Pawel Mielnik

Objective: Identifying patient characteristics that predict treatment response in psoriatic arthritis (PsA) may help optimize treat-to-target strategies. We aimed to explore overall and sex-specific predictors of secukinumab (SEC) effectiveness in European patients with PsA treated in routine care. Methods: We analyzed data from 14 registries in the European Spondyloarthritis (EuroSpA) Research Collaboration. Patients aged ≥ 18 years at diagnosis, initiating SEC treatment from January 2015 to January 2021, were included. Multiple imputation was used for missing covariates at treatment start (baseline) and Disease Activity Index for Psoriatic Arthritis based on 28 joints (DAPSA28) at 6 months. Overall and sex-stratified analyses were performed by logistic and Cox regressions to identify baseline predictors of the following treatment outcomes: (1) DAPSA28 low disease activity (LDA; DAPSA28 ≤ 14) at 6 months, (2) DAPSA28 moderate response at 6 months, and (3) SEC discontinuation within 12 months. Results: In total, 2790 patients (43% male) were included. Median age was 43 years (IQR 34-52), and SEC was the first-line biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) in 665 patients (24%). Positive predictors for both DAPSA28 LDA and DAPSA28 moderate response were male sex, fewer previous b/tsDMARDs, C-reactive protein (CRP) > 10 mg/L, and lower Health Assessment Questionnaire (HAQ) score. Absence of psoriasis, higher patient fatigue, and tender joint counts predicted SEC discontinuation within 12 months. For some outcomes, sex-specific predictors were fewer previous b/tsDMARDs and CRP > 10 mg/L among male patients and lower patient fatigue score among female patients. Conclusion: We identified overall and sex-specific predictors of SEC effectiveness in European patients with PsA. Our findings may support personalized treatment decisions.

Objective: To explore health-related quality of life (HRQOL) measured by the 36-item Short Form Health Survey (SF-36), SF-36 physical component summary (PCS), SF-36 mental component summary (MCS), and Short Form 6D (SF-6D) in adults with juvenile idiopathic arthritis (JIA) compared to patients with rheumatoid arthritis (RA) and the general population. Methods: We used 6-month follow-up data from the Norwegian Disease-Modifying Antirheumatic Drug Register (NOR-DMARD), including adult patients with JIA and RA starting or switching disease-modifying antirheumatic drug (DMARD) treatment. Age- and gender-adjusted regression analyses were used to compare outcomes among JIA, RA, and the general Norwegian population. Results: Register data were available for 232 patients with JIA and 2764 with RA at 6 months follow-up. Patients with JIA had poorer physical health compared to those with RA (adjusted difference [95% CI]: PCS −3.58 [−6.09 to −1.08]). Compared to the general population, PCS scores were lower in both JIA and RA (adjusted differences [95% CI]: JIA–general population −15.70 [−18.21 to −13.19], RA–general population −12.12 [−12.76 to −11.47]). Mental health measured by MCS was similar across the 3 groups. Average SF-6D utility levels were comparable in JIA and RA, but lower than in the general population. Similar proportions of patients with JIA and RA experienced improvements exceeding minimum clinically important difference (MCID) in SF-36 scale scores, PCS, MCS, and SF-6D after 6 months. Conclusion: Compared to patients with RA and the general population, patients with JIA had lower physical HRQOL 6 months after DMARD initiation. Mental health composite scores were similar among patients with JIA, those with RA, and the general population. Both disease groups showed similar levels of improvement with treatment.

Objectives: MTX, LEF and SSZ are conventional synthetic DMARDs (csDMARDs) with a well-established role in the treatment of RA. We aimed to estimate and compare the relative risks for adverse events (AEs) and the discontinuation of these drugs owing to AEs. Methods: We included all 3339 patients from the NOR-DMARD study treated with MTX, LEF or SSZ in monotherapy. All reported AEs were compared between treatment groups using quasi-Poisson regression. In addition, drug retention rates were analysed using Kaplan–Meier estimates with Cox regression to control for possible confounders. We analysed drug retention rates and cumulative risk of discontinuation attributable to AEs using the Kaplan–Meier estimator. We assessed age, sex, baseline DAS in 28 joints with ESR (DAS28-ESR), seropositivity, prednisolone use, previous DMARD use, year of inclusion and co-morbidity as possible cofounders. Results: We found that the discontinuation rate attributable to AEs was significantly higher for LEF and SSZ than for MTX. After the first year, it was 13.7% (95% CI 12.2, 15.2), 39.6% (95% CI 34.8, 44) and 43.4% (95% CI 38.2, 48.1) for MTX, SSZ and LEF, respectively. Similar results were found when adjusting for confounders. The overall AEs were comparable across the treatment groups. The AE profile was as expected for each drug. Conclusion: Our work has shown a similar AE profile of csDMARDs to previous data. However, higher discontinuation rates for SSZ and LEF cannot be explained easily from AE profiles.

Objective: To compare the effectiveness of tumor necrosis factor inhibitors (TNFi) ± comedication and methotrexate (MTX) monotherapy between patients with adult juvenile idiopathic arthritis (JIA) and patients with rheumatoid arthritis (RA).Methods: Adult patients with JIA and RA were identified from the Norwegian Antirheumatic Drug Register (NOR-DMARD) register. Disease activity measurements at baseline, 3, 6, and 12 months were compared between patients with JIA and RA starting (1) TNFi and (2) MTX monotherapy, using age- and gender-weighted analyses. We calculated differences between JIA and RA in mean changes in Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI), among other disease activity measures. DAS28, CDAI, SDAI, and American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) remission rates at 3, 6, and 12 months, as well as 6- and 12-month Lund Efficacy Index (LUNDEX)-corrected rates, were calculated.Results: We identified 478 patients with JIA (TNFi/MTX monotherapy, n = 358/120) and 4637 patients with RA (TNFi/MTX monotherapy, n = 2292/2345). Patients with JIA had lower baseline disease activity compared to patients with RA across treatment groups. After baseline disease activity adjustment, there were no significant differences in disease activity change from baseline to 3, 6, and 12-months of follow-up between patients with JIA and RA for either treatment group. Twelve-month remission rates were similar between groups based on DAS28 (TNFi: JIA 55.2%, RA 49.5%; MTX monotherapy: JIA 45.3%, RA 41.2%) and ACR/EULAR remission criteria (TNFi: JIA 20.4%, RA 20%; MTX monotherapy: JIA 17%, RA 12.7%). Median drug survival (yrs) was similar for JIA and RA in both treatment groups (TNFi: JIA 1.2, RA 1.4; MTX monotherapy: JIA 1.3, RA 1.6).Conclusion: TNFi and MTX monotherapy are effective in adult JIA, with similar effectiveness to that shown in RA.

In an add-on study of the WHO Solidarity trial, Norwegian investigators examined the effect of remdesivir and hydroxychloroquine on the degree of clinical respiratory failure, on SARS-CoV-2 viral l... Visual Remdesivir and Hydroxychloroquine: Effects on SARS-CoV-2 Clearance. In an add-on study of the WHO Solidarity trial, Norwegian investigators examined the effect of remdesivir and hyd... Background: New treatment modalities are urgently needed for patients with COVID-19. The World Health Organization (WHO) Solidarity trial showed no effect of remdesivir or hydroxychloroquine (HCQ) ...

Objective The objective of this study was to compare the efficacy and safety of rituximab in older vs younger patients with rheumatoid arthritis. Methods Data on 367 patients with rheumatoid arthritis treated with rituximab in the Norwegian Disease-Modifying Antirheumatic Drug (NOR-DMARD) register were analysed, comparing patients aged ≥ 65 years (n = 91) with patients aged < 65 years (n = 276). Drug survival was compared using a Kaplan–Meier analysis and Cox proportional hazard models. Disease activity, as assessed by the Disease Activity Score based on 28 joints and erythrocyte sedimentation rate (DAS28-ESR) and the Simplified Disease Activity Index, was analysed with linear mixed models. The occurrence of adverse events was analysed by quasi-Poisson regression models. Results Drug survival was similar in the two age groups. The proportion of patients who remained taking rituximab over 2 years was 72% in those under aged 65 years vs 74% in those aged ≥ 65 years. No statistically significant association with age was found for drug survival in either the unadjusted (hazard ratio 1.13, p = 0.65) or adjusted Cox proportional hazard analyses for the model with DAS28-ESR as a confounder (effect size 1.11, p = 0.73). Models including the Simplified Disease Activity Index instead of DAS28-ESR yielded similar results. Age was furthermore not significantly associated with disease activity over time, although there was a tendency towards a poorer response in older patients. In the older age group, there was a higher incidence of pneumonia (107 vs 51 per 1000 patient-years) and other serious infections (142 vs 66 per 1000 patient-years). Conclusions Rituximab is a reasonable therapeutic option for older patients with rheumatoid arthritis although vigilance is needed with regard to the infection profile. Trial Registration ClinicalTrials.gov Identifier: NCT01581294.

Identifying the separate parts in ultrasound images such as bone and skin plays a crucial role in the synovitis detection task. This paper presents a detector of bone and skin regions in the form of a classifier which is trained on a set of annotated images. Selected regions have labels: skin or bone or none. Feature vectors used by the classifier are assigned to image pixels as a result of passing the image through the bank of linear and nonlinear filters. The filters include Gaussian blurring filter, its first and second order derivatives, Laplacian as well as positive and negative threshold operations applied to the filtered images. We compared multiple supervised learning classifiers including Naive Bayes, k-Nearest Neighbour, Decision Trees, Random Forest, AdaBoost and Support Vector Machines (SVM) with various kernels, using four classification performance scores and computation time. The Random Forest classifier was selected for the final use, as it gives the best overall evaluation results.

Aortitis of ascending aorta is a recognized complication of ankylosing spondylitis (AS). There are a few published cases of diffuse aortitis and aorta collaterals inflammation that fulfill Takayasu’s arteritis (TA) criteria coexisting with AS. We have reviewed published cases from literature and present three new cases of such coexistence. We identified three patients who fulfilled definite AS New York criteria in our Takayasu’s vasculitis cohort of eight patients. One of this patients had been diagnosed with Crohn’s disease before AS and TA diagnosis. Additionally, two other patients had an inflammatory back pain and suffered of chronic uveitis. One of them had increased sacroiliac uptake of isotope in scintigraphy. Those two patients did not fulfil spondyloarthritis criteria. In this paper, we debate if TA type arteritis might be one of the AS cardiovascular complications.