Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC).
Objective: To establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement.Methods: 200 treatment-naïve patients with early arthritis were classified as...
| Publicado en: | Annals of the Rheumatic Diseases Vol. 78; no. 12; pp. 1642 - 1653 |
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| Autores principales: | , , , , , , , , , , , , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Dec2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139712916&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139712916 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00034967 ANR jtl: Annals of the Rheumatic Diseases issn: 00034967 maglogo: N pubinfo: dt: Dec2019 vid: 78 iid: 12 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 139712916 139712916 NLM31582377 139712916 10.1136/annrheumdis-2019-215751 NLM31582377 139712916 ppf: 1642 ppct: 11 formats: tig: atl: Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC). aug: au: Lliso-Ribera, Gloria Humby, Frances Lewis, Myles Nerviani, Alessandra Mauro, Daniele Rivellese, Felice Kelly, Stephen Hands, Rebecca Bene, Fabiola Ramamoorthi, Nandhini Hackney, Jason A. Cauli, Alberto Choy, Ernest H. Filer, Andrew Taylor, Peter C. McInnes, Iain Townsend, Michael J. Pitzalis, Costantino affil: Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK. sug: subj: Arthritis, Rheumatoid Therapy Biological Therapy Methods Synovial Membrane Algorithms Human Disease Progression Prospective Studies Arthritis, Rheumatoid Diagnosis Male Female Synovial Membrane Metabolism Ultrasonography Severity of Illness Indices Arthritis, Rheumatoid Classification Antirheumatic Agents Therapeutic Use Prognosis Biopsy Middle Age Validation Studies Comparative Studies Evaluation Research Multicenter Studies Funding Source Middle Aged: 45-64 years Male Female ab: Objective: To establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement.Methods: 200 treatment-naïve patients with early arthritis were classified as fulfilling RA1987 American College of Rheumatology (ACR) criteria (RA1987) or as undifferentiated arthritis (UA) and patients with UA further classified into those fulfilling RA2010 ACR/European League Against Rheumatism (EULAR) criteria. Treatment requirements at 12 months (Conventional Synthetic Disease Modifying Antirheumatic Drugs (csDMARDs) vs biologics vs no-csDMARDs treatment) were determined. Synovial tissue was retrieved by minimally invasive, ultrasound-guided biopsy and underwent processing for immunohistochemical (IHC) and molecular characterisation. Samples were analysed for macrophage, plasma-cell and B-cells and T-cells markers, pathotype classification (lympho-myeloid, diffuse-myeloid or pauci-immune) by IHC and gene expression profiling by Nanostring.Results: 128/200 patients were classified as RA1987, 25 as RA2010 and 47 as UA. Patients classified as RA1987 criteria had significantly higher levels of disease activity, histological synovitis, degree of immune cell infiltration and differential upregulation of genes involved in B and T cell activation/function compared with RA2010 or UA, which shared similar clinical and pathobiological features. At 12-month follow-up, a significantly higher proportion of patients classified as lympho-myeloid pathotype required biological therapy. Performance of a clinical prediction model for biological therapy requirement was improved by the integration of synovial pathobiological markers from 78.8% to 89%-90%.Conclusion: The capacity to refine early clinical classification criteria through synovial pathobiological markers offers the potential to predict disease outcome and stratify therapeutic intervention to patients most in need. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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