A. Kh.
61 years old
Disease progression
RINVOQ initiation
Diagnosis and History
Biologic regimens:
Striving for remission
2004
Diagnosis and History
2004 - 2018
Disease progression
2008 - 2019
Biologic regimens:
Striving for remission
June 2020
RINVOQ initiation
Patient Profile
• | A.Kh (male) is diagnosed with Rheumatoid Arthritis (RA) since age of 43 Years old. |
• | Part time chef |
• | Habits: |
• | Comorbidity: Obesity, HTN and NIDDM, Sleep Apnea Syndrome |
Diagnosis
• | Active Seropositive (RF+CCP) deforming symmetric and resistant polyarthritis RA. |
Treatment History
• | During the last 1.5 decades he tried different biologicals (see below) after few (3) years with combination therapy with c-DMARD’S including MTX, LEF, PLQ, SZP and repeated IA injections of steroids (CS) with smoldering relapsing and remitting state of disease. |
HTN - hypertension; NIDDM - non-insulin dependent diabetes mellitus; RF - rheumatoid factor; MTX – methotrexate; LEF – Leflunomide; PLQ – Plaquenil; SZP – Sulfasalazine; IA - intra-articular; CCP - Cyclic Citrullinated Peptide
*This case study reflects Dr. Suhail Aamar's professional experience and views. *This presentation may contain information on uses of products/indications that have not been approved by the Israeli MoH. *AbbVie does not endorse the use of unregistered products or products outside of their registered indications. AbbVie only recommends the use of its products in accordance with the approved Product Information.
A. Kh.
61 years old
Disease progression
RINVOQ initiation
Diagnosis and History
Biologic regimens:
Striving for remission
2004
Diagnosis and History
2004 - 2018
Disease progression
2008 - 2019
Biologic regimens:
Striving for remission
June 2020
RINVOQ initiation
Presentation
• | Symmetric polyarthritis of small joints mainly involving hand fingers and wrists, and later both elbows, knees and ankles. |
• | Slight deformities of PIP’S and MCP’S of 2 -4 fingers in both hands with some ulnar deviation of wrists. |
• | Bilateral Knees symmetric joint space narrowing on radiographs. |
• | Repeated episodes of joint swellings necessitated fluid aspirations and CS injections. |
• | Rheumatoid nodules on both elbows and dorsal aspect of right wrist. |
• | Due to later involvement of hip joints, he underwent bilateral THR. |
Clinical Characteristics
• | Average numbers of each index during last period of about 15 years of follow-up: CRP: X 4-6 times above normal limit. Pain (VAS): around 70 (in 0-100 scale). |
PIP - proximal interphalangeal joints; MCP – metacarpophalangeal; THR - total hip replacement; CRP - C-reactive protein; CS - Corticosteroids
A. Kh.
61 years old
_
Disease progression
RINVOQ initiation
Diagnosis and History
Biologic regimens:
Striving for remission
2004
Diagnosis and History
2004 - 2018
Disease progression
2008 - 2019
Biologic regimens:
Striving for remission
June 2020
RINVOQ initiation
Treatment Adjustment
• | Until June 2020, different regimens of biologicals were offered and with low to moderate clinical response, these include: Etanercept (2 yrs), Adalimumab (2 yrs), Golimumab (1 yrs), Rituximab (patient refused), Abatacept iv (0.5 yrs), Tocilizumab iv (1 yrs), Infliximab iv (1.5 yrs), Tocilizumab sc (2 yrs) …. |
• | Since 2018 only cs-DMARD’s without b-DMARD’S (2.5 yrs), due to orthopedic surgeries THR bilaterally and patient personal preference and fear due to the beginning of COVID-19 era. |
Patient Assessment
• | At the beginning of 2020 he was at high disease activity and on cs-DMARD’s with no additional b-DMARD’s and was frustrated for a long time due to little improvement and limited response to most of regimens he tried. |
• | Main complaints of generalized pain (especially of small joints of hands), Fatigue, mood instability, malfunctioning at home and work, sleep deprivation and gait instability. |
HCP Assessment
• | Active RA with resistance to multiple switches of remedies, with secondary chronic pain and fatigue and suspected secondary Fibromyalgia with Depressive episodes. Needed steroids injections as well. |
• | CDAI: 31 High disease activity (HDA) |
• | SDAI: 33 HDA |
• | DAS28-CRP: 5.8 (HDA) |
• | Patient global assessment: 75 (in 0-100 scale). |
THR - Total Hip Replacement
A. Kh.
61 years old
Disease progression
RINVOQ initiation
Diagnosis and History
Biologic regimens:
Striving for remission
2004
Diagnosis and History
2004 - 2018
Disease progression
2008 - 2019
Biologic regimens:
Striving for remission
June 2020
RINVOQ initiation
Treatment Adjustment
• | Since 06/ 2020 RINVOQ (UPA) treatment was commenced with better clinical effects |
HCP Assessment
• | LDA was achieved under treatment with UPA |
• | Reported concerns and patient outcomes became gradually better with a remarkable general resilience after 6 months. |
• | The patient visits every 4-6 months for general assessment. |
Patient Self Feedback
• | Treatment with UPA is satisfactory |
• | UPA is helpful in facing RA related stiffness and tender or swelling joints. |
• | So far, UPA is better than previous parenteral drugs (b-DMARD’s) |
• | UPA is preferable than injections, with only one tablet a day |
• | UPA has helped in general well- being and fatigue and is supportive in facing the main outcomes of this Rheumatic disease (RA) |
RINVOQ registration to RA in Israel was in May 2020
REMISSION IS A RECOMMENDED TREATMENT GOAL.
EULAR recommends aiming for sustained remission or low disease activity in every patient.1
Treat To Target (T2T) is an established approach to RA treatment that can help you aim for remission.1
KEY POINTS TO REMEMBER:
Remission is associated with improved symptoms, better health-related quality of life and physical function, less fatigue, and less radiographic progression than higher disease activity states.2,3
Early remission can make a difference. In a nationwide, observational registry study of RA patients in Sweden showed that patients with early RA, one year after symptom onset, were twice as likely as those with established RA (21.3% vs 9.8%) to be in sustained remission, and this difference remained for at least 10 years.4
Engaging in a partnership with your patients can encourage collaboration and dialogue about disease management and aiming for remission as a treatment goal in RA.1
Rinvoq Prescribing Information
For full information please see Rinvoq prescribing information Full prescribing information can be received from Abbvie Biopharmaceuticals Ltd. Israel at 4 Hacharash Street, Hod Hasharon 4524075. Tel: 09-7909600, Fax: 09-790960
1. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79(6):685-699. doi:10.1136/annrheumdis-2019-216655
2. Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther. 2014;16(1):R56. doi:10.1186/ar4491
3. van Tuyl LH, Felson DT, Wells G, Smolen J, Zhang B, Boers M; American College of Rheumatology; European League Against Rheumatism Committee to Define Remission for Clinical Trials. Evidence for predictive validity of remission on long-term outcome in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken). 2010;62(1):108-117. doi:10.1002/acr.20021
4. Einarsson JT, Willim M, Ernestam S, Saxne T, Geborek P, Kapetanovic MC. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a nationwide study in Sweden. Rheumatology (Oxford). 2019;58(2):227-236. doi:10.1093/rheumatology/key054
IL-RNQR-230003. Date of preparation: May 2023.