Objectives: Suboptimal medication adherence is a serious problem in the treatment of chronic inflammatory diseases. To measure medication adherence, electronic monitoring is regarded as superior to pill count. GLORIA is an ongoing two-year trial on the addition of low-dose (5 mg/d) prednisolone or placebo to standard care in older people (65+ years) with RA. During the entire trial, adherence is measured with electronic caps, and with pill counts. The objective is to describe medication adherence patterns, and to compare the adherence results of the two methods. Methods: The recorded adherence patterns of patients (blinded for treatment group) were classified according to descriptive categories. The cutoff for good adherence was set at 80% of prescribed pills taken. Results: Trial inclusion closed in 2018 at 451 patients, but trial follow-up is ongoing; the current dataset contains adherence data of 371 patients. Mean number of recorded 90-day periods per patient was 4 (range 1–8). Based on pill count over all periods, 90% of the patients had good adherence; based on cap data, only 20%. Cap data classified 30% of patients as non-user (<20% of days an opening) and 40% as irregular user (different adherence patterns, in or between periods). Conclusion: In our trial of older people with RA, the majority appeared to be adherent to medication according to pill count. Results from caps conflicted with those of pill counts, with patterns suggesting patients did not use the bottle for daily dispensing, despite specific advice to do so. Trial registration: NCT02585258. ClinicalTrials.gov (https://www.clinicaltrials.gov/)

Objective To compare the effectiveness of a strategy administering baricitinib versus one using TNF-inhibitors (TNFi) in patients with rheumatoid arthritis (RA) after conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) failure in a real-life treat-to-target (T2T) setting. Methods Patients with biological and targeted synthetic DMARD (b/tsDMARD) naïve RA with disease duration ≤5 years without contraindications to b/tsDMARD were randomised to either TNFi or baricitinib when csDMARD failed to achieve disease control in a T2T setting. Changes in clinical and patient-reported outcome measures (PROMs) were assessed at 12-week intervals for 48 weeks. The primary endpoint was non-inferiority, with testing for superiority if non-inferiority is demonstrated, of baricitinib strategy in the number of patients achieving American College of Rheumatology 50 (ACR50) response at 12 weeks. Secondary endpoints included 28-joint count Disease Activity Score with C reactive protein (DAS28-CRP) <2.6, changes in PROMs and radiographic progression. Results A total of 199 patients (TNFi, n=102; baricitinib, n=97) were studied. Both study groups were similar. Baricitinib was both non-inferior and superior in achieving ACR50 response at week 12 (42% vs 20%). Moreover, 75% of baricitinib patients achieved DAS28-CRP <2.6 at week 12 compared with 46% of TNFi patients. On secondary outcomes throughout the duration of the study, the baricitinib strategy demonstrated comparable or better outcomes than TNFi strategy. Although not powered for safety, no unexpected safety signals were seen in this relatively small group of patients. Conclusion Up to present, in a T2T setting, patients with RA failing csDMARDs have two main strategies to consider, Janus Kinases inhibitor versus bDMARDs (in clinical practice, predominantly TNFi). The PERFECTRA study suggested that starting with baricitinib was superior over TNFi in achieving response at 12 weeks and resulted in improved outcomes across all studied clinical measures and PROMs throughout the study duration in these patients.

Objective: Psoriatic arthritis (PsA) is associated with metabolic and cardiovascular (CV) disease. Studies have suggested that treatment with apremilast is associated with weight loss and other cardiometabolic benefits. This study aimed to examine the effects of apremilast on body weight, body composition, and CV risk factors in patients with PsA.Methods: This longitudinal, nonrandomized, multicenter trial included adults with active PsA initiating apremilast (30 mg twice daily after a step-up regimen). Patients were followed for 12 months, and measurements were done at baseline and repeated at weeks 26 and 52. Body composition, the primary outcome, was assessed using dual-energy x-ray absorptiometry. Secondary outcomes included disease activity (Disease Activity Score in 28 joints [DAS28] based on C-reactive protein [CRP]), blood pressure (BP), lipids, intima-media thickness, and glucose. Statistical analysis involved mixed models adjusted for relevant covariates.Results: Forty-four patients were included, with a mean age of 56 (SD 11) years and a median BMI (kg/m²) of 28 (IQR 24-33). A total of 17 patients completed the study, whereas 27 discontinued due to ineffectiveness or side effects. After 1 year of apremilast, significant reductions were observed in multiple body mass measures, including total fat (–7.4 kg;P= 0.005) and android fat (–1.1 kg;P= 0.002). Lean mass remained stable. BP showed minor reduction, whereas lipids, intima-media thickness, and glucose levels did not change. Disease activity improved, with a significant decrease in DAS28-CRP (–0.6;P= 0.01). Android fat correlated most strongly with disease activity reduction (r0.31;P= 0.004).Conclusion: This study demonstrates that apremilast reduces fat mass in patients with PsA and suggests beneficial CV and metabolic effects, potentially reducing the risk of CV events.

Background/Objectives: The multifactorial nature of immune-mediated inflammatory diseases (IMIDs) requires integrating pathophysiological understanding with subjective patient experiences. Patient-reported outcome measures (PROMs) are a useful tool for incorporating this in routine clinical practice. However, current PROMs do not fully encompass the complete subjective health experiences (SHE) of patients and are thus insufficient for guiding truly personalised care. The SHE model provides insights into SHE through the determinants of disease acceptance and perceived control. While validated across various demographics, its predictive power in IMIDs cohorts remains unexplored. This study aims to assess whether acceptance and perceived control in the SHE model predict health experiences in patients with IMID and how these immunological conditions compare. Methods: Questionnaires regarding health perception, acceptance, control, and subjective health experiences were distributed to 450 Dutch citizens. Descriptive statistics, reliability checks, and partial least squares structural equation modelling were used to examine relationships between variables. Results: Health perception strongly predicts SHE through acceptance and control. Across all conditions, the pathway moves from health perception to control, then to acceptance, and finally to SHE. However, the roles of acceptance and control differ by condition. In burdensome diseases like inflammatory bowel disease and rheumatoid arthritis, acceptance plays a greater role, while control has a stronger influence in conditions like psoriasis. Conclusions: This study supports the predictive validity of the SHE model for IMIDs, showing that disease acceptance and control affect health experiences differently across conditions. These insights improve the understanding of psychological factors in health experiences and call for tailored interventions for patients with IMID.

Current insights into how to personalise supportive care for patients with immune-mediated inflammatory disorders (IMIDs) remain limited. Enhancing supportive care can significantly improve patients’ quality of life and overall healthcare. The Subjective Health Experience (SHE) model offers a practical framework for segmenting patients based on disease acceptance and control, potentially guiding tailored supportive care.