA, at baseline SNRA patients had higher median tender joint counts (4.7±2.9 vs. 3.3±2.7, p = 0.004), swollen joint counts (4.3±3.0 vs. 2.9±2.3, p = 0.001) and DAS28 scores (5.1±1.0 vs. 4.7±1.0, p = 0.043). Such findings have been noted in other cohort studies and suggests that SNRA patients will require quantitatively more joint activity to meet the RA classification criteria. 

After 2 years of DMARDs therapy, all patients and measures and X-ray outcomes improved equally.  But the change in disease activity (ΔDAS28) was only greater at 1 year when comparing SNRA and SPRA (-2.84±1.32 vs. -3.70±1.29, p = 0.037) in high disease activity population (DAS28-ESR>5.1).

These data suggest that while SNRA patients may have more disease activity and more joints early in the disease, they appear to respond equally well to conventional DMARD therapy.

 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

In my in locum adventures, I see a lot of SNRA patients years after the diagnostic label was assigned to them by a former rheumatologist. Truthfully, undifferentiated or inflammatory arthritis (assuming it is steroid responsive) is a better diagnosis in the first 1-2 years before SNRA is assigned that future providers assume is a secure diagnosis.

More Like This

Two vs. Four Weeks of Antibiotic Therapy in Septic Arthritis

A prospective trial has shown that 2 weeks of antibiotic therapy is as effective as 4 weeks of antibiotic therapy, with similar outcomes but shorter hospital stays.

This Swiss study was a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. 

Bimekizumab Add-on Therapy in Rheumatoid Arthritis

Bimekizumab is a dual inhibitor of IL-17A and IL-17F that has been shown to be effective in psoriasis and psoriatic arthritis. A proof-of-concept study shows that giving bimekizumab to rheumatoid arthritis patients not adequately controlled by certolizumab pegol resulted in a rapid decrease in disease activity achieved after 12 weeks of treatment. These findings are novel as anti-IL-17 monoclonal antibody therapy has previously been shown to be ineffective in RA.

74 Percent of Rheumatoid Arthritis Patients Dissatisfied with Treatment

CreakyJoints has completed a 258 patient survey showing that nearly three-fourths of people with rheumatoid arthritis (RA) have expressed dissatisfaction with their treatments, including conventional (csDMARDs) and biologic Disease Modifying Antirheumatic Drugs (bDMARDs).

RA Women are Less Likely to Breastfeed

A large pregnancy registry has published their results showing rheumatoid arthritis (RA) patients who become pregnant are less likely to breastfeed compared to non-RA women from the general population, with many women stopping breastfeeding so that they could start medication, even though many of these meds are safe to use during lactation.

Respiratory Risks Not Increased in RA Patients with COPD

An insurance claims based study of RA patients with COPD shows that biologics do not have an increased rate of respiratory events compared to those on conventional DMARDs. A real world cohort of RA patients with COPD was drawn from US-based MarketScan databases. Patients on biologic DMARDs and/or targeted synthetic DMARDs (tsDMARDs) were propensity matched to those on conventional synthetic DMARDs (csDMARDs).