Re: RESEARCH - More RA remissions with TNF inhibitors than with DMARDs

[Guest guest]

, are there guidelines doctors follow to determine when remission

occurs? Is there a difference between " being in remission " and

having your pain and swelling disappear because of the meds you're

taking? I know we've had a discussion before about " are you really

in remission if you're still taking meds, " but this always confuses

me.

> More RA remissions with TNF inhibitors than with DMARDs

>

>

> Rheumawire

> Oct 19, 2004

> Janis

>

> San , TX - Rheumatoid arthritis (RA) patients are more

likely to

> have disease remission if they take TNF inhibitors than if they take

> traditional disease-modifying antirheumatic drugs (DMARDs), Dr

C

> Liang (Northwestern University Feinberg School of Medicine,

Chicago, IL)

> reported in a poster presentation at the American College of

> Rheumatology (ACR) 2004 meeting [1].

>

> " This cross-sectional observation of an outpatient arthritis clinic

> found a higher remission rate among RA patients on TNF-alpha

inhibitors

> than those on traditional DMARDs, " Liang tells

rheumawire. " Patients who

> took TNF inhibitors were 2.74 times more likely to be in remission. "

>

> This study collected data from 331 RA patients during regularly

> scheduled treatment at outpatient arthritis clinics. The researchers

> recorded current and past medication use as well as disease-activity

> status according to ACR criteria. Patients were grouped according to

> medication use: TNF inhibitor users (n=118) vs patients who used

> traditional DMARDs or no DMARDs (n=213). Patients were also grouped

> according to disease status (remission vs active disease).

>

> Liang said that TNF inhibitor users were about 4 years younger than

> nonusers, had disease onset about 8 years earlier than nonusers,

had RA

> duration 3 years longer, and had less frequent use of nonsteroidal

> anti-inflammatory drugs (NSAIDs), more frequent use of prednisone

and at

> a higher dose, and more previous DMARD failures.

>

> Comparing patients in remission vs not in remission showed that

those in

> remission had a shorter duration of RA, were more likely to use TNF

> inhibitors, used less prednisone and at a smaller dosage, and had

fewer

> previous DMARD failures. Also, male patients were more likely to be

in

> remission than females.

>

> Patients in remission included 24% of TNF inhibitor users vs 15% of

> patients who did not use TNF inhibitors.

>

> " This study revealed an odds ratio of 1.84 (95% CI 1.05-3.24) in

favor

> of TNF-alpha inhibitors. After adjustments for age, sex, use of

NSAIDs

> and DMARDs and prednisone dosage, the odds ratio increased to 2.50

(95%

> CI 1.34-4.66), " Liang reported.

>

>

> Source

>

> Liang GC, Cordero M, Dyer A, et al. TNF-alpha

> inhibitors are associated with more remissions in rheumatoid

arthritis

> patients when compared to traditional disease modifying anti-

rheumatic

> drugs in a cross-sectional study of an academic based clinical

practice.

> American College of Rheumatology 2004 meeting; October 16-21, 2004;

San

> , TX; Abstract 371.

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

[Guest guest]

, are there guidelines doctors follow to determine when remission

occurs? Is there a difference between " being in remission " and

having your pain and swelling disappear because of the meds you're

taking? I know we've had a discussion before about " are you really

in remission if you're still taking meds, " but this always confuses

me.

> More RA remissions with TNF inhibitors than with DMARDs

>

>

> Rheumawire

> Oct 19, 2004

> Janis

>

> San , TX - Rheumatoid arthritis (RA) patients are more

likely to

> have disease remission if they take TNF inhibitors than if they take

> traditional disease-modifying antirheumatic drugs (DMARDs), Dr

C

> Liang (Northwestern University Feinberg School of Medicine,

Chicago, IL)

> reported in a poster presentation at the American College of

> Rheumatology (ACR) 2004 meeting [1].

>

> " This cross-sectional observation of an outpatient arthritis clinic

> found a higher remission rate among RA patients on TNF-alpha

inhibitors

> than those on traditional DMARDs, " Liang tells

rheumawire. " Patients who

> took TNF inhibitors were 2.74 times more likely to be in remission. "

>

> This study collected data from 331 RA patients during regularly

> scheduled treatment at outpatient arthritis clinics. The researchers

> recorded current and past medication use as well as disease-activity

> status according to ACR criteria. Patients were grouped according to

> medication use: TNF inhibitor users (n=118) vs patients who used

> traditional DMARDs or no DMARDs (n=213). Patients were also grouped

> according to disease status (remission vs active disease).

>

> Liang said that TNF inhibitor users were about 4 years younger than

> nonusers, had disease onset about 8 years earlier than nonusers,

had RA

> duration 3 years longer, and had less frequent use of nonsteroidal

> anti-inflammatory drugs (NSAIDs), more frequent use of prednisone

and at

> a higher dose, and more previous DMARD failures.

>

> Comparing patients in remission vs not in remission showed that

those in

> remission had a shorter duration of RA, were more likely to use TNF

> inhibitors, used less prednisone and at a smaller dosage, and had

fewer

> previous DMARD failures. Also, male patients were more likely to be

in

> remission than females.

>

> Patients in remission included 24% of TNF inhibitor users vs 15% of

> patients who did not use TNF inhibitors.

>

> " This study revealed an odds ratio of 1.84 (95% CI 1.05-3.24) in

favor

> of TNF-alpha inhibitors. After adjustments for age, sex, use of

NSAIDs

> and DMARDs and prednisone dosage, the odds ratio increased to 2.50

(95%

> CI 1.34-4.66), " Liang reported.

>

>

> Source

>

> Liang GC, Cordero M, Dyer A, et al. TNF-alpha

> inhibitors are associated with more remissions in rheumatoid

arthritis

> patients when compared to traditional disease modifying anti-

rheumatic

> drugs in a cross-sectional study of an academic based clinical

practice.

> American College of Rheumatology 2004 meeting; October 16-21, 2004;

San

> , TX; Abstract 371.

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

[Guest guest]

, without meds, remission is referred to as " spontaneous. "

Spontaneous clinical remission in established RA is uncommon.

Drug-induced remission is usually what is being referred to in these

studies. Yes, there are criteria used to determine if a given patient is

in remission.

From " Clinical practice guidline for the management of rheumatoid

arthritis, " National Guideline Clearinghouse at www.guideline.gov:

" Two basic approaches to defining clinical remission in RA have been

described: the ACR criteria and the EULAR (European League Against

Rheumatism) criteria.

ACR criteria for clinical remission

Morning stiffness absent or not exceeding 15 minutes

No fatigue

No joint pain (by clinical history)

No joint tenderness

No soft tissue swelling in joints or tendon sheaths

Normal erythrocyte sedimentation rate.

The presence of five or more of these criteria for at least 2 months is

sufficient to classify a patient as in complete remission. Among the

disadvantages of these criteria are the lack of guidelines on how to

measure them, the fact that they are dichotomous, and that two of the

criteria (fatigue and morning stiffness) are not included in the

parameters recommended for the evaluation of RA patients.

EULAR criteria for clinical remission

The EULAR criteria use the DAS as a continuous variable of disease

activity. A cut-off point below 1.6 on the DAS corresponds to the ACR

definition of remission. Since the measurement scale is continuous, the

cut-off point recommended by the EULAR may vary depending on future

investigations. "

http://www.guideline.gov/summary/summary.aspx?doc_id=3683 & nbr=2909

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - More RA remissions with TNF

inhibitors than with DMARDs

>

>

> , are there guidelines doctors follow to determine when remission

> occurs? Is there a difference between " being in remission " and

> having your pain and swelling disappear because of the meds you're

> taking? I know we've had a discussion before about " are you really

> in remission if you're still taking meds, " but this always confuses

> me.

>

>

[Guest guest]

, without meds, remission is referred to as " spontaneous. "

Spontaneous clinical remission in established RA is uncommon.

Drug-induced remission is usually what is being referred to in these

studies. Yes, there are criteria used to determine if a given patient is

in remission.

From " Clinical practice guidline for the management of rheumatoid

arthritis, " National Guideline Clearinghouse at www.guideline.gov:

" Two basic approaches to defining clinical remission in RA have been

described: the ACR criteria and the EULAR (European League Against

Rheumatism) criteria.

ACR criteria for clinical remission

Morning stiffness absent or not exceeding 15 minutes

No fatigue

No joint pain (by clinical history)

No joint tenderness

No soft tissue swelling in joints or tendon sheaths

Normal erythrocyte sedimentation rate.

The presence of five or more of these criteria for at least 2 months is

sufficient to classify a patient as in complete remission. Among the

disadvantages of these criteria are the lack of guidelines on how to

measure them, the fact that they are dichotomous, and that two of the

criteria (fatigue and morning stiffness) are not included in the

parameters recommended for the evaluation of RA patients.

EULAR criteria for clinical remission

The EULAR criteria use the DAS as a continuous variable of disease

activity. A cut-off point below 1.6 on the DAS corresponds to the ACR

definition of remission. Since the measurement scale is continuous, the

cut-off point recommended by the EULAR may vary depending on future

investigations. "

http://www.guideline.gov/summary/summary.aspx?doc_id=3683 & nbr=2909

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - More RA remissions with TNF

inhibitors than with DMARDs

>

>

> , are there guidelines doctors follow to determine when remission

> occurs? Is there a difference between " being in remission " and

> having your pain and swelling disappear because of the meds you're

> taking? I know we've had a discussion before about " are you really

> in remission if you're still taking meds, " but this always confuses

> me.

>

>