Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register.

OBJECTIVES: To describe the baseline characteristics of SLE patients requiring biologic therapy in the UK and to explore short term efficacy and infection rates associated with rituximab (RTX) use. METHODS: Patients commencing biologic therapy for refractory SLE and who consented to join BILAG-BR were analysed. Baseline characteristics, disease activity (BILAG 2004/SLEDAI-2K) and rates of infection over follow-up were analysed. Response was defined as loss of all A and B BILAG scores to ⩽ 1 B score with no new A/B scores in other organ systems at 6 months. RESULTS: Two hundred and seventy SLE patients commenced biologic therapy from September 2010 to September 2015, most commonly RTX (n = 261). Two hundred and fifty (93%) patients were taking glucocorticoids at baseline at a median [interquartile range (IQR)] oral dose of 10 mg (5-20 mg) daily. Response rates at 6 months were available for 68% of patients. The median (IQR) BILAG score was 15 (10-23) at baseline and 3 (2-12) at 6 months (P < 0.0001). The median (IQR) SLEDAI-2K reduced from 8 (5-12) to 4 (0-7) (P < 0.001). Response was achieved in 49% of patients. There was also a reduction in glucocorticoid use to a median (IQR) dose of 7.5 mg (5-12 mg) at 6 months (P < 0.001). Serious infections occurred in 26 (10%) patients, being more frequent in the first 3 months post-RTX therapy. A higher proportion of early infections were non-respiratory (odds ratio = 1.98, 95% CI: 0.99, 3.9; P = 0.049). CONCLUSION: RTX is safe and is associated with improvement in disease activity in refractory SLE patients with concomitant reductions in glucocorticoid use. Early vigilance for infection post-infusion is important to further improve treatment risks and benefits

Tinkering at the edges or collaborative symbiosis? Ethnicity & rheumatology.

It is recognised that the epidemiology of disease as well as ill-health manifestations in minority populations may be at variance from orthodox formulations generated through traditional research and as described in the western medical literature. The relevance of this lies in the need to devise strategies for optimising healthcare in minority groups, which, in the UK, is a duty that has been imposed upon providers through the passage of legislation. This paper examines the effect of ethnicity on three common rheumatological conditions, namely rheumatoid arthritis, psoriatic arthropathy and osteoporosis, and concludes that a range of ethnicspecific issues have as yet failed to receive adequate attention in medical research, and, in addition, that there is a lacuna in comprehensive national strategies aimed at addressing health needs within this particular area. Approaches to remedying this deficiency are suggested based on information obtained through the lens of theme-specific workshops consisting of a mix of experienced healthcare professionals engaged in the care of individuals with rheumatological conditions. Multifaceted strategies need to be deployed to improve healthcare and to further the agenda of minority health issues in rheumatology