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JCM
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Targeted Treatment in Rheumatoid Arthritis
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Targeted Treatment in Rheumatoid Arthritis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 9116

Special Issue Editors

Dr. Cinzia Rotondo

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Guest Editor
Rheumatology Unit, Università degli Studi di Foggia, 71122 Foggia, Italy
Interests: systemic sclerosis; rheumatoid arthritis; psoriatic arthritis
Dr. Simone Parisi

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Guest Editor
Rheumatology Unit, AOU Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
Interests: rheumatology; rheumatoid arthritis; psoriatic arthritis; ostarthritis
Dr. Simone Perniola

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Guest Editor
1. Immunology Research Core Facility, Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS—Rome, 00168 Rome, Italy
2. Division of Clinical Immunology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore—Rome, 00168 Rome, Italy
Interests: clinical rheumatology; inflammation; rheumatic diseases; autoantibodies; knee osteoarthritis; rheumatology; autoimmunity

Special Issue Information

Dear Colleagues,

This Special Issue of Journal of Clinical Medicine (JCM), entitled "Targeted Treatment in Rheumatoid Arthritis", is dedicated to advancing our understanding of the latest developments in targeted treatment for this autoimmune disease. The aim of this Special Issue is to present innovative research and insights into new treatment targets and techniques for rheumatoid arthritis patients.

We would like to invite original research articles, reviews, and perspectives that focus on the development and utilization of targeted therapies to treat rheumatoid arthritis. However, we regret to inform the authors that we will not consider mini-reviews or case reports for this Special Issue.

Topics of interest include biological agents, small molecule inhibitors, immunomodulatory therapies, and personalized medicine approaches. We welcome submissions from researchers, practitioners, and scholars from around the world who are interested in improving patient outcomes for those with rheumatoid arthritis.

Overall, this Special Issue will provide an important platform for exchanging knowledge and exploring new therapeutic solutions for rheumatoid arthritis. We look forward to receiving your submissions and contributing towards advancements in targeted treatments for this condition.

Dr. Cinzia Rotondo
Dr. Simone Parisi
Dr. Simone Perniola
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • rheumatoid arthritis
  • disease-modifying anti-rheumatic drugs (DMARDs)
  • precision medicine
  • immunomodulatory therapies
  • inflammatory markers
  • patient outcomes
  • combination therapies
  • immune system dysregulation.

Published Papers (7 papers)

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Research

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9 pages, 567 KiB  
Article
Depression in Rheumatoid Arthritis: Prevalence and Effects on Disease Activity
by Cătălina-Elena Ionescu, Claudiu Costinel Popescu, Mihaela Agache, Georgiana Dinache and Cătălin Codreanu
J. Clin. Med. 2024, 13(7), 2058; https://doi.org/10.3390/jcm13072058 - 02 Apr 2024
Viewed by 541
Abstract
Background:The primary objective of this study was to estimate depression’s prevalence in a cohort of rheumatoid arthritis (RA) patients, and the secondary objective was to evaluate the impact of depression on disease activity over time. Methods: We included all patients with RA [...] Read more.
Background:The primary objective of this study was to estimate depression’s prevalence in a cohort of rheumatoid arthritis (RA) patients, and the secondary objective was to evaluate the impact of depression on disease activity over time. Methods: We included all patients with RA presenting to our clinic from 2019 to 2020, who had three follow-up visits available. Depression prevalence was calculated using the patient’s history of diagnosed depression, and disease activity was assessed using the disease activity score for 28 joints (DAS28) and its components: tender joint count (TJC), swollen joint count (SJC), pain value on a visual analog scale (VAS), and inflammatory markers. Results: A total of 400 RA patients were included, 75 of whom had diagnosed depression, generating a prevalence of 18.8%. The mean values of DAS28 and its components were higher, with statistical significance, in the depression subgroup at all three follow-ups (p < 0.001). Conclusions: Depression is prevalent in the RA population, and leads to higher disease activity in dynamic evaluations. Assessing depression could be a psychological marker for RA prognosis with an important outcome in controlling disease activity. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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12 pages, 290 KiB  
Article
Malondialdehyde Serum Levels in a Full Characterized Series of 430 Rheumatoid Arthritis Patients
by Nayra Merino de Paz, Juan Carlos Quevedo-Abeledo, Fuensanta Gómez-Bernal, Antonia de Vera-González, Pedro Abreu-González, Candelaria Martín-González, Miguel Ángel González-Gay and Iván Ferraz-Amaro
J. Clin. Med. 2024, 13(3), 901; https://doi.org/10.3390/jcm13030901 - 04 Feb 2024
Cited by 1 | Viewed by 738
Abstract
Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics [...] Read more.
Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics in RA, including a lipid profile, insulin resistance, and subclinical atherosclerosis, relates to serum MDA levels. Methods. In a cross-sectional study that included 430 RA patients, serum MDA levels were evaluated. Multivariable analysis was performed to examine the relationship of MDA with disease activity scores and disease characteristics, including subclinical carotid atherosclerosis, a comprehensive lipid molecule profile, and indices of insulin resistance and beta cell function indices. Results. The erythrocyte sedimentation rate (ESR) showed a significant and positive relationship with MDA. However, this did not occur for other acute phase reactants such as C-reactive protein or interleukin-6. Although the DAS28-ESR score (Disease Activity Score in 28 joints) had a positive and significant association with MDA serum levels, other disease activity scores that do not use the erythrocyte sedimentation rate in their formula did not show a significant relationship with MDA. Other disease characteristics, such as disease duration and the existence of rheumatoid factor and antibodies against citrullinated protein, were not related to serum MDA levels. This also occurred for lipid profiles, insulin resistance indices, and subclinical carotid atherosclerosis, for which no associations with circulating MDA were found. Conclusions. The disease characteristics are not related to circulating MDA levels in patients with RA. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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10 pages, 245 KiB  
Article
Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy
by Ildikó Tar, Edit Végh, Renáta Martos, Boglárka Soós, Ildikó Márton and Zoltán Szekanecz
J. Clin. Med. 2024, 13(2), 448; https://doi.org/10.3390/jcm13020448 - 13 Jan 2024
Viewed by 621
Abstract
In our present study, we aimed to assess the effects of anti-TNF therapy on periodontal condition in a mixed cohort of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Moreover, we wished to determine whether the baseline dental condition of these patients [...] Read more.
In our present study, we aimed to assess the effects of anti-TNF therapy on periodontal condition in a mixed cohort of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Moreover, we wished to determine whether the baseline dental condition of these patients would affect response to biological therapy. A cohort of 24 arthritis patients was consecutively recruited before starting anti-TNFα therapy. After the dropout of six patients, we evaluated the dental status of 18 subjects at baseline and after 6 months of biological therapy. Clinical responder (R) and non-responder (NR) status was determined after 6 months of anti-TNF treatment. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), PPDmax, clinical attachment loss (CAL), and CALmax were determined. During the 6-month treatment period, six patients (3 RA and 3 AS) terminated the study prematurely as they did not respond to treatment (NR). Therefore, 18 patients were included in the full analysis. There were no major differences in PI, BOP, PPD, PPD max, CAL, and CALmax, among R and NR patients. TNF inhibition resulted in increased GI (0.65 ± 0.34 vs. 0.88 ± 0.30; p < 0.05), as well as decreased PPDmax (4 ± 1.94 vs. 2.72 ± 1.36; p < 0.05) and CALmax (5.22 ± 2.56 vs. 2.72 ± 1.36; p < 0.05) after 6 months. Eight patients had incomplete canal fillings or dead pulps and/or apical periodontitis; six in the R and two in the NR group. In our present study, anti-TNF therapy seemed to worsen the extent of gingival inflammation (GI); however our results also do not support the reduction of mean CPD and CAL as reported by others. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
12 pages, 1121 KiB  
Article
Efficacy and Safety of Upadacitinib in Rheumatoid Arthritis: Real-Life Experience from a Prospective Longitudinal Multicentric Study
by Caterina Baldi, Simone Parisi, Paolo Falsetti, Jurgen Sota, Maria Chiara Ditto, Marco Capassoni, Miriana D’alessandro, Edoardo Conticini, Francesca Nacci, Clara Lisa Peroni, Laura Cometi, Enrico Fusaro, Bruno Frediani and Serena Guiducci
J. Clin. Med. 2024, 13(2), 401; https://doi.org/10.3390/jcm13020401 - 11 Jan 2024
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Abstract
Background: We provide the first prospective longitudinal multicenter experience on Upadacitinib efficacy and safety profile in Rheumatoid Arthritis (RA) in a real-life context, focusing on clinimetric and ultrasonographic (US) data. Methods: RA patients referred to three Italian tertiary Centers who started Upadacitinib were [...] Read more.
Background: We provide the first prospective longitudinal multicenter experience on Upadacitinib efficacy and safety profile in Rheumatoid Arthritis (RA) in a real-life context, focusing on clinimetric and ultrasonographic (US) data. Methods: RA patients referred to three Italian tertiary Centers who started Upadacitinib were enrolled as per ACR/EULAR classification criteria and prospectively reviewed. The primary aim of this study was to assess changes in clinimetric and ultrasonographic scores through time (at baseline, after 1 month, 3 months, and 6 months from the beginning of the therapy). Secondary aims were to: (i) estimate the impact of biologic lines of treatment and concomitant therapies on response to therapy; (ii) explore changes in laboratory parameters; and (iii) find potential predictive factors associated with response to therapy. Results: Seventy-one patients (49 Females and 22 Males) were included. Clinimetric scores, including the Disease Activity Score (DAS28-CRP) and Simplified Clinical Disease Activity Index (SDAI), and US findings (synovial hypertrophy and power Doppler) significantly improved (p = 0.029, p = 0.001, p = 0.001, p = 0.001, respectively). Regression analysis revealed a significant association between the concomitant csDMARDs therapy at baseline and the lack of improvement in synovial hypertrophy [OR −4.824, p = 0.010] as well as with DAS28-CRP [OR −0.690, p = 0.045], whereas the presence of increased ESR or CRP at baseline was able to predict a significant improvement in SDAI [OR 8.481, p = 0.003]. No adverse events, such as deep venous thrombosis, pulmonary embolism, or herpes zoster virus infection, were reported during this study observation. Conclusion: Our real-life experience confirms the efficacy of Upadacitinib in terms of clinical and ultrasonographic improvement, as well as displaying a good safety profile. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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15 pages, 297 KiB  
Article
The Influence of Rheumatoid Arthritis and Osteoarthritis on the Occurrence of Arterial Hypertension: An 8-Year Prospective Clinical Observational Cohort Study
by Dražen Bedeković, Damir Kirner, Ivica Bošnjak, Aleksandar Kibel, Sandra Šarić, Srđan Novak and Višnja Prus
J. Clin. Med. 2023, 12(22), 7158; https://doi.org/10.3390/jcm12227158 - 18 Nov 2023
Viewed by 1262
Abstract
Rheumatoid arthritis (RA) increases the risk of cardiovascular mortality and morbidity, including a 50–60% increased risk of cardiovascular disease (CVD). Arterial hypertension (HT) is considered the major contributing risk factor for CVD development in RA patients. In this investigation, we compared the incidence [...] Read more.
Rheumatoid arthritis (RA) increases the risk of cardiovascular mortality and morbidity, including a 50–60% increased risk of cardiovascular disease (CVD). Arterial hypertension (HT) is considered the major contributing risk factor for CVD development in RA patients. In this investigation, we compared the incidence and prevalence of HT between RA and osteoarthritis (OA) and the influence of HT on CVD development in CVD-naive patients in both groups. This was a prospective clinical cohort investigation with an 8-year follow-up period. A total of 201 participants, 124 with RA (investigation group) and 77 with OA (control group), without diagnosed CVD or symptomatic heart failure were included. After selection according to inclusion and exclusion criteria, both groups underwent initial and final visits, and the investigation group underwent annual visits to assess disease activity. Case report forms were completed for each visit. The obtained data were analyzed by a statistician. No difference in the incidence or prevalence of HT was found between the investigation and control groups. No difference in the prevalence of HT was reported between the study groups and age-standardized data from the general population. The investigation group had a higher incidence of CVD than the control group. RA participants with long-term remission had a marginally lower HT prevalence. Although previous studies reported a higher HT prevalence in RA than in OA and the general population, our findings did not support this. The RA group had a higher incidence of CVD, but it is possible that optimal disease control with long-term remission could reduce HT incidence and prevalence while also having beneficial effects on other cardiovascular risk factors (CV) and, consequently, CVD occurrence. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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Review

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12 pages, 1503 KiB  
Review
Janus Kinase Inhibitors in Rheumatoid Arthritis: An Update on the Efficacy and Safety of Tofacitinib, Baricitinib and Upadacitinib
by Robert Harrington, Patricia Harkins and Richard Conway
J. Clin. Med. 2023, 12(20), 6690; https://doi.org/10.3390/jcm12206690 - 23 Oct 2023
Cited by 4 | Viewed by 2112
Abstract
Janus kinase inhibitors (JAKis) are the most recent new drug class to arrive to the market for rheumatoid arthritis (RA) treatment. While they have proven to be a very effective treatment option, there remains significant concern regarding the risk of cardiovascular events, thrombosis [...] Read more.
Janus kinase inhibitors (JAKis) are the most recent new drug class to arrive to the market for rheumatoid arthritis (RA) treatment. While they have proven to be a very effective treatment option, there remains significant concern regarding the risk of cardiovascular events, thrombosis and malignancy, particularly given the findings of the post-marketing ORAL Surveillance study and FDA black box warnings. This article reviews the key findings of the most impactful cohort of studies and registry data since ORAL Surveillance. It also evaluates the role of JAKis in practice and offers guidance on risk stratifying patients and determining their suitability for a JAKi. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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18 pages, 1181 KiB  
Review
Targeted Therapy in Rheumatoid-Arthritis-Related Interstitial Lung Disease
by Robert Harrington, Patricia Harkins and Richard Conway
J. Clin. Med. 2023, 12(20), 6657; https://doi.org/10.3390/jcm12206657 - 20 Oct 2023
Cited by 1 | Viewed by 2395
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based [...] Read more.
Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based guidance on how to best treat RA-ILD. This review article aims to evaluate the evidence from cohort studies and best real word data from registries. Extensive discussion of the relative merits and drawbacks of glucocorticoids, various biologics, small molecules and anti-fibrotics is presented. The limited available guidelines in RA-ILD are also discussed and a rational treatment algorithm is offered. Full article
(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)
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