The EULAR 2015 Report - Thursday Save

These abstracts and presentations were presented Thursday 11 June at the EULAR 2015 annual meeting.

Predictors of Surgery.  A UK study recruited over 2000 early RA patients and followed them prospectively. They showed that when patients were grouped according to their disease activity, both patients with moderate and high disease activity (DAS28 > 3.2) were at high risk for future surgery (#OP0179). Another study by Widdfield and colleagues studied administrative claims data from Ontario and Quebec and showed that MTX or DMARD initiation in the first year of diagnosis was associated with an overall risk of future orthopedic surgery (#OP0020).  Predictors of joint surgery were prior use of NSAID or COX-2 inhibitors, previous joint surgery and coexistent osteoarthritis.

Flare of JIA after TNF inhibitor discontinuation.  Camacho-Lovillo  and colleagues studied 40 children with polyarticular JIA of whom 22 attempted TNFi withdrawal from either etanercept or adalimumab. The majority (66-68%) of these patients flared after an average of 3-4 mos (#THU0519).  This data is similar to that just published by Reiff who studied a larger cohort of 335 JIA or enthesitis-related arthritis. In their study, 89% flared if the TNFi was discontinued first and 12% flared if MTX was withdrawn from combination MTX+TNFi therapy (Arthritis Care Res 2015;67:658).

Treatment of Very Early RA with MTX and Tocilizumab.  317 patients with double-blind trial very early RA (2-6 weeks of disease) were randomized to receive methotrexate or tocilizumab or MTX plus TCZ in a 2 year study with a primary endpoint of sustained (>23 wks) remission (#OP0033). If remission was not achieved, hydroxychloroquine could have been added. At the end of 2 years, >84% of patients receiving TCZ or MTX+TCZ had sustained remission – both of these were equal and both were superior to MTX alone (49%). This study showed impressive remission numbers, presumably related to the very early patients enrolled or the add-on of HCQ for partial responders. It is unclear how many of these very early RA patients would ultimately have been diagnosed with undifferentiated polyarthritis and gone into remission without such interventions.  Future follow-up should be revealing.

RDW as a Marker of Inflammation?  Korean investigators reported on their comparison of 15 adult-onset Still’s patients (AOSD), 27 sepsis patients and 30 controls; specifically looking at the predictive value of serum ferritin (means of 500-5800 mg/dl) and RDW (red cell distribution width; range). While both measures were significantly elevated in AOSD and sepsis patients compared to controls, RDW was greater than ferritin in sepsis and ferritin was greater than RDW in AOSD (#THU0550). RDW has been postulated as a biomarker of inflammation. The relationship between RDW and CRP or other proinflammatory cytokines is unclear.

TNF inhibitor Reductions in Psoriatic Arthritis.  Holroyd and coworkers examined 83 patients with severe psoriatic arthritis from a biologics therapy clinic (#THU0422). Most (87%) were on their first or second biologic and 13% were on their 3rd or 4th biologic.  Patients were eligible for dose reduction if they achieved a DAS28 < 3.2 for > 6 months.  Few (15/83) met this criteria for dose reduction and only 9 of 15 were able to stay off their TNF inhibitor for a mean of 1.2 years. The 6 patients who relapsed were restarted on their former therapy and were able to recapture low disease activity, albeit at a slightly higher level of activity.