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Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-TNF therapy?

Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-TNF therapy?
Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-TNF therapy?
Objective To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti–tumor necrosis factor (anti‐TNF) therapies.
Methods As part of a real‐world approach, patients with RA receiving anti‐TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti‐TNF therapy dose by one‐third.
Results Between January 2012 and February 2014, a total of 70 patients underwent anti‐TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038).
Conclusion Combined clinical and US assessment identifies individuals in remission who may be suitable for anti‐TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.
0893-7524
746-753
Marks, Jonathan L.
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Holroyd, Christopher R.
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Dimitrov, Borislav D.
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Armstrong, Ray D.
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Calogeras, Antonia
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Cooper, Cyrus
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Davidson, Brian K.
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Dennison, Elaine M.
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Harvey, Nicholas C.
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Edwards, Christopher J.
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Marks, Jonathan L.
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Holroyd, Christopher R.
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Dimitrov, Borislav D.
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Armstrong, Ray D.
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Calogeras, Antonia
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Cooper, Cyrus
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Davidson, Brian K.
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Dennison, Elaine M.
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Harvey, Nicholas C.
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Edwards, Christopher J.
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Marks, Jonathan L., Holroyd, Christopher R., Dimitrov, Borislav D., Armstrong, Ray D., Calogeras, Antonia, Cooper, Cyrus, Davidson, Brian K., Dennison, Elaine M., Harvey, Nicholas C. and Edwards, Christopher J. (2015) Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-TNF therapy? Arthritis Care & Research, 67 (6), 746-753. (doi:10.1002/acr.22552).

Record type: Article

Abstract

Objective To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti–tumor necrosis factor (anti‐TNF) therapies.
Methods As part of a real‐world approach, patients with RA receiving anti‐TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti‐TNF therapy dose by one‐third.
Results Between January 2012 and February 2014, a total of 70 patients underwent anti‐TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038).
Conclusion Combined clinical and US assessment identifies individuals in remission who may be suitable for anti‐TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.

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Submitted date: 2014
Accepted/In Press date: 13 January 2015
e-pub ahead of print date: 20 January 2015
Published date: June 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 367477
URI: http://eprints.soton.ac.uk/id/eprint/367477
ISSN: 0893-7524
PURE UUID: d9dd8a4f-bb87-461a-9b15-46cff7b5c3be
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Elaine M. Dennison: ORCID iD orcid.org/0000-0002-3048-4961
ORCID for Nicholas C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 29 Aug 2014 11:42
Last modified: 21 Nov 2021 02:54

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Contributors

Author: Jonathan L. Marks
Author: Christopher R. Holroyd
Author: Borislav D. Dimitrov
Author: Ray D. Armstrong
Author: Antonia Calogeras
Author: Cyrus Cooper ORCID iD
Author: Brian K. Davidson

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