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Remisyonda olan romatoid artritli hastada tedavi kararı

Year 2021, Volume: 60 Suppl:1 (Rheumatology), 44 - 48, 20.01.2021

Ayten Yazıcı

https://doi.org/10.19161/etd.863635

Abstract

Romatoid artrit (RA) erişkinde en sık görülen inflamatuar artrit olup, tedavisinde remisyon veya düşük
hastalık aktivitesi hedeflenmektedir. Bu nedenle öncelikle RA’da kalıcı remisyon tanımının ve süresinin
kesin olarak belirlenmesi gerekmektedir. Mevcut önerilere göre en az altı aydır remisyonda olan ve
sabit dozda hastalık modifiye edici ilaç (DMARD) kullanan hastalarda doz azaltılması önerilmektedir.
Özellikle anti-siklik sitrüline peptid sonucu negatif, inflamatuar belirteçleri normal olan ve
ultrasonografide aktif inflamasyonu olmayan hastalarda steroid kesildikten sonra biyolojik DMARD
dozu veya sıklığının azaltılması, sonrasında konvansiyonel DMARD ile kombine kullanan ve halen
remisyonda olanlarda biyolojik DMARD’ın kesilmesi relaps açısından daha güvenli görünmektedir. Tek
başına konvansiyonel DMARD kullananlarda ise sadece doz azaltılması önerilmektedir.

Keywords

Romatoid artrit remisyon DMARD relaps

References

  • Gerd RB, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet 2017; 389: 2338-48.
  • Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations fort he management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2016; 76: 960-77.
  • Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016; 68: 1-26.
  • Schett G, Emery P, Tanaka Y, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis. 2016; 75 (8): 1428-37.
  • Smolen SF, Aletaha D, McLnnes IB. Rheumatoid arthritis. Lancet 2016; 388: 2023-38.
  • Aletaha D, Smolen JS. Remission in rheumatoid arthritis: missing objectives by using inadequate DAS28 targets. Nat Rev Rheumatol 2019; doi: 10.1038/s41584-019-0279-6. (Equb ahead of print)
  • Dubost JJ, Pereira B, Fan A, Soubrier M. Rate of remission among rheumatoid arthritis patients being treated by rheumatologist in routine practice. Joint Bone Spine 2019; doi: 10.1016j/jbspin.2019.03.006. (Equb ahead of print)
  • Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskel Dis 2017; 9: 249-62.
  • Yilmaz-Oner S, Gazel U, Can M, Atagunduz P, Direskeneli H, Inanc N. Predictors and the optimal duration of sustained remission in rheumatoid arthritis. Clin Rheumatol 2019; doi: 10.1007/s10067-019-04654-7. (Equb ahead of print)
  • Lau, CS, Chia F, Dans L, et al. 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. Int J of Rheum Dis 2019; 22: 357–75.
  • Lau CS, Chia F, Harrison A, et al. APLAR rheumatoid arthritis treatment recommendations. Int J of Rheum Dis 2015; 18: 685–713.
  • Cefle A, Keser G, Terzioğlu E ve ark. Türkiye Romatoloji Derneği romatoid artrit ulusal tedavi önerileri. Ulus Romatol Derg 2018; 10: 81-4.
  • Baker KF, Skelton AJ, Lendrem DW, et al. Predicting drug-free remission in rheumatoid arthritis: A prospective interventional cohort study. J Autoimmun 2019; doi: 10.1016/j.jaut.2019.06.009. (Equb ahead of print)
  • Van den Broke M, Lems WF, Allaart CF. BeSt practice: the success of early-targeted treatment in rheumatoid arthritis. Clin Exp Rheumatol 2012; 30: S35-8. 48 Ege Tıp Dergisi / Ege Journal of Medicine
  • Sanmarti R, Veale DJ, Martin-Mola E, et al. Reducing or maintaining the dose of subcutaneous tocilizumab in patients with rheumatoid arthritis in clinical remission: a randomized, open-label trial. Arthritis Rheumatol. 2019; doi: 10.1002/art.40905. (Equb ahead of print)
  • Tanaka Y. Stopping tumour necrosis factor-targeted biological DMARDs in rheumatoid arthritis. Rheumatology (Oxford) 2016;55(suppl 2):ii15-ii22.
  • Tanaka Y, Hirata S, Kubo S, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015; 74: 389-95.
  • Haschka J, Englbrecht M, Hueber AJ, et al. Relaps rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis 2016; 75: 45-51.
  • Mangoni AA, Okaily FA, Almoallim H, Rashidi SA, Mohammed RHA, Barbary A. Relapse rates after elective discontinuation of anti-TNF therapy in rheumatoid arthritis: a meta-analysis and review of literature. BMC Rheumatol 2019; doi: 10.1186/s41927-019-0058-7. (Equb ahead of print)
  • Henaux S, Ruyssen-Witrand A, Cantagrel A, et al. Risk of losing remission, low disease activity or radiographic progression in case of BDMARD discontinuation or tapering in rheumatoid arthritis: systemic analysis of the literature and meta-analysis. Ann Rheum Dis 2018; 77: 515-22.
  • Tanaka Y, Hirata S. Is it possible to withdraw biologics from therapy in rheumatoid arthritis? Clin Ther 2013; 35: 2028-35.
  • Tanaka Y, Hirata S. Intensive intervention can lead to a treatment holiday from biological DMARDs in patients with rheumatoid arthritis. Drugs 2014; 74 (18): 2129-39.
  • Schlager L, Loiskandl M, Alehata D, Radner D. Predictors of successful discontinuation of biologic and targeted synthetic DMARDs in patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review. Rheumatlogy (Oxford) 2019; doi: 10.1093/rheumatology/kez276. (Equb ahead of print).

Treatment decision in patient with rheumatoid arthritis in remission

Year 2021, Volume: 60 Suppl:1 (Rheumatology), 44 - 48, 20.01.2021

Ayten Yazıcı

https://doi.org/10.19161/etd.863635

Abstract

Rheumatoid arthritis (RA) is the most common inflammatory disease in adults, and remission or low
disease activity is targeted for treatment of RA. Therefore, the definition and duration of sustained
remission for RA should be determined precisely. According to current recommendations, dose
reduction is recommended in patients who use stable dose disease modifying antirheumatic drugs
(DMARD) and have been in remission for at least 6 months. Tapering of biologic DMARD (dose or
frequency) after steroid discontinuation may be considered, especially in patients who had negative
anti cyclic citrullinated peptide, normal inflammatory markers and no active signal in ultrasonography.
In persistent remission, discontinuation of biologic DMARD may be considered if treatment combined
with a conventional DMARD. Only tapering is recommended for patients who use conventional
DMARD as monotherapy.

Keywords

Rheumatoid arthritis remission DMARD relapse

References

  • Gerd RB, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet 2017; 389: 2338-48.
  • Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations fort he management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2016; 76: 960-77.
  • Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016; 68: 1-26.
  • Schett G, Emery P, Tanaka Y, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis. 2016; 75 (8): 1428-37.
  • Smolen SF, Aletaha D, McLnnes IB. Rheumatoid arthritis. Lancet 2016; 388: 2023-38.
  • Aletaha D, Smolen JS. Remission in rheumatoid arthritis: missing objectives by using inadequate DAS28 targets. Nat Rev Rheumatol 2019; doi: 10.1038/s41584-019-0279-6. (Equb ahead of print)
  • Dubost JJ, Pereira B, Fan A, Soubrier M. Rate of remission among rheumatoid arthritis patients being treated by rheumatologist in routine practice. Joint Bone Spine 2019; doi: 10.1016j/jbspin.2019.03.006. (Equb ahead of print)
  • Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskel Dis 2017; 9: 249-62.
  • Yilmaz-Oner S, Gazel U, Can M, Atagunduz P, Direskeneli H, Inanc N. Predictors and the optimal duration of sustained remission in rheumatoid arthritis. Clin Rheumatol 2019; doi: 10.1007/s10067-019-04654-7. (Equb ahead of print)
  • Lau, CS, Chia F, Dans L, et al. 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. Int J of Rheum Dis 2019; 22: 357–75.
  • Lau CS, Chia F, Harrison A, et al. APLAR rheumatoid arthritis treatment recommendations. Int J of Rheum Dis 2015; 18: 685–713.
  • Cefle A, Keser G, Terzioğlu E ve ark. Türkiye Romatoloji Derneği romatoid artrit ulusal tedavi önerileri. Ulus Romatol Derg 2018; 10: 81-4.
  • Baker KF, Skelton AJ, Lendrem DW, et al. Predicting drug-free remission in rheumatoid arthritis: A prospective interventional cohort study. J Autoimmun 2019; doi: 10.1016/j.jaut.2019.06.009. (Equb ahead of print)
  • Van den Broke M, Lems WF, Allaart CF. BeSt practice: the success of early-targeted treatment in rheumatoid arthritis. Clin Exp Rheumatol 2012; 30: S35-8. 48 Ege Tıp Dergisi / Ege Journal of Medicine
  • Sanmarti R, Veale DJ, Martin-Mola E, et al. Reducing or maintaining the dose of subcutaneous tocilizumab in patients with rheumatoid arthritis in clinical remission: a randomized, open-label trial. Arthritis Rheumatol. 2019; doi: 10.1002/art.40905. (Equb ahead of print)
  • Tanaka Y. Stopping tumour necrosis factor-targeted biological DMARDs in rheumatoid arthritis. Rheumatology (Oxford) 2016;55(suppl 2):ii15-ii22.
  • Tanaka Y, Hirata S, Kubo S, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015; 74: 389-95.
  • Haschka J, Englbrecht M, Hueber AJ, et al. Relaps rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis 2016; 75: 45-51.
  • Mangoni AA, Okaily FA, Almoallim H, Rashidi SA, Mohammed RHA, Barbary A. Relapse rates after elective discontinuation of anti-TNF therapy in rheumatoid arthritis: a meta-analysis and review of literature. BMC Rheumatol 2019; doi: 10.1186/s41927-019-0058-7. (Equb ahead of print)
  • Henaux S, Ruyssen-Witrand A, Cantagrel A, et al. Risk of losing remission, low disease activity or radiographic progression in case of BDMARD discontinuation or tapering in rheumatoid arthritis: systemic analysis of the literature and meta-analysis. Ann Rheum Dis 2018; 77: 515-22.
  • Tanaka Y, Hirata S. Is it possible to withdraw biologics from therapy in rheumatoid arthritis? Clin Ther 2013; 35: 2028-35.
  • Tanaka Y, Hirata S. Intensive intervention can lead to a treatment holiday from biological DMARDs in patients with rheumatoid arthritis. Drugs 2014; 74 (18): 2129-39.
  • Schlager L, Loiskandl M, Alehata D, Radner D. Predictors of successful discontinuation of biologic and targeted synthetic DMARDs in patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review. Rheumatlogy (Oxford) 2019; doi: 10.1093/rheumatology/kez276. (Equb ahead of print).
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Case Reports
Authors

Ayten Yazıcı 0000-0003-2167-4509

Publication Date January 20, 2021
Submission Date April 6, 2020
Published in Issue Year 2021Volume: 60 Suppl:1 (Rheumatology)

Cite

Vancouver Yazıcı A. Remisyonda olan romatoid artritli hastada tedavi kararı. EJM. 2021:44-8.
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