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Ljung L, Jönsson E, Franklin J, Berglin E, Lundquist A, Rantapää-Dahlqvist S. Incidence and predisposing factors of extra-articular manifestations in contemporary rheumatoid arthritis. Eur J Intern Med 2024:S0953-6205(24)00185-7. [PMID: 38705755 DOI: 10.1016/j.ejim.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Rheumatoid arthritis [RA) is a chronic inflammatory disease, with potential for extra-articular manifestations (ExRA). The incidence and predisposing factors for ExRA and the mortality were evaluated in an early RA inception cohort. METHODS Patients (n = 1468; 69 % females, mean age (SD) 57.3(16.3) years) were consecutively included at the date of diagnosis, between 1 January 1996 and 31 December 2016, and assessed prospectively. In December 2016 development of ExRA was evaluated by a patient questionnaire and a review of medical records. Cumulative incidence and incidence rates were compared between 5-year periods and between patients included before and after 1 January 2001. Cox proportional hazard regression models were used to identify predictors for ExRA, and models with ExRA as time-dependent variables to estimate the mortality. RESULTS After a mean (SD) follow-up of 9.3(4.9) years, 238 cases (23.3 %) had ExRA and 151 (14.7 %) had ExRA without rheumatoid nodules. Most ExRA developed within 5 years from diagnosis. Rheumatoid nodules (10.5 %) and keratoconjunctivitis sicca (7.1 %) were the most frequent manifestations, followed by pulmonary fibrosis (6.1 %). The ExRA incidence among more recently diagnosed patients was similar as to the incidence among patients diagnosed before 2001. Seropositivity, smoking and early biological treatment were associated with development of ExRA. After 15 years 20 % had experienced ExRA. ExRA was associated with increased mortality, HR 3.029 (95 % CI 2.177-4.213). CONCLUSIONS Early development of ExRA is frequent, particularly rheumatoid nodules. Predisposing factors were age, RF positivity, smoking and early biological treatment. The patients with ExRA had a 3-fold increase in mortality.
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Affiliation(s)
- Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden; Academic Specialist Center, Center for Rheumatology, Health Care Services Stockholm County (SLSO), Stockholm, Sweden
| | - Elias Jönsson
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
| | - Johan Franklin
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
| | - Ewa Berglin
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
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Abstract
Janus Kinase inhibitors (JAKi) have been approved for the treatment of Rheumatoid Arthritis (RA) for several years. They are the first oral advanced treatment with efficacy similar to, if not greater than, biologic agents. Recently, concerns over their safety was raised by the results from Oral Surveillance trial suggesting that tofacitinib, one of the JAKi, was associated with higher cardiovascular adverse events and malignancies than TNF inhibitors (TNFi). Since then, regulatory authorities have added warnings to the labels of JAKi. On this purpose, whether rheumatologists should use JAKi as first line advance treatment has become a controversial topic. Some rheumatologists have argued that biologics should be first line advance treatment since there are extensive effectiveness and safety data. In addition, with the advent of biosimilar drugs, they are the most cost-effective treatment. On the other hand, JAKi are very efficacious and are generally safe apart from older and high-risk patients. When TNFi are contraindicated and in certain RA patients ,especially when an oral drug is preferable, JAKi have significant advantage providing patients are involved in the decision-making process.
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Affiliation(s)
- Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy.
| | - Sabino Germinario
- Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy
| | - Dorottya Kacsándi
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Khabsa J, Yaacoub S, Omair MA, Al Rayes H, Akl EA. Methodology for the adolopment of recommendations for the treatment of rheumatoid arthritis in the Kingdom of Saudi Arabia. BMC Med Res Methodol 2023; 23:224. [PMID: 37817088 PMCID: PMC10563247 DOI: 10.1186/s12874-023-02031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Currently, there are no guidelines for the treatment of rheumatoid arthritis (RA) tailored to the context of the Kingdom of Saudi Arabia (KSA). Adaptation of guidelines accounts for contextual factors and becomes more efficient than de novo guideline development when relevant, good quality, and up-to-date guidelines are available. The objective of this study is to describe the methodology used for the adolopment of the 2021 American College of Rheumatology (ACR) guidelines for the treatment of RA in the KSA. METHODS We followed the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE)-ADOLOPMENT methodology. The adolopment KSA panel included relevant stakeholders and leading contributors to the original guidelines. We developed a list of five adaptation-relevant prioritization criteria that the panelists applied to the original recommendations. We updated the original evidence profiles with newly published studies identified by the panelists. We constructed Evidence to Decision (EtD) tables including contextual information from the KSA setting. We used the PanelVoice function of GRADEPro Guideline Development Tool (GDT) to obtain the panel's judgments on the EtD criteria ahead of the panel meeting. Following the meeting, we used the PANELVIEW instrument to obtain the panel's evaluation of the process. RESULTS The KSA panel prioritized five recommendations, for which one evidence profile required updating. Out of five adoloped recommendations, two were modified in terms of direction, and one was modified in terms of certainty of the evidence. Criteria driving the modifications in direction were valuation of outcomes, balance of effects, cost, and acceptability. The mean score on the 7-point scale items of the PANELVIEW instrument had an average of 6.47 (SD = 0.18) across all items. CONCLUSION The GRADE-ADOLOPMENT methodology proved to be efficient. The panel assessed the process and outcome positively. Engagement of stakeholders proved to be important for the success of this project.
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Affiliation(s)
- Joanne Khabsa
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Al Rayes
- Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Riad-El-Solh, P.O. Box: 11-0236, Beirut, 1107 2020 Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
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4
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Gossec L, Theander E, Chakravarty SD, Bergmans P, Lavie F, Noël W, Sharaf M, Siebert S, Smolen JS. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther 2023; 25:100. [PMID: 37296456 PMCID: PMC10251537 DOI: 10.1186/s13075-023-03078-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This post-hoc analysis of PsABio (NCT02627768) evaluated safety, effectiveness and treatment persistence in patients < 60 and ≥ 60 years of age receiving ustekinumab over 3 years. METHODS Measures included adverse events (AE), clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) low disease activity (LDA) including remission, Psoriatic Arthritis Impact of Disease-12 (PsAID-12), Minimal Disease Activity, dactylitis, nail/skin involvement and time to treatment stop. Data were analysed descriptively. RESULTS Overall, 336 patients < 60 and 103 ≥ 60 years received ustekinumab, with a similar gender balance. A numerically lower proportion of younger patients reported at least one AE: 124/379 (32.7%) vs 47/115 (40.9%) for patients < 60 and ≥ 60 years, respectively. Serious AEs were low (< 10%) in both groups. At 6 months, the proportion of patients with cDAPSA LDA was 138/267 (51.7%) and 35/80 (43.8%) for patients < 60 and ≥ 60 years, respectively, with the effectiveness being maintained through 36 months. PsAID-12 mean scores reduced for both groups from a baseline mean of 5.73 and 5.61 for patients < 60 and ≥ 60 years, respectively, to 3.81 and 3.88, respectively, at 6 months, and 2.02 and 3.24, respectively, at 36 months. Regarding treatment persistence, 173/336 (51.5%) vs 47/103 (45.6%) patients < 60 and ≥ 60 years, respectively, stopped or switched treatment. CONCLUSION Fewer AEs were observed over 3 years for younger versus older patients with PsA. There were no clinically meaningful treatment response differences. Persistence was numerically higher in the older age group.
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Affiliation(s)
- Laure Gossec
- Faculty of Medicine, Sorbonne Université, INSERM, IPLESP, Paris, France.
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Bd Hôpital, 75013, Paris, France.
| | - Elke Theander
- Department of Medical Affairs, Janssen-Cilag AB, Solna, Sweden
| | - Soumya D Chakravarty
- Department of Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Department of Rheumatology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Paul Bergmans
- Department of Biostatistics, Janssen-Cilag BV, Breda, Netherlands
| | - Frederic Lavie
- Department of Medical Affairs, Janssen-Cilag, Cedex, France
| | - Wim Noël
- Department of Medical Affairs, Janssen Pharmaceuticals NV, Beerse, Belgium
| | - Mohamed Sharaf
- Department of Medical Affairs, Janssen, Dubai, United Arab Emirates
| | - Stefan Siebert
- School of Infection & Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Josef S Smolen
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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5
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Omair MA, Al Rayes H, Khabsa J, Yaacoub S, Abdulaziz S, Al Janobi GA, Al Khalaf A, Al Mehmadi B, Al Nassar M, AlBalawi F, AlFurayj AS, Al-Jedai AH, Almalag HM, Almudaiheem HY, AlRehaily A, Attar MA, El Kibbi L, Halabi H, Hasan M, Singh JA, Fraenkel L, Akl EA. Recommendations for the treatment of rheumatoid arthritis in Saudi Arabia: adolopment of the 2021 American College of Rheumatology guidelines. BMC Rheumatol 2022; 6:70. [PMID: 36414983 PMCID: PMC9682746 DOI: 10.1186/s41927-022-00301-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for the treatment of rheumatoid arthritis RA for the context of Saudi Arabia, by the Saudi Society for Rheumatology (SSR). METHODS The process followed the GRADE-ADOLOPMENT methodology, and the reporting adhered to the RIGHT-Ad@pt checklist. Working groups included a coordination group and a 19-member panel representing different stakeholder groups. The Evidence to Decision (EtD) tables included evidence on health effects from the source guideline and contextual information from the Saudi setting. RESULTS The panel prioritized and adapted five recommendations from the source guideline. The process led to modifying two out of the five prioritized recommendations, all listed here. In naive patients with low disease activity, methotrexate (MTX) is conditionally recommended over sulfasalazine (SSZ) (modified direction); hydroxychloroquine (HCQ) is conditionally recommended over SSZ (unmodified). Initiation of csDMARDs with short-term glucocorticoids is conditionally recommended over csDMARDs alone in naive patients with moderate to high disease activity (modified direction). Switch to subcutaneous MTX is conditionally recommended over addition/switch to alternative DMARD(s) in patients taking oral MTX who are not at target (unmodified). Discontinuation of MTX is conditionally recommended over gradual discontinuation of the bDMARD or tsDMARD for patients taking MTX plus a bDMARD or tsDMARD who wish to discontinue a DMARD (unmodified). CONCLUSION Rheumatologists practicing in Saudi Arabia can use the adoloped recommendations generated by this project while adopting the rest of the recommendations from the 2021 ACR guidelines.
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Affiliation(s)
- Mohammed A. Omair
- grid.56302.320000 0004 1773 5396Rheumatology Unit, Department of Medicine, King Saud University, PO Box 2925, Riyadh, 11461 Saudi Arabia
| | - Hanan Al Rayes
- grid.415989.80000 0000 9759 8141Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Joanne Khabsa
- grid.411654.30000 0004 0581 3406AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- grid.411654.30000 0004 0581 3406AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sultana Abdulaziz
- grid.415296.d0000 0004 0607 1539Division of Rheumatology, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Ghada A. Al Janobi
- grid.415458.90000 0004 1790 6706Rheumatology Unit, Department of Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Abdulaziz Al Khalaf
- grid.56302.320000 0004 1773 5396Rheumatology Unit, Department of Medicine, King Saud University, PO Box 2925, Riyadh, 11461 Saudi Arabia
| | - Bader Al Mehmadi
- grid.449051.d0000 0004 0441 5633Division of Rheumatology, Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952 Saudi Arabia
| | - Mahasin Al Nassar
- grid.56302.320000 0004 1773 5396Department of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia
| | - Faisal AlBalawi
- grid.415277.20000 0004 0593 1832Section of Rheumatology, Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah S. AlFurayj
- Rheumatology Unit, Department of Medicine, Buraidah Central Hospital, B.C.H, Buraidah, Qassim Saudi Arabia
| | - Ahmed Hamdan Al-Jedai
- grid.415696.90000 0004 0573 9824Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- grid.411335.10000 0004 1758 7207College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haya Mohammed Almalag
- grid.56302.320000 0004 1773 5396Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hajer Yousef Almudaiheem
- grid.415696.90000 0004 0573 9824Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali AlRehaily
- grid.415462.00000 0004 0607 3614Department of Medicine, Section of Rheumatology, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Mohammed A. Attar
- grid.413494.f0000 0004 0490 2749Division of Rheumatology, Department of Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hussein Halabi
- grid.415310.20000 0001 2191 4301Section of Rheumatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center-Jeddah, Jeddah, Saudi Arabia
| | - Manal Hasan
- grid.411975.f0000 0004 0607 035XDivision of Rheumatology, Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jasvinder A. Singh
- grid.280808.a0000 0004 0419 1326Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL 35233 USA
- grid.265892.20000000106344187Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 510 20th Street S, Birmingham, AL 35294-0022 USA
- grid.265892.20000000106344187Department of Epidemiology at the UAB School of Public Health, Ryals Public Health Building, 1665 University Blvd, Birmingham, AL 35294-0022 USA
| | - Liana Fraenkel
- grid.414445.4Berkshire Medical Center, Pittsfield, MA USA
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, CT USA
| | - Elie A. Akl
- grid.22903.3a0000 0004 1936 9801Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
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Grazziotin LR, Currie G, Twilt M, Ijzerman MJ, Kip MMA, Koffijberg H, Benseler SM, Swart JF, Vastert SJ, Wulffraat NM, Yeung RSM, Marshall DA. Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study. Pediatr Rheumatol Online J 2022; 20:25. [PMID: 35410419 PMCID: PMC8996666 DOI: 10.1186/s12969-022-00682-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/27/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pharmacological treatment is a cornerstone of care for children with juvenile idiopathic arthritis (JIA). The objective of this study is to evaluate prescription patterns of conventional and biologic disease modifying anti-rheumatic drugs (c-DMARDs and b-DMARDs) for patients with JIA. METHODS We conducted a retrospective cohort study of children diagnosed with JIA at a rheumatology pediatric clinic. Eligibility criteria were defined as children and youth newly diagnosed with enthesis-related arthritis, polyarticular, or oligoarticular JIA between 2011 and 2019, with at least one year of observation. Data on c-DMARDs and b-DMARDs prescriptions were obtained from electronic medical charts. We used descriptive statistics, Kaplan-Meier survival methods, and Sankey diagrams to describe treatment prescription patterns. RESULTS A total of 325 patients with JIA were included, with a median observation time of 3.7 years. The most frequently prescribed c-DMARD and b-DMARD were methotrexate and etanercept, respectively. Within the first year of rheumatology care, 62% and 21% of patients had a c-DMARD and a b-DMARD prescribed, respectively. These proportions varied greatly by JIA subtype. Among the 147 (147/325, 45%) patients that had at least one b-DMARD prescribed, 24% were prescribed a second, and 7% a third-line of b-DMARD. A total of 112 unique treatment sequences were observed, with c-DMARD monotherapy followed by the addition of either a b-DMARD (56%) or another c-DMARD (30%) being the two most prevalent patterns in this cohort. CONCLUSION We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.
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Affiliation(s)
- Luiza R. Grazziotin
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada
| | - Gillian Currie
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Marinka Twilt
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Maarten J. Ijzerman
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Michelle M. A. Kip
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Hendrik Koffijberg
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Susanne M. Benseler
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, AB Canada
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrech, Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J. Vastert
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrech, Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrech, Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Rae S. M. Yeung
- grid.17063.330000 0001 2157 2938Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada ,Present Address: Health Research Innovation Centre, Room 3C56, 3280 Hospital Drive NW, AB T2N 4Z6 Calgary, Canada
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Tornero-Molina J, Alperi-López M, Castellví I, de Agustín-de Oro JJ, Escudero A, García-Vicuña R, González-Gay MÁ, Hidalgo C, Rubio E, Sanmartí R, Casamira N, Calvo-Alén J. Experts document on methotrexate use in combined therapy with biological or targeted synthetic disease modifying drugs in patients with rheumatoid arthritis. Reumatol Clin (Engl Ed) 2022; 18:33-41. [PMID: 35090610 DOI: 10.1016/j.reumae.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/20/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). METHODS Eleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted 'yes' (yes/no). RESULTS The systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients' risk management. CONCLUSIONS This document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs.
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Affiliation(s)
| | | | - Ivan Castellví
- Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Alejandro Escudero
- Servicio de Reumatología, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | - Cristina Hidalgo
- Servicio de Reumatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Esteban Rubio
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Raimon Sanmartí
- Servicio de Reumatología, Hospital Universitari Clínic, Barcelona, Spain
| | - Núria Casamira
- Departamento Médico, Laboratorios Gebro Pharma, Barcelona, Spain
| | - Jaime Calvo-Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
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Ciang NCO, Chan SCW, Lau CS, Chiu ETF, Chung HY. Risk of tuberculosis in patients with spondyloarthritis: data from a centralized electronic database in Hong Kong. BMC Musculoskelet Disord 2020; 21:832. [PMID: 33302934 PMCID: PMC7730739 DOI: 10.1186/s12891-020-03855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/ OBJECTIVE Tuberculosis (TB) is one of the most infectious comorbidities in spondyloarthritis (SpA). Our goals were to determine the crude incidence rate of and risk factors for TB in SpA. METHOD Clinical data of 2984 patients with SpA from 11 rheumatology centres were reviewed. This included demographics, duration of follow-up, comorbidities including diabetes, chronic kidney disease, chronic heart disease, chronic lung disease, stroke and malignancies, date of diagnosis of tuberculosis, use of non-steroidal anti-inflammatory drugs, duration of glucocorticoid therapy for more than 6 months, conventional (cDMARD) and biological (bDMARD) disease modifying anti-rheumatic drug therapies. Crude incidence rates were reported. Cox regression models were used to determine the risk factors for TB in patients with SpA. RESULTS Forty-three patients had TB, of which 4 (9.3%) were extra-pulmonary. The crude incidence rate of TB was 1.57 in patients with SpA, compared with 0.58 in the general population in Hong Kong. Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001). Age was associated with decreased risk (HR 0.93; p < 0.001). CONCLUSION Incidence of TB was higher in patients with SpA. Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB. Rheumatologists should avoid prolonged use of glucocorticoids and consider DMARDs other than infliximab in the treatment of at-risk patients.
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Affiliation(s)
- Natalia Chu-Oi Ciang
- Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Eva Tsz Fung Chiu
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, Hong Kong.
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9
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Tornero-Molina J, Alperi-López M, Castellví I, de Agustín-de Oro JJ, Escudero A, García-Vicuña R, González-Gay MÁ, Hidalgo C, Rubio E, Sanmartí R, Casamira N, Calvo-Alén J. Experts document on methotrexate use in combined therapy with biological or targeted synthetic disease modifying drugs in patients with rheumatoid arthritis. Reumatol Clin (Engl Ed) 2020; 18:S1699-258X(20)30200-X. [PMID: 33041228 DOI: 10.1016/j.reuma.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/16/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). METHODS Eleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted 'yes' (yes/no). RESULTS The systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients' risk management. CONCLUSIONS This document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs.
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Affiliation(s)
| | | | - Ivan Castellví
- Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Alejandro Escudero
- Servicio de Reumatología, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | - Cristina Hidalgo
- Servicio de Reumatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Esteban Rubio
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Raimon Sanmartí
- Servicio de Reumatología, Hospital Universitari Clínic, Barcelona, Spain
| | - Núria Casamira
- Departamento Médico, Laboratorios Gebro Pharma, Barcelona, Spain
| | - Jaime Calvo-Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
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10
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Navarro-Millán I, Rajan M, Lui GE, Kern LM, Pinheiro LC, Safford MM, Sattui SE, Curtis JR. Racial and ethnic differences in medication use among beneficiaries of social security disability insurance with rheumatoid arthritis. Semin Arthritis Rheum 2020; 50:988-995. [PMID: 32911290 PMCID: PMC8018290 DOI: 10.1016/j.semarthrit.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine racial/ethnic differences in the use of conventional synthetic or biologic disease-modifying anti-rheumatic drugs (csDMARDs or bDMARDs, respectively) and long-term glucocorticoids (GC) or opioids among beneficiaries of the Social Security Disability Insurance (SSDI) with rheumatoid arthritis (RA) and <65 years old. METHODS Serial cross-sectional analyses of Centers for Medicare and Medicaid Services claims data (2007, 2011, and 2014) for individuals <65 years old with RA receiving SSDI Medicare and Medicaid, no longer working because they were considered disabled. Generalized estimating equation models were used to determine whether the proportion of patients who used csDMARD, bDMARD, long-term GC, and long-term opioids differed by race/ethnicity. RESULTS There were 12,931; 15,033; and 15,599 participants in 2007, 2011, and 2014, respectively. The overall use of csDMARD without bDMARD among beneficiaries of the SSDI were 31.1%, 30.3%, and 29.2%; 50.2%, 51.7%, and 53.8% used bDMARDs; 37.6%, 36.1%, and 34.4% used long-term GC; and 61.1%, 63.8%, and 63.7% used long-term opioids in years 2007, 2011, and 2014 respectively. The use of csDMARDs without bDMARDs was higher and the use of bDMARDs was lower among Blacks compared to Whites (adjusted absolute difference: +3.0%, +5.0%, and +3.3% for csDMARDs without bDMARDs and -4.6%, -5.7%, and -4.0% for bDMARDs in 2007, 2011, and 2014, respectively; all p<0.05). The use of bDMARDs was higher among Hispanics compared to Whites (adjusted absolute difference: +7.1%, +7.3%, and +7.5% in 2007, 2011, and 2014, respectively; all p<0.05). Long-term GC use was lower among Hispanics than among Whites only in year 2014 (absolute percentage point difference of -4.2%); no other difference in long-term GC use was identified. Whites were the patients with the highest use of long-term opioids (more than two third in each calendar year). CONCLUSION Racial and ethnic differences exists in regards to the treatment of RA among beneficiaries of the SSDI. These findings suggest that this already vulnerable population of patients with RA can also have a racial and ethnic disparity that can contribute to additional disease burden and that should be examined in order to inform future interventions or even inform future policy changes to the SSDI.
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Affiliation(s)
- Iris Navarro-Millán
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States; Hospital for Special Surgery, Division of Rheumatology, New York, NY, United States.
| | - Mangala Rajan
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States
| | - Geyanne E Lui
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States
| | - Lisa M Kern
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States
| | - Laura C Pinheiro
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States
| | - Monika M Safford
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, United States
| | - Sebastian E Sattui
- Hospital for Special Surgery, Division of Rheumatology, New York, NY, United States
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL, United States
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11
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Khalid S, Yousaf MJ, Rashid A, Khan SA. Gene expression of Interleukin-18 in rheumatoid arthritis patients on disease modifying anti-rheumatic drug therapy. Pak J Med Sci 2019; 35:802-806. [PMID: 31258598 PMCID: PMC6572992 DOI: 10.12669/pjms.35.3.1070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background & Objectives: The hallmark of rheumatoid arthritis is the inflammation that is mediated by the macrophages and monocytes that cause release of pro-inflammatory cytokines like interleukin-18. It is highly expressed in serum of patients suffering from rheumatoid arthritis and has a positive association with disease activity. The aim of this study was to analyze the gene expression of interleukin-18 in rheumatoid arthritis patients on disease modifying anti-rheumatic drug therapy. Methods: The cross sectional comparative study is conducted at Department of Biochemistry and Molecular Biology and Center for Research in Experimental and Applied Medicine (CREAM-1Lab), Army Medical College, Rawalpindi, in collaboration with Rheumatology Department, Military Hospital, Rawalpindi. Study was conducted on two groups consisting of Group-I of rheumatoid arthritis patients on diseases modifying anti-rheumatic drugs and control Group-II comprising of normal healthy individuals. Non-probability purposive sampling was done from patients and controls. The duration of study was one year i-e from November 2015 to November 2016. Relative quantification of gene expression of interleukin-18 was done by Real time PCR using ∆∆CT method. Results: Expression analysis for interleukin-18 showed down regulation of gene in rheumatoid arthritis patients as compared to controls. Conclusion: Interleukin-18 gene shows down regulation in rheumatoid arthritis patients on disease modifying anti-rheumatic drugs therapy.
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Affiliation(s)
- Sabeen Khalid
- Dr. Sabeen Khalid, MBBS, MPhil. Department of Biochemistry, Aziz Fatimah Medical & Dental College, Faisalabad, Pakistan
| | - Muhammad Javad Yousaf
- Muhammad Javad Yousaf, MBBS, FCPS, MHPE. Department of Biochemistry & Molecular Biology, Army Medical College, Rawalpindi, Pakistani
| | - Amir Rashid
- Amir Rashid, MBBS, PhD. Department of Biochemistry & Molecular Biology, Army Medical College, Rawalpindi, Pakistani
| | - Saleem Ahmad Khan
- Saleem Ahmad khan, MBBS, FCPS, PhD. Department of Pathology, Army Medical College, Rawalpindi, Pakistani
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12
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Peters M, van den Bergh JP, Geusens P, Scharmga A, Loeffen D, Weijers R, van Rietbergen B, van Tubergen A. Prospective Follow-Up of Cortical Interruptions, Bone Density, and Micro-structure Detected on HR-pQCT: A Study in Patients with Rheumatoid Arthritis and Healthy Subjects. Calcif Tissue Int 2019; 104:571-581. [PMID: 30707271 DOI: 10.1007/s00223-019-00523-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of the study was to prospectively investigate change (repair or progression) in the number, surface area and volume of cortical interruptions, bone density (vBMD) and micro-structural parameters assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) in finger joints of patients with rheumatoid arthritis (RA) treated with synthetic disease modifying anti-rheumatic drugs (sDMARDs) and/or biologic DMARDs (bDMARDs) over a 1-year follow-up period, and in comparison with healthy subjects (HS). METHODS Thirty-two patients with RA (221 joints, 53% on bDMARDs) and 32 HS (117 joints) were assessed at baseline and after 1 year using semi-automatic analysis of HR-pQCT images. Mean changes (group level) and the proportion of joints (joint level) with changes beyond the least significant change were calculated. RESULTS At baseline, 530 interruptions were identified in patients, and 136 in HS. The mean of the interruption parameters did not significantly change in either group Mean vBMD decreased more in patients than in HS (- 4.4 versus - 1.1 mgHA/cm3, respectively). In patients versus HS, proportionally more joints showed repair in interruption volume (6.6% versus 1.7%, respectively) and loss of vBMD (26.7% versus 12.9%, respectively). In patients on sDMARDs versus patients on bDMARDs, proportionally more joints showed progression in the number of interruptions and loss of vBMD (6.1% versus 1.8% and 31.3% versus 17.2%, respectively). CONCLUSIONS HR-pQCT is able to quantify bone repair and progression. Cortical interruption-, vBMD-, and micro-structure were impaired in RA, of which vBMD and micro-structure further deteriorated, particularly in patients on sDMARDs.
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Affiliation(s)
- M Peters
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands.
- NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - J P van den Bergh
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - P Geusens
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - A Scharmga
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
- NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - D Loeffen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Weijers
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B van Rietbergen
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A van Tubergen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
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13
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Abstract
PURPOSE OF REVIEW Patients with autoimmune rheumatic disease are at increased risk of infection after surgery. The goal of this manuscript is to review current evidence on important contributors to infection risk in these patients and the optimal management of immunosuppression in the perioperative setting. RECENT FINDINGS Recent studies have confirmed that patients with autoimmune rheumatic disease, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are at increased risk of infection after surgery, with most evidence coming from studies of joint replacement surgery. Immunosuppression, disease activity, comorbidities, demographics, and surgeon and hospital volume are all important contributors to post-operative infection risk. Recently published guidelines regarding immunosuppression management before joint replacement recommend continuing the conventional disease-modifying drugs used to treat RA (e.g., methotrexate) without interruption, holding more potent conventional therapies for 1 week unless the underlying disease is severe, and holding biologic therapies for one dosing interval before surgery. Recent observational data suggests that holding biologics may not have a substantial impact on infection risk. These data also implicate glucocorticoids as a major contributor to post-operative infection risk. Observational data supports recent recommendations to continue many therapies in the perioperative period with only short interruptions of biologics and other potent immunosuppression. Even brief interruptions may not significantly lower risk, although the field continues to evolve. Clinicians should also consider other risk factors and should focus on minimizing glucocorticoids before surgery when possible to limit the risk of post-operative infection.
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Affiliation(s)
- Joshua F Baker
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.,Philadelphia VA Medical Center, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael D George
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.
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14
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Ataman Ş, Sunar İ, Yilmaz G, Bodur H, Nas K, Ayhan FF, Akgül Ö, Akinci A, Altay Z, Birtane M, Soy Buğdayci D, Çapkin E, Çevik R, Garip Çimen Y, Duruöz MT, Elhan AH, Gürer G, Kaçar C, Kamanli A, Kaptanoğlu E, Kaya T, Kocabaş H, Kuru Ö, Alkan Melikoğlu M, Özel S, Rezvani A, Sezer İ, Yurdakul FG. Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations. Arch Rheumatol 2018; 33:251-71. [PMID: 30632540 DOI: 10.5606/ArchRheumatol.2018.6911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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15
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Kisiel B, Kruszewski R, Juszkiewicz A, Raczkiewicz A, Bachta A, Kłos K, Duda K, Maliborski A, Szymański K, Płoski R, Saracyn M, Niemczyk S, Kisiel K, Tłustochowicz M, Tłustochowicz W. Common atherosclerosis genetic risk factors and subclinical atherosclerosis in rheumatoid arthritis: the relevance of disease duration. Rheumatol Int 2018; 39:327-336. [PMID: 30374689 DOI: 10.1007/s00296-018-4186-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is a common systemic autoimmune disease characterized by increased cardiovascular morbidity. Several previous studies assessed associations between common atherosclerotic genetic risk factors and subclinical atherosclerosis (SA) in RA patients, yet most of them gave negative results. We undertook a cross-sectional study to evaluate the association between previously reported SNPs and subclinical atherosclerosis in a cohort of Polish RA patients. 29 SNPs associated with atherosclerosis in general population were genotyped in 289 RA patients: 116 patients with SA (increased carotid intima-media thickness and/or presence of carotid plaque) and 173 patients without SA. To assess the cumulative effect of SNPs we calculated 3 weighted genetic risk scores: GRSIMT, GRSCP and GRSCAD, comprising intima-media thickness-associated SNPs, carotid plaque-associated SNPs and coronary artery disease-associated SNPs, respectively. None of the SNPs showed a significant association with SA. However, we found an association between SA and GRSIMT. Interestingly, this association was limited to patients with short disease duration (P = 0.00004 vs. P > 0.5, for comparison of GRSIMT among patients within the 1st quartile of disease duration vs. others, respectively). Patients within the 1st quartile of disease duration were more frequently disease modifying anti-rheumatic drugs (DMARDs)-naïve and less frequently treated with biologics. Our study suggests that in patients with early RA subclinical atherosclerosis may be driven by similar genetic factors as in general population, while in long-lasting disease, the role common genetic risk factors may decrease. Possibly, this effect may be due to the influence of DMARDs.
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Affiliation(s)
- Bartłomiej Kisiel
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland.
| | - Robert Kruszewski
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Aleksandra Juszkiewicz
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Anna Raczkiewicz
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Artur Bachta
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Krzysztof Duda
- Department of Radiology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Artur Maliborski
- Department of Radiology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Konrad Szymański
- Department of Medical Genetics, Medical University of Warsaw, ul. Pawińskiego 3c, 02-106, Warszawa, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, ul. Pawińskiego 3c, 02-106, Warszawa, Poland
| | - Marek Saracyn
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland.,Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Katarzyna Kisiel
- Department of Pediatric Dermatology, Center of Dermatology, Międzyleski Specialist Hospital, ul. Bursztynowa 2, 04-749, Warszawa, Poland
| | - Małgorzata Tłustochowicz
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
| | - Witold Tłustochowicz
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warszawa, Poland
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16
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Wong PKK, Bagga H, Barrett C, Chong G, Hanrahan P, Kodali T, Marabani M, Prince HM, Riordan J, Swarbrick P, White R, Young L. A Practical Approach to the Use of Conventional Synthetic, Biologic and Targeted Synthetic Disease Modifying Anti-Rheumatic Drugs for the Treatment of Inflammatory Arthritis in Patients with a History of Malignancy. Curr Rheumatol Rep 2018; 20:64. [PMID: 30173305 DOI: 10.1007/s11926-018-0774-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used in the treatment of inflammatory arthritis (IA) for many years. More recently, biologic (bDMARDs) and targeted synthetic (tsDMARDs) DMARDs have further improved treatment. Due to increased patient longevity and effective oncology treatment, rheumatologists often encounter patients with IA and previous malignancy. The immunosuppressive effect of DMARDs causes concern regarding impaired tumour surveillance with a potential increased risk of malignancy. We reviewed the literature regarding the risk of malignancy in patients on cs-/b-/tsDMARDS and sought to provide practical advice regarding use of these drugs in patients with previous malignancy. RECENT FINDINGS Data from randomised controlled trials is limited as patients with pre-existing malignancy are often excluded. Reassuringly, an increasing range of "real world" data from various national b/tsDMARD registries has not provided a convincing signal that these drugs increase tumour recurrence. Nevertheless, awareness of, and adherence to, national screening guidelines for malignancy is important. Given the improvement in quality of life achieved with these novel and well-tolerated therapeutic agents, the benefit/risk profile remains overwhelmingly favourable in most patients.
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17
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Wood PR, Manning E, Baker JF, England B, Davis L, Cannon GW, Mikuls TR, Caplan L. Blood glucose changes surrounding initiation of tumor-necrosis factor inhibitors and conventional disease-modifying anti-rheumatic drugs in veterans with rheumatoid arthritis. World J Diabetes 2018; 9:53-58. [PMID: 29531640 PMCID: PMC5840570 DOI: 10.4239/wjd.v9.i2.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study.
METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi’s, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs (DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation. Similar data were obtained for patients with proximate values available for glycosylated hemoglobin A1C values within a window 2 mo preceding, and 12 mo following, medication initiation. RBG and A1C measurements were compared before and after initiation events using paired t-tests, and multivariate regression analysis was performed including established comorbidities and demographics.
RESULTS Two thousands one hundred and eleven patients contributed at least one proximate measurement surrounding the initiation of any examined medication. A significant decrease in RBG was noted surrounding 653 individual hydroxychloroquine-initiation events (-3.68 mg/dL, P = 0.04), while an increase was noted for RBG surrounding 665 prednisone-initiation events (+5.85 mg/dL, P < 0.01). A statistically significant decrease in A1C was noted for sulfasalazine initiation, as measured by 49 individual initiation events (-0.70%, P < 0.01). Multivariate regression analyses, using methotrexate as the referent, suggest sulfasalazine (β = -0.58, P = 0.01) and hydroxychloroquine (β = -5.78, P = 0.01) use as predictors of lower post-medication-initiation RBG and A1C values, respectively. Analysis by drug class suggested prednisone (or glucocorticoids) as predictive of higher medication-initiation event RBG among all start events as compared to DMARDs, while this analysis did not show any drug class-level effect for TNFi. A diagnosis of congestive heart failure (β = 4.69, P = 0.03) was predictive for higher post-initiation RBG values among all medication-initiation events.
CONCLUSION No statistically significant hypoglycemic effects surrounding TNFi initiation were observed in this large cohort. Sulfasalazine and hydroxychloroquine may have epidemiologically significant acute hypoglycemic effects.
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Affiliation(s)
- Patrick R Wood
- Denver Veterans Affairs Medical Center, Division of Rheumatology, University of Colorado, Aurora, CO 80045, United States
| | - Evan Manning
- Denver Veterans Affairs Medical Center, Division of Rheumatology, University of Colorado, Aurora, CO 80045, United States
| | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Bryant England
- Omaha Veterans Affairs Medical Center, Division of Rheumatology, University of Nebraska, Omaha, NE 68198, United States
| | - Lisa Davis
- Denver Health and Hospital, Division of Rheumatology, University of Colorado, Aurora, CO 80045, United States
| | - Grant W Cannon
- George Wahlen Veterans Affairs Medical Center, Division of Rheumatology, University of Utah, Salt Lake City, UT 84148, United States
| | - Ted R Mikuls
- Omaha Veterans Affairs Medical Center, Division of Rheumatology, University of Nebraska, Omaha, NE 68198, United States
| | - Liron Caplan
- Denver Veterans Affairs Medical Center, Division of Rheumatology, University of Colorado, Aurora, CO 80045, United States
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18
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Mathew AJ, Ganapati A, Kabeerdoss J, Nair A, Gupta N, Chebbi P, Mandal SK, Danda D. Chikungunya Infection: a Global Public Health Menace. Curr Allergy Asthma Rep 2017; 17:13. [PMID: 28233156 DOI: 10.1007/s11882-017-0680-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chikungunya virus (CHIKV) has been involved in epidemics in African and Asian subcontinents and, of late, has transcended to affect the Americas. Aedes aegypti and Aedes albopictus are the major vectors for CHIKV infection, which results in dissemination of virus to various vital organs. Entry of virus into these tissues causes infiltration of innate immune cells, monocytes, macrophages, neutrophils, natural killer cells, and adaptive immune cells. Macrophages bearing the replicating virus, in turn, secrete pro-inflammatory cytokines IL-1β, TNF-α, and IL-17. Together, this pro-inflammatory milieu induces osteoclastogenesis, bone loss, and erosion. CHIKV is characterized by fever, headache, myalgia, rash, and symmetric polyarthritis, which is generally self-limiting. In a subset of cases, however, musculoskeletal symptoms may persist for up to 3-5 years. Viral culture and isolation from blood cells of infected patients are the gold standards for diagnosis of CHIKV. In routine practice, however, assays for anti-CHIKV IgM antibodies are used for diagnosis, as elevated levels in blood of infected patients are noted from 10 days following infection for up to 3-6 months. Early diagnosis of CHIKV is possible by nucleic acid detection techniques. Treatment of acute CHIKV is mainly symptomatic, with analgesics, non-steroidal anti-inflammatory agents (NSAIDs), and low-dose steroids. No vaccines or anti-viral medicines have been approved for clinical therapy in CHIKV as yet. Hydroxychloroquine and methotrexate have been used in chronic CHIKV infection with variable success.
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19
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Thomas K, Vassilopoulos D. Immunization in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:946-963. [PMID: 27964798 DOI: 10.1016/j.berh.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/25/2022]
Abstract
Immunization represents the most efficient and simplest intervention to prevent certain viral and bacterial infections in the general population as well as in the vulnerable population of patients with inflammatory rheumatic diseases treated with immunosuppressives. Here, we present an updated review of literature data regarding the safety and efficacy of immunizations against different pathogens in rheumatic patients treated with conventional immunosuppressives or the newer biologic agents while at the same time we provide practical guidance for the appropriate vaccine administration in this patient population.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece.
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20
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Kalyoncu U, Solmaz D, Emmungil H, Yazici A, Kasifoglu T, Kimyon G, Balkarli A, Bes C, Ozmen M, Alibaz-Oner F, Erten S, Cagatay Y, Cetin GY, Yilmaz S, Yildiz F, Pamuk ON, Kucuksahin O, Kilic L, Yazisiz V, Karadag O, Koca SS, Hayran M, Akar S, Aksu K, Akkoc N, Keser G, Gonullu E, Kisacik B, Onat AM, Soy M, Inanc N, Direskeneli H, Sayarlioglu M, Erken E, Turgay M, Cefle A, Ertenli I, Pay S. Response rate of initial conventional treatments, disease course, and related factors of patients with adult-onset Still's disease: Data from a large multicenter cohort. J Autoimmun 2016; 69:59-63. [PMID: 26970681 DOI: 10.1016/j.jaut.2016.02.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) is a rare condition, and treatment choices are frequently dependent on expert opinions. The objectives of the present study were to assess treatment modalities, disease course, and the factors influencing the outcome of patients with AOSD. METHODS A multicenter study was used to reach sufficient patient numbers. The diagnosis of AOSD was based on the Yamaguchi criteria. The data collected included patient age, gender, age at the time of diagnosis, delay time for the diagnosis, typical AOSD rash, arthralgia, arthritis, myalgia, sore throat, lymphadenopathy, hepatomegaly, splenomegaly, pleuritis, pericarditis, and other rare findings. The laboratory findings of the patients were also recorded. The drugs initiated after the establishment of a diagnosis and the induction of remission with the first treatment was recorded. Disease patterns and related factors were also investigated. A multivariate analysis was performed to assess the factors related to remission. RESULTS The initial data of 356 patients (210 females; 59%) from 19 centers were evaluated. The median age at onset was 32 (16-88) years, and the median follow-up time was 22 months (0-180). Fever (95.8%), arthralgia (94.9%), typical AOSD rash (66.9%), arthritis (64.6%), sore throat (63.5%), and myalgia (52.8%) were the most frequent clinical features. It was found that 254 of the 306 patients (83.0%) displayed remission with the initial treatment, including corticosteroids plus methotrexate with or without other disease-modifying antirheumatic drugs. The multivariate analysis revealed that the male sex, delayed diagnosis of more than 6 months, failure to achieve remission with initial treatment, and arthritis involving wrist/elbow joints were related to the chronic disease course. CONCLUSION Induction of remission with initial treatment was achieved in the majority of AOSD patients. Failure to achieve remission with initial treatment as well as a delayed diagnosis implicated a chronic disease course in AOSD.
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Affiliation(s)
- Umut Kalyoncu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Dilek Solmaz
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Hakan Emmungil
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Ayten Yazici
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Turkey.
| | - Timucin Kasifoglu
- Eskisehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey.
| | - Gezmiş Kimyon
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Gaziantep, Turkey.
| | - Ayşe Balkarli
- Pamukkale University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Denizli, Turkey.
| | - Cemal Bes
- Abant Izzet Baysal University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Bolu, Turkey.
| | - Mustafa Ozmen
- Izmir Ataturk Training and Research Hospital Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Fatma Alibaz-Oner
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Sükran Erten
- Yildirim Beyazit University, Ankara Ataturk Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Yonca Cagatay
- T.C Istanbul Bilim University, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Gözde Yıldırım Cetin
- Sutcu Imam University, Department of Internal Medicine, Division of Rheumatology, Kahramanmaras, Turkey.
| | - Sedat Yilmaz
- Gulhane School of Medicine Division of Rheumatology, Ankara, Turkey.
| | - Fatih Yildiz
- Cukurova University Department of Internal Medicine, Division of Rheumatology, Adana, Turkey.
| | - Omer Nuri Pamuk
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey.
| | - Orhan Kucuksahin
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Levent Kilic
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Veli Yazisiz
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Antalya, Turkey.
| | - Omer Karadag
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Süleyman Serdar Koca
- Fırat University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Elazıg, Turkey.
| | - Mutlu Hayran
- Hacettepe University Faculty of Medicine, Department of Preventive Oncology, Ankara, Turkey.
| | - Servet Akar
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Kenan Aksu
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Nurullah Akkoc
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Gokhan Keser
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey.
| | - Emel Gonullu
- Eskisehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskisehir, Turkey.
| | - Bunyamin Kisacik
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Gaziantep, Turkey.
| | - Ahmet Mesut Onat
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Gaziantep, Turkey.
| | - Mehmet Soy
- Abant Izzet Baysal University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Bolu, Turkey.
| | - Nevsun Inanc
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Haner Direskeneli
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
| | - Mehmet Sayarlioglu
- Sutcu Imam University, Department of Internal Medicine, Division of Rheumatology, Kahramanmaras, Turkey.
| | - Eren Erken
- Cukurova University Department of Internal Medicine, Division of Rheumatology, Adana, Turkey.
| | - Murat Turgay
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Ayse Cefle
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Kocaeli, Turkey.
| | - Ihsan Ertenli
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Salih Pay
- Gulhane School of Medicine Division of Rheumatology, Ankara, Turkey.
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21
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Arroyo-Ávila M, Vilá LM. Rheumatic Manifestations in Patients with Chikungunya Infection. P R Health Sci J 2015; 34:71-77. [PMID: 26061056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chikungunya virus (CHIKV) infection is a common cause of febrile arthritis. The most common manifestations of acute infection are fever, symmetrical polyarthralgias or polyarthritis, myalgias, and maculopapular rash. Up to 80% of patients may develop musculoskeletal manifestations that persist longer than 3 months, causing impairment in their quality of life. The most common chronic manifestations are persistent or relapsing-remitting polyarthralgias, polyarthritis, and myalgias. Fingers, wrists, knees, ankles, and toes are the most frequently involved, but proximal joints and axial involvement can occur in the chronic stage. Chronic manifestations of CHIKV infection may resemble those of some autoimmune connective tissue diseases. Furthermore, CHIKV infection can cause cryoglobulinemia and may induce rheumatoid arthritis and seronegative spondyloarthropathies in genetically susceptible individuals. The Centers for Disease Control and Prevention recommend acetaminophen and non steroidal anti-inflammatory drugs for the acute rheumatic manifestations of CHIKV infection. However, some studies suggest that low-dose corticosteroids for about 1-2 months (depending on clinical course) are beneficial in relieving acute rheumatic symptoms. Conversely, hydroxychloroquine in combination with corticosteroids or other disease modifying anti-rheumatic drugs (DMARDs) has been successful in treating chronic rheumatic manifestations. Methotrexate and sulfasalazine (alone or in combination) have also been effective for chronic CHIKV arthritis. Patients with CHIKV infection should be closely monitored to identify those with chronic arthritis who would benefit from a rheumatologic evaluation and early treatment with DMARDs.
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Affiliation(s)
- Mariangelí Arroyo-Ávila
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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22
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Alonso A, González CM, Ballina J, García Vivar ML, Gómez-Reino JJ, Marenco JL, Fernández-Nebro A, Ordás C, Cea-Calvo L, Arteaga MJ, Sanmartí R. Efficacy and safety of golimumab as add-on therapy to disease-modifying antirheumatic drugs in rheumatoid arthritis: results of the GO-MORE study in Spain. ACTA ACUST UNITED AC 2014; 11:144-50. [PMID: 25022442 DOI: 10.1016/j.reuma.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/11/2014] [Accepted: 05/02/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of golimumab in the 140 patients included in Spain as the first part of the GO-MORE trial, a multinational study involving patients with active rheumatoid arthritis (RA) despite treatment with different disease-modifying antirheumatic drugs (DMARDs). PATIENTS AND METHODS The patients received subcutaneous golimumab 50mg once a month during 6 months. The primary endpoint was the percentage of individuals with a good or moderate EULAR DAS28-ESR response after 6 months of treatment. RESULTS A total of 140 patients were included. Of these, 76.4% had very active disease (DAS28-ESR>5.1). 76.4% were taking methotrexate, 40.0% other DMARDs in monotherapy or combined, and 65.0% received corticosteroids. After 6 months, 82.9% of the patients showed a good or moderate EULAR response, 41.4% had low disease activity, and 30.7% were in remission. The percentage of responders one month after the first dose was 69.3%. The efficacy was similar in patients treated with methotrexate or other DMARDs, with different methotrexate doses, with or without corticosteroids, or in subjects who had failed one or more DMARDs. The response to golimumab was observed from the first dose. Golimumab was well tolerated and its safety profile was consistent with the findings of previous studies. Serious adverse events were reported in 11 patients (7.9%). CONCLUSION The addition of subcutaneous golimumab 50 mg once a month to different DMARDs in patients with active RA yielded a moderate or good response after 6 months in 82.9% of the cases. The response was observed early, from the start of the second month, after a single dose of golimumab.
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Affiliation(s)
- Alberto Alonso
- Departamento de Reumatología, Hospital de Cruces, Barakaldo, Vizcaya, España
| | - Carlos M González
- Departamento de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Javier Ballina
- Departamento de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - María L García Vivar
- Departamento de Reumatología, Hospital Universitario de Basurto, Bilbao, Vizcaya, España
| | - Juan J Gómez-Reino
- Departamento de Reumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Jose Luis Marenco
- Departamento de Reumatología, Hospital Universitario de Valme, Sevilla, España
| | - Antonio Fernández-Nebro
- Departamento de Reumatología, Hospital Regional Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Carmen Ordás
- Departamento de Reumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - Luis Cea-Calvo
- Departamento de Medical Affairs, Merck Sharp & Dohme de España.
| | - María J Arteaga
- Departamento de Medical Affairs, Merck Sharp & Dohme de España
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