Improvement in patient-reported outcomes after rituximab in rheumatoid arthritis patients: An open-label assessment of 175 patients.

OBJECTIVE: Patient-reported outcomes (PROs) reflect treatment efficacy from the patients' perspective. The objective was to assess PROs improvement with rituximab in rheumatoid arthritis. METHODS: Patients with long-standing rheumatoid arthritis received rituximab 1000mg twice at 2 weeks interval, and were assessed over 6 months. PROs including physical PROs (pain, functional assessment, physical quality of life) and mental or mixed aspects (fatigue, sleep and mental quality of life) were assessed. Standardized response means were calculated. Early improvement in PROs was used to predict EULAR response at 6 months. RESULTS: For the 175 patients (mean age 54.6±10.6 years, mean disease duration 12.9±9.3 years), the plateau of efficacy of rituximab on PROs was reached at week 12, and the effect was more prominent on physical PROs (e.g., pain standardized response means -0.75 [95% confidence interval -0.91; -0.60]), than on sleep (-0.43; [-0.56; -0.29]). It was not possible to accurately predict 6-month EULAR response by early improvement in PROs. CONCLUSION: Rituximab was effective on PROs with an early effect. PROs reflecting physical aspects were more modulated by this biologic than other PROs (fatigue, sleep or mental quality of life). Links between sleep difficulties, fatigue and RA should be further studied.

Ultrasound study of entheses in psoriasis patients with or without musculoskeletal symptoms: A prospective study.

OBJECTIVE: To estimate the prevalence of ultrasonographic enthesitis in psoriasis patients with or without musculoskeletal symptoms and to investigate their evolution under systemic treatments given for the cutaneous symptoms. PATIENTS AND METHODS: Prospective bi-centre (rheumatology and dermatology) study over 6months, including psoriasis pts requiring systemic treatment, with or without musculoskeletal symptoms and/or psoriatic arthritis (PsA). Clinical assessment (M0 and M6) included: BASDAI, HAQ, SPARCC, PASI and nail disease. US assessment (M0 and M6) with Grey Scale and PD of 10 entheses was performed by one trained rheumatologist blinded to clinical and biological data, scoring morphological, structural lesions and PD signal. RESULTS: Complete data were obtained on 340 entheses in 34 patients. Twenty-two were asymptomatic (PsO) and 12 symptomatic (PsA). They received conventional treatment and/or biologics. AT BASELINE: US abnormalities were found in 97.1% total population and in 86.4% PsO patients. 95/340 enthesitis were observed, 57/220 in PsO vs 38/120 in PsA (P=0.258). Neither group had PD signal. Presence of 24/90 enthesitis in patients with nail disease vs 33/130 without (P=0.831). AT M6: Twenty-three patients were assessed. US morphological (thickness and hypoechogenicity) abnormalities were improved in PsO (n=13) (P=0.021) and PsA patients (n=10) (P=0.164) with a significant decrease of BASDAI, HAQ, SPARCC. CONCLUSION: We observed a high frequency of US enthesitis in psoriasis patients, with or without musculoskeletal symptoms, requiring systemic treatment. At 6months, US morphological abnormalities were likely to improve. Further studies would be interesting to validate our data and to assess their potential impact on PsA development.