Dr. Victoria Konzett
MedUni Wien RESEARCHER OF THE MONTH July 2024
In modern rheumatoid arthritis management, a large proportion of patients reaches treatment targets like low disease activity or even remission. This increasing number of patients on target, alongside constant discussion about treatment safety and the optimal benefit-to-risk balance of life-long immunotherapies, directly link into considerations about treatment tapering or even withdrawal. Biomarkers and predictors for patients eligible for such measures are currently lacking, as are quantitative outcome parameters for respective recurrence of disease activity (also termed “flares”). Such parameters would allow for consistent evaluation and comparison of treatment strategies for tapering, withdrawal, and therapy re-administration.
In our work we now aimed at providing such quantitative definitions; by mapping substantial worsening of disease activity, as measured with a patient-reported anchor, onto the quantitative scales of two commonly used disease activity scores, the SDAI and CDAI.[4, 5] The definitions were estimated and extensively validated in two large real-world independent cohorts, and will be useful for guiding decision making in clinical practice and designing clinical trials.
Selected Literature
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Konzett V, Kerschbaumer A, Smolen JS, et al. Definition of rheumatoid arthritis flare based on SDAI and CDAI. Ann Rheum Dis. 2023 Oct 27.
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Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 Oct 22; 388(10055):2023-2038.
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Smolen JS, Landewe RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan; 82(1):3-18.
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Smolen JS, Breedveld FC, Schiff MH, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford). 2003 Feb; 42(2):244-257.
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Aletaha D, Nell VP, Stamm T, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005; 7(4):R796-806.
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Konzett V, Kerschbaumer A, Smolen JS, et al. Determination of the most appropriate ACR response definition for contemporary drug approval trials in rheumatoid arthritis. Ann Rheum Dis. 2023 Sep 27.