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This article is authorized to be reproduced from the WeChat public account of "Rheumatism World".
Recently, the research team of Professor Zhang Zhuoli of the Department of Rheumatology and Immunology of Peking University First Hospital published an original work in the top journal Annals of the Rheumatic Diseases ("Rheumatology Yearbook", IF= 16.
102) Published online research paper entitled "Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020".
It is reported that this study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the sole unit.
The study revealed for the first time the dynamic changes and clinical characteristics of glucocorticoid reduction and discontinuation in patients with rheumatoid arthritis (RA) under the background of traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs).
As the world's first real-world study of hormone reduction under the background treatment of csDMARD, the results of this study will provide important real-world evidence for the formulation of hormone reduction strategies in rheumatoid arthritis and the optimization of the clinical use of hormones.
▲Paper published in Annals of the Rheumatic Diseases Glucocorticoids still play an important role in the treatment of rheumatoid arthritis due to their potent anti-inflammatory properties.
Many clinical studies have confirmed that glucocorticoids can not only quickly and effectively control inflammation and relieve patients' joint symptoms, but also have the effect of inhibiting the progress of bone destruction.
Therefore, the European Union Against Rheumatism (EULAR) management guidelines recommend that the initial treatment of rheumatoid arthritis can be combined with glucocorticoids as a bridging treatment before the onset of csDMARD, especially for patients with moderate to high disease activity.
However, long-term glucocorticoid therapy may increase the risk of serious infections, diabetes, osteoporosis and other adverse events, even at very low doses.
Therefore, the EULAR 2019 management guidelines emphasize that hormones in the treatment of rheumatoid arthritis should be reduced and stopped as soon as clinically feasible, and the ideal stopping time is about 3 months.
However, the current hormone reduction strategy in rheumatoid arthritis still lacks evidence-based evidence, which has also led to vast differences in the use of hormones in clinical practice.
Although the EULAR management guidelines recommend that csDMARD combined with hormones can be used as the first-line treatment for patients with rheumatoid arthritis, there is currently no research report on the reduction and discontinuation of hormones and clinical features under the csDMARD combined with hormone therapy.
Image source: Nat Rev Rheumatol.
2010 Dec;6(12):693-702.
In response to this key issue, Professor Zhang Zhuoli’s research team is based on the decade-long real-world rheumatoid arthritis of the Department of Rheumatology and Immunology, Peking University First Hospital The standard treatment cohort (Treat-to-TARget in RA, TARRA cohort), for the first time, fully revealed the dynamic trajectory and clinical characteristics of the reduction and withdrawal of hormones in patients with rheumatoid arthritis in the context of csDMARDs treatment.
After screening 1432 patients with rheumatoid arthritis in the TARRA cohort according to the predetermined intake and exclusion criteria, a total of 207 patients with rheumatoid arthritis who were initially initiating hormones combined with csDMARD were included in the study.
The initial median prednisolone or equivalent dose of the enrolled patients was 10 (5-10) mg/d, which decreased to 7.
5 (5-10) mg/d at the third month, and decreased to 7.
5 (5-10) mg/d at the sixth month 5.
0 (2.
5~10) mg/d, until the 48th month reduced to 0 (0~5.
0) mg/d.
During a median follow-up of 38.
6 months, 59.
9% (124/207) of the patients stopped using hormones.At the 6th month, 1, 2 years, and 3 years, the cumulative hormone withdrawal rates were 9.
7%, 26.
6%, 48.
0%, and 58.
6%, respectively, and the median hormone withdrawal time was 27 months (Figure 1).
Figure 1.
Kaplan Meier survival curve of cumulative hormone discontinuation rate in RA patients during follow-up.
110 patients were newly treated patients.
In these patients, the cumulative hormone discontinuation rate was 12.
7 at 6 months, 1 year, 2 years, and 3 years, respectively.
%, 30.
0%, 50.
9% and 60.
6%, the median time to stop the hormone is 24 months.
At the same time, an analysis of patients who visited before and after 2014 found that after 2014, the median time to stop hormones in patients with rheumatoid arthritis was significantly shortened, while the rate of discontinuation increased significantly (20.
0 months vs.
36.
0 months; 64.
1% vs.
.
56.
5%, P=0.
002).
Among the patients who stopped using hormones, more than half of the patients were in clinical remission when the hormones were stopped, and more than two-thirds of the patients had no disease recurrence within 6 months after stopping the hormones.
As the world’s first real-world study of hormone reduction and discontinuation under csDMARD background treatment, the results of this study show that rheumatologists can consider stopping the treatment of rheumatoid arthritis patients receiving hormone combined with csDMARD when their disease activity is well controlled.
Hormone, and most patients did not experience short-term relapse after stopping the hormone; however, the time of stopping the hormone in clinical practice is much longer than the time recommended by the current guidelines, which suggests that there is still a certain amount of hormone reduction and stopping between clinical practice and management guidelines.
gap.
The important findings of the study will provide important evidence-based evidence for the formulation of hormone reduction strategies in rheumatoid arthritis and the optimization of the clinical use of hormones.
"Rheumatism Yearbook" was founded in 1939.
It is a sub-issue of the British Medical Journal (BMJ) and the official journal of EULAR.
It is also an original journal with the highest impact factor in rheumatology.
"Rheumatism Yearbook" covers all aspects of rheumatism, including musculoskeletal system diseases, arthritis diseases, connective tissue diseases, etc.
It publishes basic, clinical and translational scientific research, including authoritative management guidelines for various diseases. In Clarivate Analytics' latest 2019 journal citation report, the journal ranked second among 32 rheumatology journals, with an impact factor of 16.
102, JCR Q1 area.
The corresponding author of the paper is Professor Zhang Zhuoli from the Department of Rheumatology and Immunology, Peking University First Hospital, and the first author is Xie Wenhui, a doctoral student.
This study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the only research unit and was funded by the National Natural Science Foundation of China.
.
It is reported that based on the TARRA cohort, Professor Zhang Zhuoli’s research team has carried out a series of original work on the treatment of rheumatoid arthritis and published it in internationally renowned journals, such as the benefit of the treatment of the treatment of rheumatoid arthritis in China (Clin Exp Rheumatol.
2018) ;36:820-828), sustained clinical remission rate and predictive factors (Int J Rheum Dis.
2019;22:1670-1678), early clinical remission rate and predictive factors (Clin Rheumatol.
2020;39:381-389), The impact of comorbidities on standard treatment (Arthritis Res Ther.
2020;22:100), the influence of standard treatment on imaging progress (Clin Rheumatol.
2021;40:1307-1315), and the first proposed low disease activity under the Boolean definition ( Rheumatol Ther.
2020 Dec 23) and so on.
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on hormone reduction in the treatment standard, and aims to provide real-world evidence for the development of hormone reduction strategies in rheumatoid arthritis.
At the same time, the research team also prospectively established a clinical follow-up cohort for systemic lupus erythematosus, a clinical follow-up cohort for psoriatic arthritis, and a collaborative intensive treatment cohort for rheumatoid arthritis (CENTRA cohort).
Based on these cohorts, the research team is continuing to carry out and publish a series of high-level studies, such as the mortality and prognostic factors of the Chinese population with systemic lupus erythematosus (Lupus.
2018;27:1742-1752) and lupus compliance status and predictive factors (Rheumatology ( Oxford).
2020;59:3400-3407).
The establishment of these prospective cohorts and the publication of high-level research papers reflect that the Department of Rheumatology and Immunology of Peking University First Hospital has a world-class clinical research platform and level.
In the future, the research team will definitely develop in the field of rheumatism.
Going further, keep moving forward without forgetting the original intention.
Article link: https://ard.
bmj.
com/content/early/2021/04/01/annrheumdis-2021-220112 Expert profile Zhang Zhuoli, chief physician, professor, and doctoral supervisor, currently serves as the Department of Rheumatology and Immunology, Peking University First Hospital Director, currently Deputy Chairman and Secretary-General of Rheumatology, Chinese Medical Association, Head of the Imaging Group of the Rheumatology Branch of the Chinese Medical Doctor Association, Head of the Imaging Group of the Rheumatology and Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association, and Rheumatology Branch of the Beijing Medical Association Vice chairman, leader of the rheumatism group of the National Medical Examination Center of the Health Commission.
He has been engaged in basic and clinical research on rheumatism and immunology for a long time, and has achieved a number of original and applied results, won a number of scientific research grants and awards, and published more than 300 papers, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, Blood, Eur Respir J, J Am Acad Dermatol, Autoimmun Rev and other top international magazines.
At present, Professor Zhang Zhuoli's team has led the domestic application of innovative technologies such as musculoskeletal ultrasound, magnetic resonance, and mini arthroscopy in rheumatism, which has promoted the development of rheumatology in my country.
The Department of Rheumatology and Immunology of Peking University First Hospital has been nominated in the ranking of Fudan University's Best Hospital Specialties in China for seven consecutive years, and has been ranked in the top 10 of the Chinese Academy of Medical Sciences' scientific and technological influence rankings for five consecutive years.
It has become a uniquely attractive rheumatology specialty in China.
one. In order to further promote the development of domestic rheumatism and immunology, Professor Zhang Zhuoli led the team to sponsor more than forty sessions of "Musculoskeletal Ultrasound Standardized Operation Training", "New Imaging Techniques in Rheumatism Application Training Course", "Peking University Rheumatology Hot Spots" "Forum" and other exchange courses have won unanimous praise from domestic rheumatologists.
Source of title picture: 123RF Note: This article aims to introduce the progress of medical and health research, not a recommendation for treatment plans.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
Click "Watching" to share new medical knowledge
Recently, the research team of Professor Zhang Zhuoli of the Department of Rheumatology and Immunology of Peking University First Hospital published an original work in the top journal Annals of the Rheumatic Diseases ("Rheumatology Yearbook", IF= 16.
102) Published online research paper entitled "Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020".
It is reported that this study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the sole unit.
The study revealed for the first time the dynamic changes and clinical characteristics of glucocorticoid reduction and discontinuation in patients with rheumatoid arthritis (RA) under the background of traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs).
As the world's first real-world study of hormone reduction under the background treatment of csDMARD, the results of this study will provide important real-world evidence for the formulation of hormone reduction strategies in rheumatoid arthritis and the optimization of the clinical use of hormones.
▲Paper published in Annals of the Rheumatic Diseases Glucocorticoids still play an important role in the treatment of rheumatoid arthritis due to their potent anti-inflammatory properties.
Many clinical studies have confirmed that glucocorticoids can not only quickly and effectively control inflammation and relieve patients' joint symptoms, but also have the effect of inhibiting the progress of bone destruction.
Therefore, the European Union Against Rheumatism (EULAR) management guidelines recommend that the initial treatment of rheumatoid arthritis can be combined with glucocorticoids as a bridging treatment before the onset of csDMARD, especially for patients with moderate to high disease activity.
However, long-term glucocorticoid therapy may increase the risk of serious infections, diabetes, osteoporosis and other adverse events, even at very low doses.
Therefore, the EULAR 2019 management guidelines emphasize that hormones in the treatment of rheumatoid arthritis should be reduced and stopped as soon as clinically feasible, and the ideal stopping time is about 3 months.
However, the current hormone reduction strategy in rheumatoid arthritis still lacks evidence-based evidence, which has also led to vast differences in the use of hormones in clinical practice.
Although the EULAR management guidelines recommend that csDMARD combined with hormones can be used as the first-line treatment for patients with rheumatoid arthritis, there is currently no research report on the reduction and discontinuation of hormones and clinical features under the csDMARD combined with hormone therapy.
Image source: Nat Rev Rheumatol.
2010 Dec;6(12):693-702.
In response to this key issue, Professor Zhang Zhuoli’s research team is based on the decade-long real-world rheumatoid arthritis of the Department of Rheumatology and Immunology, Peking University First Hospital The standard treatment cohort (Treat-to-TARget in RA, TARRA cohort), for the first time, fully revealed the dynamic trajectory and clinical characteristics of the reduction and withdrawal of hormones in patients with rheumatoid arthritis in the context of csDMARDs treatment.
After screening 1432 patients with rheumatoid arthritis in the TARRA cohort according to the predetermined intake and exclusion criteria, a total of 207 patients with rheumatoid arthritis who were initially initiating hormones combined with csDMARD were included in the study.
The initial median prednisolone or equivalent dose of the enrolled patients was 10 (5-10) mg/d, which decreased to 7.
5 (5-10) mg/d at the third month, and decreased to 7.
5 (5-10) mg/d at the sixth month 5.
0 (2.
5~10) mg/d, until the 48th month reduced to 0 (0~5.
0) mg/d.
During a median follow-up of 38.
6 months, 59.
9% (124/207) of the patients stopped using hormones.At the 6th month, 1, 2 years, and 3 years, the cumulative hormone withdrawal rates were 9.
7%, 26.
6%, 48.
0%, and 58.
6%, respectively, and the median hormone withdrawal time was 27 months (Figure 1).
Figure 1.
Kaplan Meier survival curve of cumulative hormone discontinuation rate in RA patients during follow-up.
110 patients were newly treated patients.
In these patients, the cumulative hormone discontinuation rate was 12.
7 at 6 months, 1 year, 2 years, and 3 years, respectively.
%, 30.
0%, 50.
9% and 60.
6%, the median time to stop the hormone is 24 months.
At the same time, an analysis of patients who visited before and after 2014 found that after 2014, the median time to stop hormones in patients with rheumatoid arthritis was significantly shortened, while the rate of discontinuation increased significantly (20.
0 months vs.
36.
0 months; 64.
1% vs.
.
56.
5%, P=0.
002).
Among the patients who stopped using hormones, more than half of the patients were in clinical remission when the hormones were stopped, and more than two-thirds of the patients had no disease recurrence within 6 months after stopping the hormones.
As the world’s first real-world study of hormone reduction and discontinuation under csDMARD background treatment, the results of this study show that rheumatologists can consider stopping the treatment of rheumatoid arthritis patients receiving hormone combined with csDMARD when their disease activity is well controlled.
Hormone, and most patients did not experience short-term relapse after stopping the hormone; however, the time of stopping the hormone in clinical practice is much longer than the time recommended by the current guidelines, which suggests that there is still a certain amount of hormone reduction and stopping between clinical practice and management guidelines.
gap.
The important findings of the study will provide important evidence-based evidence for the formulation of hormone reduction strategies in rheumatoid arthritis and the optimization of the clinical use of hormones.
"Rheumatism Yearbook" was founded in 1939.
It is a sub-issue of the British Medical Journal (BMJ) and the official journal of EULAR.
It is also an original journal with the highest impact factor in rheumatology.
"Rheumatism Yearbook" covers all aspects of rheumatism, including musculoskeletal system diseases, arthritis diseases, connective tissue diseases, etc.
It publishes basic, clinical and translational scientific research, including authoritative management guidelines for various diseases. In Clarivate Analytics' latest 2019 journal citation report, the journal ranked second among 32 rheumatology journals, with an impact factor of 16.
102, JCR Q1 area.
The corresponding author of the paper is Professor Zhang Zhuoli from the Department of Rheumatology and Immunology, Peking University First Hospital, and the first author is Xie Wenhui, a doctoral student.
This study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the only research unit and was funded by the National Natural Science Foundation of China.
.
It is reported that based on the TARRA cohort, Professor Zhang Zhuoli’s research team has carried out a series of original work on the treatment of rheumatoid arthritis and published it in internationally renowned journals, such as the benefit of the treatment of the treatment of rheumatoid arthritis in China (Clin Exp Rheumatol.
2018) ;36:820-828), sustained clinical remission rate and predictive factors (Int J Rheum Dis.
2019;22:1670-1678), early clinical remission rate and predictive factors (Clin Rheumatol.
2020;39:381-389), The impact of comorbidities on standard treatment (Arthritis Res Ther.
2020;22:100), the influence of standard treatment on imaging progress (Clin Rheumatol.
2021;40:1307-1315), and the first proposed low disease activity under the Boolean definition ( Rheumatol Ther.
2020 Dec 23) and so on.
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on hormone reduction in the treatment standard, and aims to provide real-world evidence for the development of hormone reduction strategies in rheumatoid arthritis.
At the same time, the research team also prospectively established a clinical follow-up cohort for systemic lupus erythematosus, a clinical follow-up cohort for psoriatic arthritis, and a collaborative intensive treatment cohort for rheumatoid arthritis (CENTRA cohort).
Based on these cohorts, the research team is continuing to carry out and publish a series of high-level studies, such as the mortality and prognostic factors of the Chinese population with systemic lupus erythematosus (Lupus.
2018;27:1742-1752) and lupus compliance status and predictive factors (Rheumatology ( Oxford).
2020;59:3400-3407).
The establishment of these prospective cohorts and the publication of high-level research papers reflect that the Department of Rheumatology and Immunology of Peking University First Hospital has a world-class clinical research platform and level.
In the future, the research team will definitely develop in the field of rheumatism.
Going further, keep moving forward without forgetting the original intention.
Article link: https://ard.
bmj.
com/content/early/2021/04/01/annrheumdis-2021-220112 Expert profile Zhang Zhuoli, chief physician, professor, and doctoral supervisor, currently serves as the Department of Rheumatology and Immunology, Peking University First Hospital Director, currently Deputy Chairman and Secretary-General of Rheumatology, Chinese Medical Association, Head of the Imaging Group of the Rheumatology Branch of the Chinese Medical Doctor Association, Head of the Imaging Group of the Rheumatology and Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association, and Rheumatology Branch of the Beijing Medical Association Vice chairman, leader of the rheumatism group of the National Medical Examination Center of the Health Commission.
He has been engaged in basic and clinical research on rheumatism and immunology for a long time, and has achieved a number of original and applied results, won a number of scientific research grants and awards, and published more than 300 papers, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, Blood, Eur Respir J, J Am Acad Dermatol, Autoimmun Rev and other top international magazines.
At present, Professor Zhang Zhuoli's team has led the domestic application of innovative technologies such as musculoskeletal ultrasound, magnetic resonance, and mini arthroscopy in rheumatism, which has promoted the development of rheumatology in my country.
The Department of Rheumatology and Immunology of Peking University First Hospital has been nominated in the ranking of Fudan University's Best Hospital Specialties in China for seven consecutive years, and has been ranked in the top 10 of the Chinese Academy of Medical Sciences' scientific and technological influence rankings for five consecutive years.
It has become a uniquely attractive rheumatology specialty in China.
one. In order to further promote the development of domestic rheumatism and immunology, Professor Zhang Zhuoli led the team to sponsor more than forty sessions of "Musculoskeletal Ultrasound Standardized Operation Training", "New Imaging Techniques in Rheumatism Application Training Course", "Peking University Rheumatology Hot Spots" "Forum" and other exchange courses have won unanimous praise from domestic rheumatologists.
Source of title picture: 123RF Note: This article aims to introduce the progress of medical and health research, not a recommendation for treatment plans.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
Click "Watching" to share new medical knowledge
