Treat to target - case series of patients with rheumatoid arthritis and no radiographic progression at long-term follow up
PDF ENG
PDF BG (Български)

Keywords

rheumatoid arthritis, remission, radiographic progression, treat to target

How to Cite

Emin, S., Boyadzhieva, V., Stoilov, N., Lazarov, D., Ivanova, M., & Stoilov, R. (2025). Treat to target - case series of patients with rheumatoid arthritis and no radiographic progression at long-term follow up. Rheumatology (Bulgaria), 32(4), 72-80. https://doi.org/10.35465/32.4.2024.pp72-80

Abstract

Rheumatoid arthritis is a chronic autoimmune inflammatory joint disease characterized by pain, morning stiffness and symmetrical polyarthritis, leading to destruction of the affected joints in long term. The goal of the treat-to-target strategy in treating the disease is to achieve remission or low disease activity. Today, there are various conventional, biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), which are widely used in rheumatological practice in order to personalize the therapeutic strategy for each patient. One of the main goals of treatment is to suppress and slow the radiographic progression of the disease, which leads to disability, impaired quality of life and reduced work capacity of patients. There are different scales for assessing joint destruction, based on radiographic examination of small and large joints of the hands and feet, due to which we can assess structural changes in dynamics. We present three clinical cases of patients with long-standing seropositive rheumatoid arthritis, treated with conventional and/or biologic DMARDs, who achieved long-term remission and minimal radiographic progression of the disease.

https://doi.org/10.35465/32.4.2024.pp72-80
PDF ENG
PDF BG (Български)

References

  1. GBD 2019: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. https://vizhub.healthdata.org/gbd-results/.
  2. Kobelt G., Kasteng F. (2009). Access to Innovative Treatments in Rheumatoid Arthritis in Europe, EFPIA Report. Available at: http://www.comparatorreports.se/Access%20to%20RA%20Treatments%20October%202009.pdf [Google Scholar]
  3. Boyadzhieva V, Stoilov N, Ivanova M, Petrova G, Stoilov R. Real World Experience of Disease Activity in Patients With Rheumatoid Arthritis and Response to Treatment With Varios Biologic DMARDs. Front Pharmacol. 2018 Nov 20;9:1303. doi: 10.3389/fphar.2018.01303. PMID: 30524277; PMCID: PMC6256982.
  4. Williams, J.D., Scott, D.L., DeBrito, F.B. et al. Rheumatoid inflammation and joint destruction: cause and effect or parallel phenomena?. Agents and Actions 18, 538–543 (1986). https://doi.org/10.1007/BF01964961
  5. Vyas S, Bhalla AS, Ranjan P, Kumar S, Kumar U, Gupta AK. Rheumatoid Arthritis Revisited - Advanced Imaging Review. Pol J Radiol. 2016 Dec 31;81:629-635. doi: 10.12659/PJR.899317. PMID: 28105245; PMCID: PMC5223782.
  6. Ory PA. Interpreting radiographic data in rheumatoid arthritis. Ann Rheum Dis. 2003 Jul;62(7):597-604. doi: 10.1136/ard.62.7.597. PMID: 12810418; PMCID: PMC1754596.
  7. van der Heijde DM. Overview of radiologic efficacy of new treatments. Rheum Dis Clin North Am. 2004 May;30(2):285-93, vi. doi: 10.1016/j.rdc.2004.01.002. PMID: 15172041.
  8. Resnick D, Kyriakos M and Greenway GD. Rheumatoid arthritis. Diagnosis of Bone and Joint Disorders. 4th edition. Philadelphia: WB Saunders; 2002. pp. 891-974.
  9. Steinbocker O, Traeger C H, Bateman R C (1949) Journal of the American Medical Association 140, 649–662
  10. Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheu- matoid arthritis and related conditions by standard reference films. Acta Radiol Ser Diagn 18:481–491. https://doi.org/10.1177/02841 8517701800415
  11. Larsen A (1995) How to apply Larsen score in evaluating radio- graphs of rheumatoid arthritis in longterm studies? J Rheumatol 22:1974–1975
  12. Genant HK (1983) Methods of assessing radiographic change in rheumatoid arthritis. Am J Med 75:35–47. https://doi. org/10.1016/0002-9343(83)90473-4
  13. Sharp JT, Lidsky MD, Collins LC, Moreland J (1971) Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnor- malities. Arthritis Rheum 14:706–720. https://doi.org/10.1002/ art.1780140605
  14. van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 2000 Jan;27(1):261-3. PMID: 10648051.
  15. Van Der Heijde D, Dankert T, Nieman F et al (1999) Reliabil- ity and sensitivity to change of a simplification of the Sharp/ van der Heijde radiological assessment in rheumatoid arthritis. Rheumatology 38:941–947. https://doi.org/10.1093/rheumatolo gy/38.10.941
  16. Salaffi F, Carotti M, Carlo MD. Conventional radiography in rheumatoid arthritis: new scientific insights and practical application , Int J Clin Exp Med 2016;9(9):17012-17027
  17. Hulsmans HM, Jacobs JW, van der Heijde DM, van Albada-Kuipers GA, Schenk Y, Bijlsma JW. The course of radiologic damage during the first six years of rheumatoid arthritis. Arthritis Rheum. 2000 Sep;43(9):1927-40. doi: 10.1002/1529-0131(200009)43:9<1927::AID-ANR3>3.0.CO;2-B. PMID: 11014342.
  18. Garber, A.J. (2014), Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab, 16: 193-205. https://doi.org/10.1111/dom.12129
  19. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, Combe B, Cutolo M, de Wit M, Dougados M, Emery P, Gibofsky A, Gomez-Reino JJ, Haraoui B, Kalden J, Keystone EC, Kvien TK, McInnes I, Martin-Mola E, Montecucco C, Schoels M, van der Heijde D; T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631-7. doi: 10.1136/ard.2009.123919. Epub 2010 Mar 9. Erratum in: Ann Rheum Dis. 2011 Aug;70(8):1519. Erratum in: Ann Rheum Dis. @011 Jul;70(7):1349. van der Heijde, Desirée [corrected to van der Heijde, Désirée]. PMID: 20215140; PMCID: PMC3015099.
  20. Prevoo ML, Van‘t Hof MA, Kuper HH et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995, 38:44-8.
  21. Anderson J, Caplan L, Yazdany J et al. Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice. Arthritis Care Res (Hoboken). 2012; 64(5): 640-647.
  22. Boyadzhieva, V., Stoilov, N., Ivanova, M., & Stoilov, R. (2019). Treatment of rheumatoid arthritis: csDMARDS versus bDMARDS. Prospective study to evaluate disease activity. Rheumatology (Bulgaria), 27(1), 3-15. https://doi.org/10.35465/27.1.2019.pp3-15
  23. den Broeder AA, Joosten LAB, Saxne T, et al. Long term anti-tumour necrosis factor a monotherapy in rheumatoid arthritis: effect on radiological course and prognostic value of markers of cartilage turnover and endothelial activation. Ann Rheum Dis. 2002;61:311–18.
  24. Weinblatt ME, Keystone EC, Furst DE, Moreland LW, Weisman MH, Birbara CA, Teoh LA, Fischkoff SA, Chartash EK. Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum. 2003 Jan;48(1):35-45. doi: 10.1002/art.10697. Erratum in: Arthritis Rheum. 2003 Mar;48(3):855. PMID: 12528101.
  25. Rau R. Adalimumab (a fully human anti-tumour necrosis factor α monoclonal antibody) in the treatment of active rheumatoid arthritis: the initial results of five trials. Ann Rheum Dis 2002 Nov; 61Suppl 2: Ü70–3
  26. Keystone EC, Breedveld FC, van der Heijde D, et al. Longterm effect of delaying combination therapy with tumor necrosis factor inhibitor in patients with aggressive early rheumatoid arthritis: 10-year efficacy and safety or adalimumab from the randomized controlled PREMIER trial with open-label extension. J Rheumatol 2014;41:5–14.
  27. Drosos AA, Tsifetaki N, Tsiakou EK, Timpanidou M, Tsampoulas C, Tatsis CK, Kotoulas K, Moutsopoulos HM. Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study. Clin Exp Rheumatol. 1997 May-Jun;15(3):263-7. PMID: 9177920.
  28. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R, Sharp J, Perez JL, Spencer-Green GT. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006 Jan;54(1):26-37. doi: 10.1002/art.21519. PMID: 16385520.
  29. Verhoeven, M.M.A., Tekstra, J., Jacobs, J.W.G., Bijlsma, J.W.J., van Laar, J.M., Pethö-Schramm, A., Borm, M.E.A., Lafeber, F.P.J. and Welsing, P.M.J. (2022), Efficacy of Tocilizumab Monotherapy Versus Tocilizumab and Methotrexate Combination Therapy in the Prevention of Radiographic Progression in Rheumatoid Arthritis: An Analysis Using Individual Patient Data From Multiple Clinical Trials. Arthritis Care Res, 74: 889-895. https://doi.org/10.1002/acr.24524
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Downloads

Download data is not yet available.