Menu Close

From Research to Practice: Essential Learnings from the EULAR Annual Congress

Title of the study: Treat-to-target approach allows to induce sustained clinical remission in over 60% of patients with early axial spondyloarthritis

Background

Early treatment in inflammatory rheumatic diseases helps achieve drug-free remission.1 EULAR suggests early intervention in inflammatory arthritis since conventional synthetic disease-modifying antirheumatic drugs (csDMARD) have been shown to slow disease progress in rheumatoid arthritis and psoriatic arthritis.2 This study explores if early tight control, treat-to-target approach helps in axial spondyloarthritis (axSpA), which often starts with slow-onset back pain and is often diagnosed late.3

Rheumatologists define remission in several ways, using measures like:

  • Less than 15 minutes of stiffness in the morning
  • Little or no joint pain, based on your history
  • One or fewer tender joints
  • One or fewer swollen joints
  • Blood tests that show low levels of inflammation
  • An assessment by the patient that on a 0–10 scale, arthritis activity is 1 or less

Study Details

  • Evaluated tight control and treat-to-target treatment approach in new axSpA patients.
  • Patients, untreated before, followed ASAS-EULAR guidelines. They first received two non-steroidal anti-inflammatory drugs (NSAIDs) for at least 4 weeks.
  • Patients who didn’t improve with NSAIDs started golimumab.
  • Patients were followed until achieving sustained remission, defined as inactive disease at two visits, 12 weeks apart.
  • After achieving sustained clinical remission, treatment was stopped and participants were followed in routine clinical practice to see if they stayed in drug-free remission.

Findings

The study showed that a tight control, treat-to-target approach can help achieve drug-free remission in new axSpA patients.

Of 55 patients who completed the trial, 61.8% achieved sustained clinical remission, and 21.8% had low disease activity at Week 52. This is the first clinical trial in early axSpA in which sustained inactive disease status has been achieved in over 60% of patients

Key Takeaways

Early and tight control, treat-to-target treatment approach can help axSpA patients reach and maintain drug-free remission. This approach could change how we treat early axSpA, emphasizing the importance of early diagnosis and treatment.

Additional Learning Resources

Title of studies:

  • Novel and innovative approaches to raising awareness of childhood arthritis
  • The transition from pediatric to adult healthcare: a leap into the dark?

Background

Childhood arthritis, like juvenile idiopathic arthritis (JIA), affects many young people. General awareness that children and young people get arthritis is low.4 Sessions at EULAR 2024 highlighted the need for better awareness and smooth transition from pediatric to adult care.

Details of Studies

One study from Juvenile Arthritis Research – a patient organisation in the United Kingdom that is involved in a variety of projects to raise awareness and support JIA patients and their families – looked at innovative projects the organisation has run to raise awareness. Many of these projects are low cost and the ideas can be used in other countries.

Another study from Italy explored the transition from pediatric to adult healthcare. Presenting the work at EULAR 2024, Matteo Santopietro highlighted that one of the main obstacles that families and patients face in the transition from their pediatric to adult rheumatologist is a lack of clear information about this process. He went on to say “there is often unstructured communication between the two doctors, and a risk of interruptions in therapeutic continuity.”

In fact, results showed that up to 30% of caregivers felt they did not have complete information on the transition process. For patients, three critical areas were identified. First, there are bureaucratic aspects that make the transition process excessively long. In addition, patients reported that there was insufficient communication and coordination between their pediatric and adult doctors. And finally, there was an emotional or psychological aspect – including the need to adapt to new medical environments and take increased responsibility for their own health – with patients reporting this made them feel left alone.

Findings

Low awareness of childhood arthritis is low, causing delays in diagnosis, worse clinical outcomes and the burden of loneliness and stigma.

Key Takeaways

The studies stressed the need for better public understanding and support for young patients. Ensuring a smooth transition from pediatric to adult care can help young patients receive better treatment and support.

Additional Learning Resources

Title of studies:

  1. Glucocorticoid withdrawal does not increase the risk of flares during remission in Systemic Lupus Erythematosus.
  2. Impact of glucocorticoid dose threshold in definition of Lupus Low Disease Activity State.

Background

Glucocorticoids are important for treating systemic lupus erythematosus (SLE), but they have long-term side effects. Reducing the dose is key, but the best target dose is still debated. EULAR recommends a dose of no more than
5 mg/day, while the lupus low disease activity state (LLDAS) allows up to 7.5 mg/day. It’s also unclear if stopping glucocorticoids after remission is safe.

Details of Studies

At the 2024 EULAR congress in Vienna, two studies looked at these issues. They focused on finding the best dose of glucocorticoids and whether patients can safely stop taking them after remission.

Findings

Study 1: Risk of Flare with Glucocorticoid Use

This study looked at the risk of flare-ups in people with SLE who either stopped or stayed on low-dose glucocorticoids. The researchers analyzed data from patients in remission.

  • Participants: 484 patients in remission
  • Groups: 360 stopped glucocorticoids; 124 stayed on 5 mg/day or less
  • Results:
    • 85 flares occurred over 87 months on average
    • 48 flares in those who stopped glucocorticoids
    • 37 flares in those who stayed on low-dose
    • Annual flare rate: 8.5 per 100 patients (stopped) vs. 1.65 per 100 patients (low-dose)

The study found that stopping glucocorticoids after tapering is safe and has a low risk of flare-ups.

Study 2: Comparing Glucocorticoid Dose Thresholds

This study compared two dose limits for glucocorticoids in SLE management:
5 mg/day (EULAR recommendation) vs. 7.5 mg/day (LLDAS definition). They checked if the lower dose better prevented flares, organ damage, and death.

  • Participants: 2,213 patients
  • Outcomes:
    • 2.1% died, 29% had organ damage, 67% had flares
    • 87% achieved 7.5 mg limit in 47% of visits
    • 83% achieved 5 mg limit in 42% of visits

Both dose thresholds provided similar protection against flares, organ damage, and death. The study supports keeping the 7.5 mg/day limit in the LLDAS definition, as lowering it to 5 mg/day did not show additional benefits.

Key Takeaways

Determining the right dose of glucocorticoids is crucial for SLE treatment. Further research is needed to establish the safest dose and to understand if stopping the medication after remission is safe and effective.

Additional Learning Resources

Title of the study: Multi-modal analysis of synovial tissue macrophages informs on treatment response in naive to treatment Rheumatoid Arthritis

Background

New research presented at the 2024 EULAR congress looks at using multi-modal analysis to predict how patients with rheumatoid arthritis (RA) will respond to treatment. This study aims to find biomarkers that can help doctors decide the best treatment for each patient.

Biologic markers, commonly termed “biomarkers,” are substances in the body (for example, blood or joint fluid) that can be measured and inform patient conditions and assist with early diagnosis, optimization of treatment and disease monitoring.

Study Details

Researchers studied the synovial tissue, which lines the joints, in patients with RA who had not yet received treatment. They used advanced techniques to analyze inflammation and identify specific immune cell markers. The goal was to see if these markers could predict how well patients would respond to conventional RA treatments.

Findings

The study found that certain types of immune cells in the joint tissue are linked to how well patients respond to treatment. This suggests that analyzing these cells can help doctors predict which treatments will work best for different patients.

Key Takeaways

Using multi-modal analysis to study joint tissue can improve treatment decisions for RA patients. This approach can help doctors choose the best treatment early, leading to better outcomes for patients.

Additional Learning Resources

References

  1. Combe B, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017;76(6):948–59
  2. Gaujoux-Viala C, et al. Efficacy of conventional synthetic disease-modifying antirheumatic drugs, glucocorticoids and tofacitinib: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2014;73:510–15.
  3. Zhao SS, et al. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology 2021;60,(4):1620–8.
  4. Beesley RP, Beesley RM. Community awareness of childhood arthritis in the UK. Rheumatol Adv Pract 2024;8(1):rkad099.