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Rheumatoid Arthritis: HELP
Articles by Dr. Paul Emery
Based on 314 articles published since 2008

Between 2008 and 2019, P. Emery wrote the following 314 articles about Arthritis, Rheumatoid.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13
1 Guideline EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. 2014

Smolen, Josef S / Landewé, Robert / Breedveld, Ferdinand C / Buch, Maya / Burmester, Gerd / Dougados, Maxime / Emery, Paul / Gaujoux-Viala, Cécile / Gossec, Laure / Nam, Jackie / Ramiro, Sofia / Winthrop, Kevin / de Wit, Maarten / Aletaha, Daniel / Betteridge, Neil / Bijlsma, Johannes W J / Boers, Maarten / Buttgereit, Frank / Combe, Bernard / Cutolo, Maurizio / Damjanov, Nemanja / Hazes, Johanna M W / Kouloumas, Marios / Kvien, Tore K / Mariette, Xavier / Pavelka, Karel / van Riel, Piet L C M / Rubbert-Roth, Andrea / Scholte-Voshaar, Marieke / Scott, David L / Sokka-Isler, Tuulikki / Wong, John B / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna, Austria. ·Ann Rheum Dis · Pubmed #24161836.

ABSTRACT: In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at 3 months). Tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, biosimilars), abatacept, tocilizumab and, under certain circumstances, rituximab are essentially considered to have similar efficacy and safety. If the first bDMARD strategy fails, any other bDMARD may be used. The recommendations also address tofacitinib as a targeted sDMARD (tsDMARD), which is recommended, where licensed, after use of at least one bDMARD. Biosimilars are also addressed. These recommendations are intended to inform rheumatologists, patients, national rheumatology societies and other stakeholders about EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. They are based on evidence and expert opinion and intended to improve outcome in patients with RA.

2 Guideline Treating rheumatoid arthritis to target: recommendations of an international task force. 2010

Smolen, Josef S / Aletaha, Daniel / Bijlsma, Johannes W J / Breedveld, Ferdinand C / Boumpas, Dimitrios / Burmester, Gerd / Combe, Bernard / Cutolo, Maurizio / de Wit, Maarten / Dougados, Maxime / Emery, Paul / Gibofsky, Alan / Gomez-Reino, Juan Jesus / Haraoui, Boulos / Kalden, Joachim / Keystone, Edward C / Kvien, Tore K / McInnes, Iain / Martin-Mola, Emilio / Montecucco, Carlomaurizio / Schoels, Monika / van der Heijde, Désirée / Anonymous5440652. ·Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, Vienna, Austria. josef.smolen@wienkav.at ·Ann Rheum Dis · Pubmed #20215140.

ABSTRACT: BACKGROUND: Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA). OBJECTIVE: /st> To develop recommendations for achieving optimal therapeutic outcomes in RA. METHODS: A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived. RESULTS: The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (> or =9/10). CONCLUSION: The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.

3 Guideline Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations. 2008

Aletaha, D / Landewe, R / Karonitsch, T / Bathon, J / Boers, M / Bombardier, C / Bombardieri, S / Choi, H / Combe, B / Dougados, M / Emery, P / Gomez-Reino, J / Keystone, E / Koch, G / Kvien, T K / Martin-Mola, E / Matucci-Cerinic, M / Michaud, K / O'Dell, J / Paulus, H / Pincus, T / Richards, P / Simon, L / Siegel, J / Smolen, J S / Sokka, T / Strand, V / Tugwell, P / van der Heijde, D / van Riel, P / Vlad, S / van Vollenhoven, R / Ward, M / Weinblatt, M / Wells, G / White, B / Wolfe, F / Zhang, B / Zink, A / Felson, D / Anonymous4270609 / Anonymous4280609. ·Medical University of Vienna, Vienna, Austria. daniel.aletaha@meduniwien.ac.at ·Arthritis Rheum · Pubmed #18821648.

ABSTRACT: OBJECTIVE: To make recommendations on how to report disease activity in clinical trials of rheumatoid arthritis (RA) endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). METHODS: The project followed the EULAR standardized operating procedures, which use a three-step approach: 1) expert-based definition of relevant research questions (November 2006); 2) systematic literature search (November 2006 to May 2007); and 3) expert consensus on recommendations based on the literature search results (May 2007). In addition, since this is the first joint EULAR/ACR publication on recommendations, an extra step included a meeting with an ACR panel to approve the recommendations elaborated by the expert group (August 2007). RESULTS: Eleven relevant questions were identified for the literature search. Based on the evidence from the literature, the expert panel recommended that each trial should report the following items: 1) disease activity response and disease activity states; 2) appropriate descriptive statistics of the baseline, the endpoints and change of the single variables included in the core set; 3) baseline disease activity levels (in general); 4) the percentage of patients achieving a low disease activity state and remission; 5) time to onset of the primary outcome; 6) sustainability of the primary outcome; 7) fatigue. CONCLUSION: These recommendations endorsed by EULAR and ACR will help harmonize the presentations of results from clinical trials. Adherence to these recommendations will provide the readership of clinical trials with more details of important outcomes, while the higher level of homogeneity may facilitate the comparison of outcomes across different trials and pooling of trial results, such as in meta-analyses.

4 Editorial Introduction: the future of rheumatoid arthritis management. 2016

Emery, Paul. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. ·Curr Opin Rheumatol · Pubmed #26945336.

ABSTRACT: -- No abstract --

5 Editorial Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution? 2013

El Zorkany, Bassel / Alwahshi, Humaid A / Hammoudeh, Mohamed / Al Emadi, Samar / Benitha, Romela / Al Awadhi, Adel / Bouajina, Elyes / Laatar, Ahmed / El Badawy, Samir / Al Badi, Marzooq / Al-Maini, Mustafa / Al Saleh, Jamal / Alswailem, Ramiz / Ally, Mahmood Moosa Tar Mahomed / Batha, Wafaa / Djoudi, Hachemi / El Garf, Ayman / El Hadidi, Khaled / El Marzouqi, Mohamed / Hadidi, Musa / Maharaj, Ajesh Basantharan / Masri, Abdel Fattah / Mofti, Ayman / Nahar, Ibrahim / Pettipher, Clive Allan / Spargo, Catherine Elizabeth / Emery, Paul. · ·Clin Rheumatol · Pubmed #23274756.

ABSTRACT: Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.

6 Editorial Remission in inflammatory arthritis: a new immunological target. 2011

Saleem, Benazir / Walsh, Ceara A E / Emery, Paul. · ·Immunotherapy · Pubmed #21463185.

ABSTRACT: -- No abstract --

7 Editorial Updating the 2003 European regulatory requirements for registering disease-modifying drugs to be used in the treatment of rheumatoid arthritis. 2011

Smolen, Josef S / Boers, Maarten / Abadie, Eric C / Breedveld, Ferdinand C / Emery, Paul / Bardin, Thomas / Goel, Niti / Ethgen, Dominique J / Avouac, Bernard P / Durez, Patrick / Flamion, Bruno / Laslop, Andrea / Miossec, Pierre / Reiter, Susanne / Reginster, Jean-Yves / Anonymous890684. · ·Rheumatology (Oxford) · Pubmed #21242246.

ABSTRACT: -- No abstract --

8 Editorial 2010 ACR-EULAR classification criteria for rheumatoid arthritis. 2010

Villeneuve, Edith / Nam, Jackie / Emery, Paul. · ·Rev Bras Reumatol · Pubmed #21125184.

ABSTRACT: -- No abstract --

9 Editorial The American College of Rheumatology/European League Against Rheumatism criteria for the classification of rheumatoid arthritis: a game changer. 2010

Cohen, Stanley / Emery, Paul. · ·Arthritis Rheum · Pubmed #20872597.

ABSTRACT: -- No abstract --

10 Editorial Delay in receiving rheumatology care leads to long-term harm. 2010

Bykerk, Vivian / Emery, Paul. · ·Arthritis Rheum · Pubmed #20722032.

ABSTRACT: -- No abstract --

11 Editorial The American College of Rheumatology/European League Against Rheumatism Criteria for the classification of rheumatoid arthritis: a game changer. 2010

Cohen, Stanley / Emery, Paul. · ·Ann Rheum Dis · Pubmed #20699239.

ABSTRACT: -- No abstract --

12 Review Genome-wide association study of response to methotrexate in early rheumatoid arthritis patients. 2018

Taylor, John C / Bongartz, Tim / Massey, Jonathan / Mifsud, Borbala / Spiliopoulou, Athina / Scott, Ian C / Wang, Jianmei / Morgan, Michael / Plant, Darren / Colombo, Marco / Orchard, Peter / Twigg, Sarah / McInnes, Iain B / Porter, Duncan / Freeston, Jane E / Nam, Jackie L / Cordell, Heather J / Isaacs, John D / Strathdee, Jenna L / Arnett, Donna / de Hair, Maria J H / Tak, Paul P / Aslibekyan, Stella / van Vollenhoven, Ronald F / Padyukov, Leonid / Bridges, S Louis / Pitzalis, Costantino / Cope, Andrew P / Verstappen, Suzanne M M / Emery, Paul / Barnes, Michael R / Agakov, Felix / McKeigue, Paul / Mushiroda, Taisei / Kubo, Michiaki / Weinshilboum, Richard / Barton, Anne / Morgan, Ann W / Barrett, Jennifer H / Anonymous8581104 / Anonymous8591104 / Anonymous8601104. ·Leeds Institute of Cancer and Pathology, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Vanderbilt University, Nashville, TN, USA. · Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. · NIHR Manchester BRC, Central Manchester Foundation Trust, Manchester, UK. · Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK. · Centre for Population Health Sciences, Usher Institute, University of Edinburgh Old Medical School, Teviot Place, Edinburgh, UK. · Pharmatics Ltd., 9, Little France Road, Edinburgh, UK. · Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University and Department of Rheumatology, Haywood Hospital, High Lane, Burslem, Staffordshire, UK. · Department of Medical and Molecular Genetics, King's College London, London, UK. · Roche Products, Welwyn Garden City, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, UK. · Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Institute of Genetic Medicine, Newcastle University, Newcastle, UK. · Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and NIHR Newcastle Biomedical Research Centre in Ageing and Long Term Conditions, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. · University of Kentucky College of Public Health, Lexington, KY, 40536, USA. · University Medical Center Utrecht, Utrecht, The Netherlands. · Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. · GlaxoSmithKline, Stevenage, UK. · Cambridge University, Cambridge, UK. · Ghent University, Ghent, Belgium. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. · Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. · Barts and The London School of Medicine & Dentistry, William Harvey Research Institute, Queen Mary University, London, UK. · Academic Department of Rheumatology, Faculty of Life Sciences and Medicine, King's College London, London, UK. · RIKEN Center for Integrative Medical Sciences, Tokyo, Japan. · Mayo Clinic, Rochester, MN, USA. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. a.w.morgan@leeds.ac.uk. ·Pharmacogenomics J · Pubmed #29795407.

ABSTRACT: Methotrexate (MTX) monotherapy is a common first treatment for rheumatoid arthritis (RA), but many patients do not respond adequately. In order to identify genetic predictors of response, we have combined data from two consortia to carry out a genome-wide study of response to MTX in 1424 early RA patients of European ancestry. Clinical endpoints were change from baseline to 6 months after starting treatment in swollen 28-joint count, tender 28-joint count, C-reactive protein and the overall 3-component disease activity score (DAS28). No single nucleotide polymorphism (SNP) reached genome-wide statistical significance for any outcome measure. The strongest evidence for association was with rs168201 in NRG3 (p = 10

13 Review The RA-MAP Consortium: a working model for academia-industry collaboration. 2018

Cope, Andrew P / Barnes, Michael R / Belson, Alexandra / Binks, Michael / Brockbank, Sarah / Bonachela-Capdevila, Francisco / Carini, Claudio / Fisher, Benjamin A / Goodyear, Carl S / Emery, Paul / Ehrenstein, Michael R / Gozzard, Neil / Harris, Ray / Hollis, Sally / Keidel, Sarah / Levesque, Marc / Lindholm, Catharina / McDermott, Michael F / McInnes, Iain B / Mela, Christopher M / Parker, Gerry / Read, Simon / Pedersen, Ayako Wakatsuki / Ponchel, Frederique / Porter, Duncan / Rao, Ravi / Rowe, Anthony / Schulz-Knappe, Peter / Sleeman, Matthew A / Symmons, Deborah / Taylor, Peter C / Tom, Brian / Tsuji, Wayne / Verbeeck, Denny / Isaacs, John D / Anonymous4791104. ·Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 1UL, UK. · Queen Mary University of London, UK. · GlaxoSmithKline. · Newcastle University, UK. · Janssen. · Pfizer. · University of Birmingham, UK. · University of Glasgow, UK. · University of Leeds, UK. · University College London, UK. · UCB Pharma. · Elsai. · AstraZeneca. · Abbvie. · Roche. · Grunenthal. · Protagen AG. · MedImmune. · University of Manchester, UK. · University of Oxford, UK. · University of Cambridge, UK. · Amgen. ·Nat Rev Rheumatol · Pubmed #29213124.

ABSTRACT: Collaboration can be challenging; nevertheless, the emerging successes of large, multi-partner, multi-national cooperatives and research networks in the biomedical sector have sustained the appetite of academics and industry partners for developing and fostering new research consortia. This model has percolated down to national funding agencies across the globe, leading to funding for projects that aim to realise the true potential of genomic medicine in the 21st century and to reap the rewards of 'big data'. In this Perspectives article, the experiences of the RA-MAP consortium, a group of more than 140 individuals affiliated with 21 academic and industry organizations that are focused on making genomic medicine in rheumatoid arthritis a reality are described. The challenges of multi-partner collaboration in the UK are highlighted and wide-ranging solutions are offered that might benefit large research consortia around the world.

14 Review Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. 2018

Takase-Minegishi, Kaoru / Horita, Nobuyuki / Kobayashi, Kouji / Yoshimi, Ryusuke / Kirino, Yohei / Ohno, Shigeru / Kaneko, Takeshi / Nakajima, Hideaki / Wakefield, Richard J / Emery, Paul. ·Center for Rheumatic Diseases, Yokohama City University Medical Center. · Department of Pulmonology. · Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. ·Rheumatology (Oxford) · Pubmed #28340066.

ABSTRACT: Objective: To evaluate diagnostic test accuracy of US compared with MRI for the detection of synovitis in RA patients. Methods: A systematic literature search was performed in the PubMed, EMBASE, Cochrane Library and Web of Science Core Collection databases. Studies evaluating the diagnostic test accuracy of US for synovitis detected by MRI as the reference standard for wrist, MCP, PIP and knee joints were included. To assess the overall accuracy, we calculated the diagnostic odds ratio using a DerSimonian-Laird random effects model and the area under the curve (AUC) for the hierarchical summary receiver operating characteristics using Holling's proportional hazards models. The summary estimate of the sensitivity and specificity were obtained using the bivariate model. Results: Fourteen of 601 identified articles were included in the review. The diagnostic odds ratio was 11.6 (95% CI 5.6, 24; I2 = 0%), 28 (95% CI 12, 66; I2 = 11%), 23 (95% CI 6.5, 84; I2 = 19%) and 5.3 (95% CI 0.60, 48; I2 = 0%) and the AUC was 0.81, 0.91, 0.91 and 0.61 for wrist, MCP, PIP and knee joints, respectively. The summary estimates of sensitivity and specificity were 0.73 (95% CI 0.51, 0.87)/0.78 (95% CI 0.46, 0.94), 0.64 (95% CI 0.43, 0.81)/0.93 (95% CI 0.88, 0.97), 0.71 (95% CI 0.33, 0.93)/0.94 (95% CI 0.89, 0.97) and 0.91 (95% CI 0.56, 0.99)/0.60 (95% CI 0.20, 0.90) for wrist, MCP, PIP and knee joints, respectively. Conclusion: US is a valid and reproducible technique for detecting synovitis in the wrist and finger joints. It may be considered for routine use as part of the standard diagnostic tools in RA.

15 Review What can palindromic rheumatism tell us? 2017

Mankia, Kulveer / Emery, Paul. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: k.s.mankia@leeds.ac.uk. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: p.emery@leeds.ac.uk. ·Best Pract Res Clin Rheumatol · Pubmed #29221602.

ABSTRACT: Palindromic rheumatism (PR) is a syndrome characterised by recurrent, self-resolving inflammatory attacks in and around the joints. An association between PR and rheumatoid arthritis (RA) has long been postulated; a significant proportion of PR patients eventually develop RA and the majority also have anti-CCP antibodies. Therefore, PR is often considered a prodrome of RA. However, the clinical and imaging phenotype of PR has several important distinctions from RA. This suggests that despite the similarities, distinct disease mechanisms are at play. Given the paucity of evidence-based therapy in PR, a better understanding of these mechanisms will be important for refined and targeted therapeutic approaches for this important condition.

16 Review Periodontal disease and periodontal bacteria as triggers for rheumatoid arthritis. 2017

Cheng, Zijian / Meade, Josephine / Mankia, Kulveer / Emery, Paul / Devine, Deirdre A. ·Division of Oral Biology, School of Dentistry, University of Leeds, UK. · Leeds Musculoskeletal Biomedical Research Unit, School of Medicine, University of Leeds, UK. · Division of Oral Biology, School of Dentistry, University of Leeds, UK. Electronic address: d.a.devine@leeds.ac.uk. ·Best Pract Res Clin Rheumatol · Pubmed #29221594.

ABSTRACT: There is an epidemiological association between periodontitis and rheumatoid arthritis (RA), which is hypothesised to lead to enhanced generation of RA-related autoantibodies that can be detected years before the onset of RA symptoms. Periodontitis is a common dysbiotic disease; tissue damage occurs because the immune system fails to limit both the resident microbial community and the associated local immune response. Certain periodontal bacteria, including Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, may contribute to RA autoantibody production through direct post-translational modification of proteins or, indirectly, by influencing neutrophil-mediated neo-epitope generation. Oral bacteria that invade the blood may also contribute to chronic inflammatory responses and generation of autoantibodies. The putative association between periodontitis and the development of RA raises the potential of finding novel predictive markers of disease and disease progression and for periodontitis treatment to be included in the future as an adjunct to conventional RA immunotherapy or as part of a preventive strategy.

17 Review Down-titration of biologics for the treatment of rheumatoid arthritis: a systematic literature review. 2017

Lau, Chak Sing / Gibofsky, Allan / Damjanov, Nemanja / Lula, Sadiq / Marshall, Lisa / Jones, Heather / Emery, Paul. ·Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Pok Fu Lam, Hong Kong. CSLau@hku.hk. · Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA. · Belgrade University School of Medicine, Belgrade, Serbia. · Envision Pharma Group, Market Access Solutions, London, UK. · Medical Affairs, Pfizer, Collegeville, PA, USA. · Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. ·Rheumatol Int · Pubmed #28852832.

ABSTRACT: Biologic therapies have improved the management of rheumatoid arthritis (RA) and the treat-to-target approach has resulted in many patients achieving remission. In the current treatment landscape, clinicians have begun considering dose reduction/tapering for their patients. Rheumatology guidelines in Asia, Europe, and the United States include down-titration of biologics but admit that the level of evidence is moderate. We conducted a systematic literature review to assess the published studies that evaluate down-titration of biologics in RA. The published literature was searched for studies that down-titrated the following biologics: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Eligible studies included randomized controlled trials (RCTs), non-RCTs, observational, and pharmacoeconomic studies. The outcomes of interest were (1) efficacy and health-related quality of life, (2) disease flares, and (3) impact on cost. Eleven full-text publications were identified; only three were RCTs. Study results suggest that dosing down may be an option in many patients who have achieved remission or low disease activity. However, some patients are likely to experience a disease flare. Across the studies, the definition of disease flare and the down-titration criteria were inconsistent, making it difficult to conclude which patients may be appropriate and when to attempt down-titration. Studies have evaluated the practice of dosing down biologic therapy in patients with RA; however, a relatively small number of RCTs have been published. Although down-titration may be an option for some patients in LDA or remission, additional RCTs are needed to provide guidance on this practice.

18 Review Synovial tissue research: a state-of-the-art review. 2017

Orr, Carl / Vieira-Sousa, Elsa / Boyle, David L / Buch, Maya H / Buckley, Christopher D / Cañete, Juan D / Catrina, Anca I / Choy, Ernest H S / Emery, Paul / Fearon, Ursula / Filer, Andrew / Gerlag, Danielle / Humby, Frances / Isaacs, John D / Just, Søren A / Lauwerys, Bernard R / Le Goff, Benoit / Manzo, Antonio / McGarry, Trudy / McInnes, Iain B / Najm, Aurélie / Pitzalis, Constantino / Pratt, Arthur / Smith, Malcolm / Tak, Paul P / Thurlings, Rogier / Fonseca, João E / Veale, Douglas J / Tas, Sander W. ·Centre for Arthritis and Rheumatic Disease, University College Dublin, Dublin Academic Medical Centre, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. · Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal. · University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, California 92093, USA. · Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. · Rheumatology Research Group, University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK. · Arthritis Unit, Rheumatology Department, Hospital Clínic, IDIBAPS, Villarroel, 170, 08036 Barcelona, Spain. · Rheumatology Unit, Department of Medicine (Solna), Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden. · Cardiff University School of Medicine, Institute of Infection and Immunity, 1 st Floor, Tenovus Building, Heath Park, Cardiff CF14 4XN, UK. · Department of Molecular Rheumatology, Trinity College Dublin, University of Dublin, College Green, Dublin 2, Ireland. · Department of Clinical Immunology &Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, POBox 22700, 1100 DE, Amsterdam, Netherlands. · Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, UK. · Centre for Experimental Medicine and Rheumatology, John Vane Science Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. · Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. · Department of Medicine, Svendborg Hospital, Odense University Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark. · Université catholique de Louvain and Department of Rheumatology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium. · Rheumatology Unit, Nantes University Hospital, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. · Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100 Pavia, Italy. · Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences University of Glasgow, 120 University Avenue, Glasgow G12 8TA, UK. · Rheumatology, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia. · GlaxoSmithKline, Cambridge, UK. · Institute for Molecular Life Sciences, RadboudUMC, Theodoor Craanenlaan 11, Nijmegen 6525 GA, Netherlands. ·Nat Rev Rheumatol · Pubmed #28701760.

ABSTRACT: The synovium is the major target tissue of inflammatory arthritides such as rheumatoid arthritis. The study of synovial tissue has advanced considerably throughout the past few decades from arthroplasty and blind needle biopsy to the use of arthroscopic and ultrasonographic technologies that enable easier visualization and improve the reliability of synovial biopsies. Rapid progress has been made in using synovial tissue to study disease pathogenesis, to stratify patients, to discover biomarkers and novel targets, and to validate therapies, and this progress has been facilitated by increasingly diverse and sophisticated analytical and technological approaches. In this Review, we describe these approaches, and summarize how their use in synovial tissue research has improved our understanding of rheumatoid arthritis and identified candidate biomarkers that could be used in disease diagnosis and stratification, as well as in predicting disease course and treatment response.

19 Review EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. 2017

Smolen, Josef S / Landewé, Robert / Bijlsma, Johannes / Burmester, Gerd / Chatzidionysiou, Katerina / Dougados, Maxime / Nam, Jackie / Ramiro, Sofia / Voshaar, Marieke / van Vollenhoven, Ronald / Aletaha, Daniel / Aringer, Martin / Boers, Maarten / Buckley, Chris D / Buttgereit, Frank / Bykerk, Vivian / Cardiel, Mario / Combe, Bernard / Cutolo, Maurizio / van Eijk-Hustings, Yvonne / Emery, Paul / Finckh, Axel / Gabay, Cem / Gomez-Reino, Juan / Gossec, Laure / Gottenberg, Jacques-Eric / Hazes, Johanna M W / Huizinga, Tom / Jani, Meghna / Karateev, Dmitry / Kouloumas, Marios / Kvien, Tore / Li, Zhanguo / Mariette, Xavier / McInnes, Iain / Mysler, Eduardo / Nash, Peter / Pavelka, Karel / Poór, Gyula / Richez, Christophe / van Riel, Piet / Rubbert-Roth, Andrea / Saag, Kenneth / da Silva, Jose / Stamm, Tanja / Takeuchi, Tsutomu / Westhovens, René / de Wit, Maarten / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands. · Zuyderland Medical Center, Heerlen, The Netherlands. · Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany. · Rheumatology Department, Karolinska Institute, Stockholm, Sweden. · Rhumatologie B, Hopital Cochin, Paris, France. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. · Division of Rheumatology, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. · Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. · Birmingham NIHR Wellcome Trust Clinical Research Facility, Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK. · Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA. · Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. · Centro de Investigación Clínica de Morelia SC, Michoacán, México. · Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France. · Research Laboratory and Division of Clinical Rheumatology, University of Genoa, Genoa, Italy. · Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands. · Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland. · Fundación Ramón Dominguez, Hospital Clinico Universitario, Santiago, Spain. · Department of Rheumatology, Sorbonne Universités, Pitié Salpêtrière Hospital, Paris, France. · Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg University Hospital and University of Strasbourg, CNRS, Strasbourg, France. · Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK. · V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation. · European League Against Rheumatism, Zurich, Switzerland. · Cyprus League against Rheumatism, Nicosia, Cyprus. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China. · Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, INSERM U1184, Center for Immunology of viral Infections and Autoimmune Diseases (IMVA), Le Kremlin Bicêtre, France. · Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. · Organización Médica de Investigación, Buenos Aires, Argentina. · Department of Medicine, University of Queensland, Queensland, Australia. · Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic. · National Institute of Rheumatology and Physiotherapy, Semmelweis University, Budapest, Hungary. · Rheumatology Department, FHU ACRONIM, Pellegrin Hospital and UMR CNRS 5164, Bordeaux University, Bordeaux, France. · Department of Rheumatology, Bernhoven, Uden, The Netherlands. · University of Cologne, Cologne, Germany. · Division of Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, Coimbra, Portugal. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Keio University School of Medicine, Keio University Hospital, Tokyo, Japan. · Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · Department Medical Humanities, VU Medical Centre, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #28264816.

ABSTRACT: Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.

20 Review Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis. 2017

Allen, P B / Olivera, P / Emery, P / Moulin, D / Jouzeau, J-Y / Netter, P / Danese, S / Feagan, B / Sandborn, W J / Peyrin-Biroulet, L. ·Division of Gastroenterology, Ulster Hospital, Belfast, UK. · Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · UMR 7365 IMoPA CNRS-Université de Lorraine, Biopôle de l'Université de Lorraine, Campus Biologie-Santé, Vandœuvre-lès-Nancy Cedex, France. · Department of Gastroenterology, IBD Center, Istituto Clinico Humanitas, Humanitas University, Milan, Italy. · Western University, London, ON, Canada. · Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA. · Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-les-Nancy, France. ·Aliment Pharmacol Ther · Pubmed #28247573.

ABSTRACT: BACKGROUND: Crohn's disease (CD) and rheumatoid arthritis are chronic, progressive and disabling conditions that frequently lead to structural tissue damage. Based on strategies originally developed for rheumatoid arthritis, the treatment goal for CD has recently moved from exclusively controlling symptoms to both clinical remission and complete mucosal healing (deep remission), with the final aim of preventing bowel damage and disability. AIM: To review the similarities and differences in treatment goals between CD and rheumatoid arthritis. METHODS: This review examined manuscripts from 1982 to 2016 that discussed and/or proposed therapeutic goals with their supportive evidence in CD and rheumatoid arthritis. RESULTS: Proposed therapeutic strategies to improve outcomes in both rheumatoid arthritis and CD include: (i) evaluation of musculoskeletal or organ damage and disability, (ii) tight control, (iii) treat-to-target, (iv) early intervention and (v) disease modification. In contrast to rheumatoid arthritis, there is a paucity of disease-modification trials in CD. CONCLUSIONS: Novel therapeutic strategies in CD based on tight control of objective signs of inflammation are expected to change disease course and patients' lives by halting progression or, ideally, preventing the occurrence of bowel damage. Most of these strategies require validation in prospective studies, whereas several disease-modification trials have addressed these issues in rheumatoid arthritis over the last decade. The recent approval of new drugs in CD such as vedolizumab and ustekinumab should facilitate initiation of disease-modification trials in CD in the near future.

21 Review Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission. 2016

D'Agostino, Maria Antonietta / Terslev, Lene / Wakefield, Richard / Østergaard, Mikkel / Balint, Peter / Naredo, Esperanza / Iagnocco, Annamaria / Backhaus, Marina / Grassi, Walter / Emery, Paul. ·Rheumatology Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Third Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. · Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain. · Ultrasound Unit, Rheumatology Department, Sapienza Università di Roma, Rome, Italy. · Department of Internal Medicine, Rheumatology and Clinical Immunology Academic Hospital of the Charité Berlin, Park-Klinik Weissensee Berlin, Berlin, Germany. · Clinica Reumatologica-Scuola di Specializzazione in Reumatologia Università Politecnica delle Marche, Ancona, Italy. ·Ann Rheum Dis · Pubmed #27553213.

ABSTRACT: The absence of specific guidance on how to use ultrasound (US) to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of US in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to European League against Rheumatism (EULAR) imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely five novel algorithms, which identify when US could be used. They are designed to aid diagnosis, to inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs.

22 Review Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. 2016

Schett, Georg / Emery, Paul / Tanaka, Yoshiya / Burmester, Gerd / Pisetsky, David S / Naredo, Esperanza / Fautrel, Bruno / van Vollenhoven, Ronald. ·Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany. · Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK. · Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany. · The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. · Duke University Medical Center, Medical Research Service, Durham, North Carolina, USA. · Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. · Rheumatology Department, UPMC-GRC 08, Pierre Louis Institute for Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France. · ARC: Amsterdam Rheumatology and Immunology Center. ·Ann Rheum Dis · Pubmed #27261493.

ABSTRACT: Improvements in the control of inflammation in rheumatoid arthritis (RA) by conventional synthetic and biologic disease-modifying antirheumatic drugs (DMARDs) have led to a substantial change in the clinical outcomes of patients during the last 30 years. Current treatment can lead to sustained remission in some patients raising questions about the optimal management strategies in this subgroup of patients. Today, tapering of DMARDs and even their discontinuation appears as an interesting concept for achieving a more tailored and dynamic treatment approach of RA, especially in patients, who achieved full disease control by DMARD treatment. In this review article, current developments of DMARD tapering are discussed. The article provides an overview of existing studies on this topic and addresses new strategies to reach drug-free remission. Furthermore, concepts for defining patients eligible for DMARD tapering are described and potential future strategies in using biomarkers in predicting the risk for disease relapse after initiation of DMARD tapering are addressed. These findings are finally considered in light of the vision to achieve cure as an ultimate goal in patients with RA achieving full control of inflammation.

23 Review A new window of opportunity in rheumatoid arthritis: targeting at-risk individuals. 2016

Mankia, Kulveer / Emery, Paul. ·aLeeds Institute of Rheumatic and Musculoskeletal MedicinebLeeds Musculoskeletal Biomedical Research Unit, Leeds, UK. ·Curr Opin Rheumatol · Pubmed #27027813.

ABSTRACT: PURPOSE OF REVIEW: Progress in our understanding of the preclinical events in rheumatoid arthritis (RA) has provided important insights into disease pathogenesis. Studying prospective cohorts of individuals at risk for RA development offers the opportunity to accurately characterize the sequence of events in preclinical disease as well as quantify the risk of different preclinical phenotypes. These data may provide the basis for preventive strategies in RA. RECENT FINDINGS: RA-related systemic autoimmunity and inflammation occur long before clinical arthritis. There is growing evidence that initiating events may occur at mucosal surfaces including the periodontium, lung and gut and may be influenced by the local microbiome. For potential preventive strategies to be feasible, it is important that individuals at high risk for RA development can be readily identified from the general population. To this end, studying multiple biomarkers in prospective cohorts of at-risk individuals enables risk prediction in different at-risk phenotypes. RA prevention using immunomodulation is currently being investigated in individuals at high risk of RA development. SUMMARY: The prospective study of at-risk individuals can provide invaluable aetiological insights as well as facilitating accurate risk prediction data. In this way, high-risk individuals may be identified for preventive interventions.

24 Review Preclinical Rheumatoid Arthritis: Progress Toward Prevention. 2016

Mankia, Kulveer / Emery, Paul. ·: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. ·Arthritis Rheumatol · Pubmed #26814677.

ABSTRACT: -- No abstract --

25 Review Glucocorticoids and Rheumatoid Arthritis. 2016

Ferreira, Joana Fonseca / Ahmed Mohamed, Alaa Abdelkhalik / Emery, Paul. ·Rheumatology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal. · Rheumatology, Physical medicine and Rehabilitation Department, Assiut University Hospitals, Assiut 71515, Egypt. · Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. Electronic address: p.emery@leeds.ac.uk. ·Rheum Dis Clin North Am · Pubmed #26611549.

ABSTRACT: Glucocorticoids (GCs) were discovered in the 1940s and were administered for the first time to patients with rheumatoid arthritis in 1948. However, side effects were subsequently reported. In the last 7 decades, the mechanisms of action for both therapeutic properties and side effects have been elucidated. Mechanisms for minimizing side effects were also developed. GCs are the most frequently used class of drugs in the treatment of rheumatoid arthritis because of their efficacy in relieving symptoms and their low cost. A review of clinical applications, side effects, and drug interactions is presented.