Evolution of assessment of long-term control of and treat-to-target in atopic dermatitis / 中华皮肤科杂志

Research progress in the establishment of long-term control goals and treat-to-target in the treatment of atopic dermatitis (AD) was searched and summarized in this review. The TREatment of ATopic eczema (TREAT) Registry Taskforce defined a minimum follow-up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment; the international Harmonising Outcome Measures for Eczema (HOME) group recommended that the long-term control of AD should be measured by either the Recap of Atopic Eczema (RECAP) instrument or the Atopic Dermatitis Control Tool (ADCT) . In order to achieve the treat-to-target in AD, a panel comprising 87 participants from 28 countries developed and published "Treat-to-target in atopic dermatitis: an international consensus on a set of core decision points for systemic therapies" in early 2021, which recommended 3 months and 6 months as two evaluation time points, and various disease outcome domains spanning symptoms, signs, quality of life plus patient global assessment as the target. By setting the time-specific outcome thresholds, the consensus provided a framework for shared decision-making on systemic treatment adjustment for AD patients. This review summarizes concepts and indicators related to the assessment of long-term control of and treat-to-target in AD, in the hope of providing some ideas for clinical management, especially the long-term control, of AD in China.

Study on the effect of functional movement on the recurrence of patients with ankylosing spondylitis after treat-to-target therapy / 中华风湿病学杂志

Objective:To investigate the effect of functional movement assessment on the recurrence of patients with ankylosing spondylitis (AS) after treat-to-target therapy.Methods:The clinical data of 61 patients with AS in Chengdu were collected including clinical symptoms and AS disease activity (ASDAS). After 24 weeks adalimumab treatment, motor function score of AS patients(ASDAS<1.3) was assessed by functional movement screen (FMS), then adalimumab was discontinued and the rest of the concurrent drugs were continued until the disease relapse or up to 1 year. The data of the two groups were compared using t-test analysis and Cox proportionate hazard model. Results:① The recurrence rate of patients with AS after treat-to-target therapy within 1 year follow-up was 57.4%; ② The recurrence group was younger [(27±7) vs (31±6), t=5.96, P=0.02], the ASADAS value was at the high end when adalimumab was withdrawal [(1.29±0.07) vs (0.87±0.16), t=177.31, P<0.01], and the FMS value was lower after treat-to-target [(12.9±2.7) vs (16.2±1.9), t=29.23, P<0.01], The time to reaching the treatment target was longer [(2.9±1.2) month vs (1.7±0.6) month, t=19.89, P<0.01] than the stable group; ③ The cut-off value of the FMS test of AS patients after treat-to-target therapy was 14.25 (sensitivity was 84.6%, specificity was 80%) . The time to treat-to-target was a risk factor for recurrence ( RR=2.285, P<0.05), and the FMS value after treat-to-target was a protective factor ( RR=0.625, P<0.05). Conclusion:After discontinuing the adalimumab, about half of the patients relapse. The time reaching the treatment target and the FMS value after treat-to-target therapy are the risk factors for disease recurrence.

Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies

Abstract Objective Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance.

Treat to target in systemic lupus erythematosus / Tratamiento por objetivos en el lupus eritematoso sistémico

ABSTRACT Systemic lupus erythematosus (SLE) is the most representative disorder within systemic autoimmune diseases. The treat-to-target strategy in SLE was established half a decade ago and, since then, remarkable advances have been made. An international consensus has defined and unified the term remission and also low disease activity has been proposed as an alternative and, perhaps, more realistic target. Both of them have proven to be meaningful in terms of improving several outcomes, and have opened the path for future research in clinical trials.

RESUMEN El lupus eritematoso sistémico (LES) es el trastorno más representativo dentro de las enfermedades autoinmunes sistémicas. La estrategia de tratamiento por objetivos en el LES se estableció hace media década y desde entonces se han producido notables avances. Un consenso internacional ha definido y unificado el término remisión y también se ha propuesto la baja actividad de la enfermedad como un objetivo alternativo y quizás más realista. Ambos han demostrado ser significativos en cuanto a la mejora de varios resultados y han abierto el camino para futuras investigaciones en ensayos clínicos.

Advances in research on treat-to-target approach in ulcerative colitis / 西安交通大学学报(医学版)

Ulcerative colitis (UC) is a chronic, progressive and heterogeneous inflammatory bowel disease. Strategies for management of UC are shifting from simple control of symptoms toward clinical/patient-reported outcome remission (resolution of rectal bleeding and diarrhea/altered bowel habit) and endoscopic remission (mucosal healing), with the final aim of blocking the progression of the disease and promising better long-term outcomes. The therapeutic target for UC is a comprehensive one that combines subjective and objective goals as well as short-term and long-term goals. In order to achieve these goals, it is necessary to assess the severity of the disease first and predict the risk of UC progression, and then provide early intervention and individualized treatment for high-risk patients. The treatment should be timely tailored by close monitoring. Although the clinical implementation of UC treat-to-target (T2T) approach remains challenging, T2T strategy is the key-point for improving the quality of disease management.

Application of 7-joint ultrasound score in evaluation on treat-to-target of rheumatoid arthritis / 中国医学影像技术

Objective: To explore the application value of 7-joint ultrasound score in the treat-to-target of rheumatoid arthritis. Methods Totally 40 patients with rheumatoid arthritis in active stage were enrolled. The changes of disease activity score of 28 joints (DAS28), synovitis, tenosynovitis and 7-joint ultrasound score before and after treatment were analyzed in accordance with the principles of clinical standard treatment, and the correlation of changes of synovitis, tenosynovitis, 7-joint ultrasound score and changes of DAS28 were analyzed. Results: Compared with those before treatment, DAS28, synovitis, tenosynovitis and 7-joint ultrasound score decreased significantly after escalation therapy (all P<0.001), but changes in bone erosion were not statistically significant (P=0.317). The changes of synovitis, tenosynovitis, 7-joint ultrasound score and DAS28 showed relatively weak correlation (rs=0.363, 0.318, 0.317, P=0.021, 0.045, 0.047). Conclusion: 7-joint ultrasound score can be used to detect changes of disease activity of rheumatoid arthritis, but not yet be advocated as testing index for treat-to-target escalation.

Early Biologic Treatment in Pediatric Crohn's Disease: Catching the Therapeutic Window of Opportunity in Early Disease by Treat-to-Target / 대한소아소화기영양학회지

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.

Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea

BACKGROUND: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. METHODS: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) (2.6 ≤ DAS28 < 3.2). RESULTS: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (−0.38 vs. −0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). CONCLUSION: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.

An Update on the Diagnosis and Management of Gout

Gout is characterised by monosodium urate crystal deposition in synovial fluid, articular surfaces, and other tissues, which occurs after the chronic elevation of uric acid levels above the saturation point of 360mmol/L (6mg/dL). Amongst all inflammatory arthropathies, gout is the most common. Given the rising prevalence of gout, it is imperative to keep up with the recent advances in the nunderstanding of the pathophysiology, diagnostic modalities, and therapies of gout. It is important to understand that gout is not as harmless a condition as perceived in the past and is, in fact, associated with significant morbidity and even mortality if left untreated. This article seeks to provide a useful review of the current standard of care and to discuss new developments in the management of gout applicable in any family medicine practice setting.

Central nervous system lupus:an update / 医学研究生学报

At present, central nervous system involvement is the most common in neuropsychiatric lupus.This article discus-ses the research status of central nervous system lupus in the past few years which include characteristics of clinical presentation, etio-pathological mechanism, neuroimaging diagnosis and therapeutic strategy.Actually, the advanced technology, especially neuroimmu-nology and neuroimaging, in combination with early diagnosis, effective assessment and treat to target strategy could decrease global disease activity, ameliorate quality of life and increase life expectancy.Furthermore, the prospective researches should be paid more attention in lupus registries, neuropsychiatric questionnaires, damage index and improvement of severe refractory cases in clinic.

The outcomes of patients with rheumatoid arthritis treated by different combination of synthetic disease modifying antirheumatic drugs under the treat-to-target strategy / 中华风湿病学杂志

Objective To investigate the outcomes of patients with rheumatoid arthritis (RA) treated by different combination of synthetic disease modifying antirheumatic drugs (DMARDs) under the guidance of treat-to-target strategy.Methods Forty-two RA patients with high disease activity were enrolled into this randomized,open-label and prospective study.It was comprised of a maximal 36-week induction phase and then followed by a maintenance phase up to 84 weeks.Combination of synthetic DMARDs was initiated in the induction phase,with or without low dose glucocorticoids (GCs) during the first 12 weeks.Patients who achieved low disease activity (LDA) were randomized into two maintenance groups.An increase of DAS28 by 0.6 was defined as relapse.The patients achieved LDA in the induction phase,relapsed during maintenance phase and possible relevant risk factors were analyzed.Results Twenty-seven (64％) patients achieved LDA during the induction phase.More non-smoking patients achieved LDA than those smoked [85％ (11/13) vs 55％(16/29),P＜0.05].During the maintenance phase,14 (61％) out of 27 patients relapsed.Patients taking GCs during the first 12 weeks had a significantly higher relapse rate compared to those without GC (83％ vs 36％,P=0.021).Patients who entered maintenance phase at week 12 had a significantly higher tendency to relapse compared to those who entered the maintenance phase at week 24 [75％(9/12) vs 33％(3/9),P=0.026].Conclusion Smoking seems to be a risk factor for RA patients who fail to reach LDA.Low dose GCs as a bridge therapy may require a longer duration.High relapse rates in both the maintenance groups indicat that a longer tight induction phase may be appropriate before downstairs therapy.