Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry

Contains fulltext : 152779.pdf (publisher's version ) (Open Access)OBJECTIVES: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival. METHODS: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate. RESULTS: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi. CONCLUSIONS: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX

The role of physical activity and sedentary behavior in predicting daily pain and fatigue in older adults: A diary study

Background: Little attention has been paid to within-person daily associations among light physical activity (PA), moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) with subsequent bodily pain and fatigue. Daily reports of pain and fatigue are less likely to be affected by recall bias and to conflate days of high and low pain/fatigue into one overall score. Purpose: The purpose of this study was to examine daily within-person associations between pain, fatigue, and physical health and ascertain whether such associations are moderated by individual differences in these variables. Methods: Participants were 63 community-living older adults (female n = 43, mean age = 70.98 years). Questionnaires measured typical levels of PA, SB, bodily pain, fatigue, and physical health. Subsequently, on a daily basis over a 1-week period, participants’ levels of light PA, MVPA, and SB were measured using accelerometers. Participants completed a questionnaire rating their pain and fatigue at the end of each day. Results: Multilevel modeling revealed positive within-person associations between daily light PA, daily MVPA, and pain, as well as negative within-person associations between daily SB and pain. For individuals with higher typical levels of fatigue, there was a negative association between daily light PA, MVPA, and fatigue. For individuals with better levels of physical health, there was also a negative association between daily MVPA and fatigue. For those with higher typical levels of fatigue and better levels of physical health, there was a positive association between daily SB and fatigue. No such interaction effects were found between high levels of typical pain and PA or SB. Conclusions: Our findings indicate that efforts to promote daily PA in older adults might be more effective for those who report high typical levels of fatigue and physical health, compared to those who report high levels of daily physical pain