Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 15523252 | [Diagnosis, progression and prognosis, aetiology and treatment of adult-onset Still's dise | 2004 Sep 11 | DIAGNOSTIC DOUBTS: Despite an increased awareness of the clinical features of the disease, adult onset Still's disease (AOSD) remains a diagnosis of exclusion. Many diagnostic criteria have been published, and the most popular are those proposed by Yamaguchi, even though they do not consider the presence of hyperferritinemia or the decrease of it glycosylated fraction, and they include exclusion criteria that are difficult to satisfy. UNPREDICTABLE PROGRESSION: Three evolutive forms have been described: monocyclic, intermittent with articular and/or systemic flares, chronic, usually in the form of chronic polyarthritis. Vital prognosis is sometimes compromised by severe systemic manifestations or the occurrence of amyloidosis, whilst destructive polyarthritis, particularly common in the chronic form, may compromise the function. The aetiology of AOSD remains unknown. THERAPEUTIC UNCERTAINTIES: Treatment is largely empirical in the absence of randomized clinical trials because of the rarity of the disease. Nonsteroidal anti-inflammatory drugs could be used in moderately severe forms of the disease, but they rare rarely sufficient. Around 80% of the patients require corticosteroids. Among the disease modifying drugs, methotrexate still remains the most effective. The role of the new anti-TNF molecules remains to be specified. | |
| 12819466 | Biologic therapies in the spondyloarthritis: new opportunities, new challenges. | 2003 Jul | Therapeutic options for patients suffering from the more severe forms of spondyloarthritis have been rather limited in the last decades. There is now accumulating evidence that antitumor necrosis factor therapy is highly effective in spondyloarthritis, especially in ankylosing spondylitis and psoriatic arthritis. Based on the data recently published on more than 500 patients with ankylosing spondylitis and psoriatic arthritis, this treatment seems to be even more effective than in rheumatoid arthritis. The antitumor necrosis factor-alpha agents currently available, infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira), are approved for the treatment of rheumatoid arthritis in the United States and partly in Europe. The situation in spondyloarthritis is different from that of rheumatoid arthritis because there is an unmet medical need, especially in ankylosing spondylitis: no therapies with disease-modifying antirheumatic drugs are available for severely affected patients, especially with spinal disease. Thus, tumor necrosis factor blockers may even be considered a first-line treatment in a patient with active ankylosing spondylitis and psoriatic arthritis whose condition is not sufficiently controlled with nonsteroidal antiinflammatory drugs in the case of axial disease, and sulfasalazine or methotrexate in the case of peripheral arthritis. For infliximab, a dose of 5 mg/kg was required, and intervals between 6 and 12 weeks were necessary to suppress disease activity constantly-also a major aim for long-term treatment. The standard dosage of etanercept is 2 x 25 mg subcutaneously per week. There are no studies yet on adalimumab (standard rheumatoid arthritis dose, 20-40 mg subcutaneously every 1-2 weeks) in spondyloarthritis. Infliximab was very recently approved for AS in Europe. The efficacy of etanercept was first demonstrated in psoriatic arthritis, and it is now approved for this indication. A double-blind study has also been performed in ankylosing spondylitis, with similarly clear efficacy. There is preliminary evidence that both agents do also work in other spondyloarthritis, such as undifferentiated spondyloarthritis. Ideally, both agents will be approved soon for the short-term treatment of severe, uncontrolled spondyloarthritis. In parallel, studies should be performed to document the long-term efficacy of this treatment. There is hope that ankylosis may be preventable, but it remains to be shown whether patients benefit from long-term antitumor necrosis factor therapy and whether radiologic progression and ankylosis can be stopped. Severe adverse events have remained rare. Complicated infections including tuberculosis have been reported. These can be largely prevented by appropriate screening. At it stands now, the benefits of antitumor necrosis factor therapy in ankylosing spondylitis seem to outweigh these shortcomings. | |
| 12215860 | Synovial fluid levels of E-selectin and intercellular adhesion molecule-1: relationship to | 2002 Sep | E-selectin and intercellular adhesion molecule (ICAM)-1 are crucial to the inflammatory response in chronic inflammatory arthritis. Soluble (s) levels of these molecules in sera and synovial fluid (SF) correlate with some clinical parameters and synovial tissue expression of the same molecules in rheumatoid arthritis. Studies of sera from children with chronic inflammatory arthritis corroborate this information; corresponding SF data are relatively lacking. We thus studied SF sE-selectin and sICAM-1 in 28 children with active juvenile rheumatoid arthritis or a spondyloarthropathy. Levels were correlated with erythrocyte sedimentation rate (ESR), SF leukocyte counts, duration of disease, and duration of response to concomitant intra-articular corticosteroid injection. Levels were compared according to use of methotrexate and/or sulfasalazine. Synovial fluid sE-selectin correlated with ESR and SF leukocyte counts. There was a trend toward lower sICAM-1 in patients treated with sulfasalazine and/or methotrexate. We conclude that SF levels of sE-selectin accurately reflect intra-synovial inflammation. Soluble ICAM-1 levels may reflect the effects of disease-modifying agents. | |
| 12070839 | [Adult Still's disease: study of a series of 11 cases]. | 2002 Feb | Adult Still's disease is a systemic disease of unknown etiology. We report a retrospective study of 11 cases (9 females and 2 males) of adult Still's disease collected during 25 years. The mean age was 36 years. Fever, arthritis and skin rash was constant. Adenopathies and splenomegaly were observed in 2 patients. The laboratory findings was characterized by a constant inflammatory syndrome and leucocytosis. Hypertransaminasemia and hyperferritinemia were observed respectively in 7 cases and 3 cases. Corticosteroids were prescribed in all patients. Methotrexate was administered in 3 patients. Outcome was favorable in 10 cases, death incurred in one patient, secondary to acute hepatitis. | |
| 15168985 | Spondylo-arthropathies. | 2003 Sep | Spondylo-arthropathies are a broad group of inflammatory diseases that primarily involve the axial skeleton and the sacro-iliac joints. The pattern of peripheral joint involvement in spondylo-arthropathies differs from rheumatoid arthritis. Spondylo-arthropathies are known to include several conditions like ankylosing spondylitis, reactive arthritis (including Reiter's syndrome), arthritis associated with psoriasis and inflammatory bowel disease, juvenile and also undifferentiated spondylo-arthropathies. The characteristic features of spondylo-arthropathies are absence of rheumatoid factor, inflammatory low backache, sacro-iliitis, peripheral arthritis, enthesopathy, tendency to familial aggregation and association with HLA-B27. ESR may be elevated and patients may exhibit anaemia of chronic inflammation. HLA-B27 is a useful adjunctive test. The radiologic interpretation is very important. Non-steroidal anti-inflammatory drugs and spinal exercises are the cornerstone of therapy. Intra-articular corticosteroids are helpful. Patients may be benefited from, sulfasalazine, methotrexate or azathioprine. | |
| 12906020 | Etanercept: new preparation. Useful after methotrexate failure in inflammatory rheumatism. | 2003 Aug | There is no reference second-line treatment for patients with rheumatoid arthritis, juvenile chronic arthritis, psoriatic arthropathy or ankylosing spondylitis after failure or intolerance of a slow-acting antirheumatic drug such as methotrexate. Etanercept, a immunosuppressant targeting TNF-alpha (like infliximab), is now approved in France for use in these situations, with the exception of spondylitis. In the second-line treatment of adults with rheumatoid arthritis, the clinical evaluation dossier on etanercept contains data from dose-finding studies and two placebo-controlled trials involving patients in whom several single-agent treatments had failed. At a dose of 25 mg subcutaneously twice a week, etanercept worked partially in about half the patients. Without direct comparisons, the place of etanercept relative to other slow-acting antirheumatic drugs is difficult to establish. From indirect comparisons, etanercept seems a slightly better treatment option than infliximab. In the first-line treatment of rheumatoid arthritis, one trial showed that etanercept worked faster than methotrexate, but there was no significant difference between the two treatments after two years. Little is known about the efficacy of etanercept in patients with juvenile chronic arthritis who do not respond adequately to methotrexate. There are no comparative trials. One double-blind placebo-controlled trial showed that etanercept, when it worked, remained active for at least 7 months. In one trial, etanercept was more effective than placebo in patients with psoriatic arthropathy and ankylosing spondylitis who continued to receive their usual treatment, which included a slow-acting antirheumatic drug in about 50% of cases. More than 50% of patients treated with etanercept have a cutaneous reaction to the injection. These reactions are usually mild or moderate. Active pharmacovigilance is needed, given its mechanism of action, and previous notifications of a wide variety of adverse effects (even though it is sometimes difficult to establish a foolproof link between etanercept and the adverse effect). Long-term studies of large numbers of patients are needed to determine the precise risk of side effects including haematological, infectious, neurological, oncological and immunological effects. In practice, methotrexate remains the first-line treatment for inflammatory arthritis. Etanercept can be a useful second-line treatment, especially in juvenile chronic arthritis. | |
| 11994038 | Juvenile rheumatoid arthritis: therapeutic perspectives. | 2002 | Juvenile rheumatoid arthritis (JRA) is the most common childhood chronic systemic autoimmune inflammatory disease. The therapeutic approach to JRA has, to date, been casual and based on extensions of clinical experiences gained in the management of adult rheumatoid arthritis (RA). The physiology of inflammation has been systemically studied and this has led to the identification of specific therapeutic targets and the development of novel approaches to the management of JRA. The classical treatments of the disease such as methotrexate, sodium aurothiomalate and sulfasalazine, are not always effective in controlling RA and JRA. This has necessitated the development of novel agents for treating RA, most of which are biological in nature and are targeted at specific sites of the inflammatory cascades. These biological therapeutic strategies in RA have proved successful and are being applied in the management of JRA. These developments have been facilitated by the advances in molecular biology which have heralded the advent of biodrugs (recombinant proteins) and gene therapy, in which specific genes can be introduced locally to enhance in vivo gene expression or suppress gene(s) of interest with a view to down-regulating inflammation. Some of these biodrugs, such as anti-tumor necrosis factor alpha (anti-TNFalpha), monoclonal antibodies (infliximab, adalimumab), TNF soluble receptor constructs (etanercept) and interleukin-1 receptor antagonist (IL-1Ra) have been tested and shown to be effective in RA. Etanercept has now been licensed for JRA. Clinical trials of infliximab in JRA are planned. Studies show that the clinical effects are transient, necessitating repeated treatments and the risk of vaccination effects. Anti-inflammatory cytokines such as IL-4, IL-10, transforming growth factor-beta and interferon-beta (IFN-beta) are undergoing clinical trials. Many of these agents have to be administered parenterally and production costs are very high; thus, there is a need, especially for pediatric use, to develop agents that can be taken orally. Long-term studies will be required to assess the tolerability and toxicity of these approaches in JRA, since cytokines and other mediators play important roles in host defenses, and the chronic inhibition, exogenous administration or constitutive over-expression of some cytokines/mediators may have undesirable effects. | |
| 15336954 | Combination benefit of a pyrimidylpiperazine derivative (Y-40138) and methotrexate in arth | 2004 Aug 30 | Anti-tumor necrosis factor-alpha (TNFalpha) antibody in combination with methotrexate dramatically decreases joint destruction in rheumatoid arthritis. The aim of this study was to examine combined treatment with N-[1-(4-([4-(pyrimidin-2-yl)piperazin-1-yl]methyl)phenyl)cyclopropyl] acetamide HCl (Y-40138) and methotrexate in rat adjuvant-induced arthritis. The increase in hindpaw volume and joint destruction was suppressed by single therapeutic administration (days 15-20) of Y-40138 (30 mg/kg, p.o.), but not by prophylactic administration (days 1-9). However, arthritic progression was suppressed by single prophylactic administration of methotrexate (0.3 mg/kg, p.o.), but not by therapeutic administration. Combined administration (days 10-20) of Y-40138 (0.3-1 mg/kg) and methotrexate (0.03 mg/kg) synergistically suppressed the increase in hindpaw volume and joint destruction. We concluded that Y-40138 in combination with methotrexate synergistically suppressed arthritic progression. These data suggest that combined treatment with Y-40138 and methotrexate may increase efficacy of therapy for rheumatoid arthritis. | |
| 12739045 | Methotrexate inhibits interleukin-6 production in patients with juvenile rheumatoid arthri | 2003 May | OBJECTIVES: Methotrexate (MTX) is one of the most widely used disease-modifying antirheumatoid drugs in the treatment of juvenile rheumatoid arthritis (JRA). We studied its effect on the production of two proinflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha), by peripheral blood cells in patients with JRA. METHODS: Interleukin-6 and TNFalpha levels were measured at 0 and 4 weeks in whole blood cultures with and without lipopolysaccharide (LPS) stimulation in 19 children treated with MTX (10 mg/m(2 )per week) or placebo. Ten healthy individuals were included as healthy controls. RESULTS: Spontaneous production of IL-6 and TNFalpha by peripheral blood cells of patients with JRA was higher than in healthy controls ( P<0.01). However, IL-6 and TNFalpha production after LPS stimulation was similar in healthy controls and patients. The two groups of patients, i.e., those treated with placebo and those treated with MTX, had similar spontaneous and induced IL-6 and TNFalpha production. At 4 weeks, the drop in spontaneous IL-6 and TNFalpha production was no different in the two groups, but LPS-stimulated IL-6 production was significantly lower in the MTX-treated group than the placebo group ( P<0.05). CONCLUSION: Methotrexate reduces the production of IL-6 by activated cells, and this may be responsible for its anti-inflammatory property. | |
| 12681200 | [Incidence and characteristics of tuberculosis in patients with autoimmune rheumatic disea | 2003 Apr | OBJECTIVE: To describe the incidence and characteristics of the infection caused by Mycobacterium tuberculosis in patients with autoimmune diseases. PATIENTS AND METHODS: Searching in the database of the department at our institution, all new cases of tuberculosis from 1991 to 2000 were identified in patients with autoimmune diseases; the total follow-up time was calculated as the difference between first and last visits. Time with immunosuppressive drug therapy was obtained for patients with rheumatoid arthritis from a database oriented to the longitudinal follow-up of these patients. The incidence density was calculated as the quotient between the absolute frequency of cases and the sum of individual periods at risk for each subgroup. RESULTS: Fifteen cases of tuberculosis were identified from 3,634 risk patients followed for an accumulated period of 9,795 years (overall incidence 153 per 100,000 patients-year). Fourteen patients were receiving disease-modifying drugs and eleven were receiving corticosteroids at diagnosis. The location of tuberculosis infection was the lung for 33.3% of cases. The incidence by drugs in patients with rheumatoid arthritis was 143 per 100,000 patients-year with methotrexate, 2,703 per 100,000 patients-year with azathioprin, 7,692 per 1,000 patients-year with cyclophosphamide, and 4,878 per 100,000 patients-year for anti-TNFalpha. CONCLUSIONS: Compared with the general population, the incidence density of tuberculosis is increasing in our population, with a higher frequency of extrapulmonary involvement. The incidence density is variable among patients with rheumatoid arthritis depending upon the used drugs. | |
| 19807313 | Cost-effectiveness analysis of biological treatments for rheumatoid arthritis. | 2004 Jun | This review compares the cost-effectiveness of four biologics - adalimumab (Humira, Abbott Laboratories), anakinra (Kineret, Amgen Inc.), etanercept (Enbrel, Wyeth) and infliximab (Remicade, Schering-Plough) - used in the treatment of rheumatoid arthritis. A decision analytic model was constructed to estimate the costs and effectiveness of these biologics used alone or in combination with methotrexate during 1 year, from the perspective of a managed care organization. The direct costs consisted of drugs and healthcare resources. Effectiveness was measured by quality-adjusted life years based on preference weights and health states in which patients achieved one out of four levels of response according to the American College of Rheumatology (ACR) response criteria (No ACR, ACR20, ACR50 and ACR70), and experienced one of the four levels of adverse events (e.g., no, mild, moderate and severe) due to their treatments. Results were sensitive to changes in treatment costs and probabilities of health states in directions as predicted. For monotherapy and combination therapy regimens, anakinra was the least expensive option while etanercept dominated other treatments. | |
| 15077313 | Monitoring neutrophil activation in juvenile rheumatoid arthritis by S100A12 serum concent | 2004 Apr | OBJECTIVE: Phagocytes are extensively involved in the synovial inflammation associated with chronic arthritis. The aim of our study was to determine neutrophil activation in juvenile rheumatoid arthritis (JRA) by analyzing S100A12 (EN-RAGE; calgranulin C), a proinflammatory protein secreted by human neutrophils. METHODS: S100A12 serum concentrations were determined in 124 patients with chronic active polyarticular-, oligoarticular-, or systemic-onset JRA. S100A12 was also analyzed in synovial fluid obtained from 22 patients. Changes in S100A12 levels in response to anti-tumor necrosis factor alpha (anti-TNF alpha) therapy, intraarticular injections of corticosteroids, and methotrexate (MTX) treatment were analyzed. Forty-five patients were followed up after successful antiinflammatory treatment, for a mean period of 2.8 years. RESULTS: The mean serum level of S100A12 was 395 ng/ml in patients with active polyarticular JRA and 325 ng/ml in patients with active oligoarticular JRA (normal <120 ng/ml). The level of S100A12 was approximately 10-fold higher in synovial fluid than in serum, indicating release at sites of local inflammation. In patients with systemic-onset JRA, the mean level of S100A12 was 3,700 ng/ml. Moreover, serum levels decreased in response to different antiinflammatory therapies (i.e., intraarticular injections of corticosteroids, MTX, or etanercept). S100A12 levels were elevated in 20 patients who experienced disease flares after the initial induction of remission, even weeks before the relapses became clinically apparent. CONCLUSION: S100A12 serum concentrations indicate neutrophil activation in JRA and correlate with disease activity. S100A12 may indicate synovial inflammation even when other signs of arthritis are absent. Its function as a proinflammatory factor secreted by activated neutrophils makes this protein a potential target for future therapies. | |
| 14748999 | [Treatment of patients with juvenile rheumatoid arthritis with combination of leflunomide | 2003 Jun | OBJECTIVE: To evaluate the efficacy and safety of the combined therapy with leflunomide and methotrexate in the patients with juvenile rheumatoid arthritis (JRA). METHODS: Forty patients with active polyarthritis JRA were divided into 2 groups. Group 1 (n = 21) received leflunomide tablet (1 mg/(kg x day) on days 1 - 3; then [(0.2 - 0.4) mg/kg per day] plus methotrexate (0.3 mg/kg i.v. every two weeks till clinical remission, then oral tablet 0.2 mg/kg weekly). Group 2 received the same doses of methotrexate in the same way. Permitted concomitant drugs included stable doses of NSAIDs and a low dose of prednisone during the course of treatments. The clinical assessments included the number of tender and swollen joints, tender articular index, swollen articular index, general articular function score, parents and physician's evaluation score, erythrocyte sedimentation rate, serum C-reactive protein and rheumatoid factor. Drug safety was assessed by observing the reaction of mucous membrane, skin, gastrointestinal tract, nervous system, hematologic changes, liver and renal function. Statistical comparison between two groups was performed by using analysis of variance, t test and chi(2) test. RESULTS: Efficacy and safety was assessed at 12th and 26th week. Average improvement rate of leflunomide plus methotrexate group at 12th week and 26th week was respectively 39.6% and 71.9%; while that of control group was 27.5% and 49.5%, i.e., there was significant difference between the two groups (P < 0.01). Average remission rate of leflunomide plus methotrexate group at 12th week and 26th week was respectively 4.76% and 38.10%; while that of control group (methotrexate only) was respectively 0, 0. The clinical improvement in the group treated with leflunomide plus methotrexate was significantly greater than control group (P < 0.01). There was no significant difference (9.5% v 5.3%) in occurrence rate of side effects between the two groups. Side effects included leucocytopenia and raised aminotransferase. They were mostly mild and tolerable. CONCLUSION: The effect of the leflunomide and methotrexate therapy in patients with active JRA was better than methotrexate alone. The combination therapy with leflunomide and methotrexate was safe and well tolerated. | |
| 12788115 | Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated | 2003 Jun | PURPOSE: To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis. DESIGN: Interventional case series. METHOD: Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001. RESULTS: Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery. CONCLUSIONS: With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL. | |
| 17143663 | Pharmacokinetics and efficacy of low-dose methotrexate in patients with rheumatoid arthrit | 2004 | This article evaluates the relationship between the pharmacokinetics of methotrexate (MTX), its efficacy in the treatment of rheumatoid arthritis (RA), and serum folic acid (FA) levels. The pharmacokinetics of MTX was studied in 29 patients with RA treated with low-dose MTX. The weekly dose of MTX was given orally at 2-4 mg every 12 h over a period of 24-36 h. Blood samples were taken 4 h after the first administration in any given week. A Bayesian method was used to estimate individual MTX pharmacokinetic variables. We then investigated the efficacy of MTX and the serum FA levels in these patients. We examined C-reactive protein levels (CRP) and the erythrocyte sedimentation rate (ESR), and analyzed the values obtained before and after MTX treatment in order to evaluate the efficacy of the MTX treatment. The degree of improvement in CRP and ESR was significantly correlated with the length of time the MTX concentration-time curve remained above 0.02 microM in one week. Furthermore, the degree of improvement in CRP was also significantly correlated with the area under the concentration-time curve (AUC) for MTX. These results suggest that serum MTX measurements could be useful in determining individual patient regimens. | |
| 11982303 | Lyme arthritis. | 2002 Mar | Infection with B. burgdorferi can cause a large joint inflammatory arthritis in patients who have not been treated for early Lyme disease; the knee is the most common joint affected. The diagnosis depends on a history of known exposure to the spirochete, characteristic clinical features, and serologic studies (ELISA and Western blot) confirming exposure to the spirochete. In most patients, antibiotic therapy is curative, but in a smaller percentage of patients, the presence of the HLA-DR beta 1*0401 haplotype can trigger treatment-resistant arthritis, in which antibiotic therapy is ineffective; in these instances, remittive agents, such as hydroxychloroquine and methotrexate, are indicated. Arthroscopic synovectomy may be considered when antibiotic therapy is not curative. Fibromyalgia can follow infection with B. burgdorferi but is unresponsive to antibiotic therapy; it is treated with tricyclic antidepressants and an exercise program. Lyme arthritis is the only chronic inflammatory arthritis in which the specific cause is known and can be cured. As such, it serves as an excellent model with which to study the pathogenesis of more common inflammatory arthritides, such as rheumatoid arthritis. | |
| 12463461 | Infliximab for psoriasis and psoriatic arthritis. | 2002 Nov | Tumor Necrosis Factor alpha (TNF) as proinflammatory cytokine plays in the pathogenesis of many diseases an important role. In psoriasis and in psoriatic arthritis TNF is up-regulated in the skin lesion and in the synovitis. Recent trials showed that the blockade of TNF with the chimeric antibody infliximab is able to improve both, the skin lesions and the synovitis of the joints. In psoriasis in 82% of patients treated with infliximab achieved an over 75% response in the PASI index. In Psoriatic arthritis the skin improvement was correlating with the reduction of synovitis and in a small MRI controlled study all patients achieved an ACR 20 response within 10 weeks. Patients with psoriatic arthritis, who have been included in spondylarthopathy trials showed similar improvement rates. In all trials unexpected safety problems have not been reported, but the trials have been small in population and short in duration. Infliximab was used between 5 and 10 mg/kg at week 0, 2, 6 and every 8 week. It some trials the retreatment periods varied. In contrast to the treatment of rheumatoid arthritis with infliximab methotrexate was not always used as comedication. In some cases infliximab has been used in combination with other DMARDs but no trial did evaluate the combination treatment vs. the monotherapy. | |
| 16279220 | [Psoriasis arthritis--long-term treatment of two patients with leflunomide]. | 2004 Sep | The prodrug leflunomide is an immunomodulatory agent whose M1 metabolite inhibits the proliferation of T- and B-lymphocytes. The efficacy of leflunomide in rheumatoid arthritis suggests it may be useful psoriasis arthritis. Two patients with psoriasis arthritis in whom NSAIDs, glucocorticosteroids, sulfasalazine, cyclosporine and methotrexate were not as effective as expected were treated with leflunomide for 18 and 27 months. At regular visits examination of the joints (according to the ACR criteria) and the skin (PASI), the visual analogue scale for pain, and the quality of life (HAQ) were assessed. In both patients progression of the joint disease was arrested, pain reduced and quality of life improved. The cutaneous findings did not change, even though topical therapy was continued. Leflunomide is a long-term treatment option for patients with predominantly joint disease. In case of insufficient response, combination with other anti-inflammatory drugs, e.g. methotrexate, is possible. As leflunomide has little effect on psoriatic skin lesions, additional topical therapy is necessary. | |
| 17041462 | Abnormalities of bone mineral density and bone metabolism in Venezuelan patients with rheu | 2003 Aug | Patients with rheumatoid arthritis (RA) are at increased risk for osteoporosis and bone fractures. To our knowledge, the frequency of osteopenia and osteoporosis in patients with RA from Latin America has not been established. In this study, we have examined the bone mineral density (BMD) by dual-energy x-ray absorptiometry, as well as biochemical markers of bone metabolism, in a population of 85 Venezuelan RA patients. Twenty-seven patients (29.4%) fulfilled the World Health Organization's (WHO) criteria for either trabecular osteopenia or osteoporosis compared with 10 healthy controls (8.1%; odds ratio [OR] = 3.25; P = 0.004). In addition, 30 patients (26.4%) showed cortical osteopenia or osteoporosis compared with 5 healthy controls (4.0%; OR = 8.18; P < 0.00001). Past or concurrent use of prednisone or methotrexate was not related to decreased BMD. Rheumatoid patients showed increased serum levels of osteocalcin (P = 0.002) and 24-hour urine excretion of N-telopeptide cross-links (P = 0.03). The bone marker profiles suggest an increased bone turnover during the premenopausal stage in these patients. After menopause, a resorptive pattern seems to predominate, leading to accelerated bone mass loss in RA patients. In conclusion, Venezuelan female patients with RA may be at increased risk for osteopenia or osteoporosis, particularly after menopause. Our study supports the initiation of antiresorptive medication in Latin American premenopausal patients with RA, as in other ethnic groups, to diminish the risk of osteoporosis in the postmenopausal stage. | |
| 24387113 | Outcome of patients with rheumatoid arthritis treated by step-wise administration of disea | 2003 Mar | Abstract Disease-modifying antirheumatic drugs (DMARDs) are expected to relieve polyarthritis, and thereby improve the patient's quality of life and eventually alter the prognosis of rheumatoid arthritis (RA) or the progressive joint destruction caused by it. DMARDs may cause adverse reactions and become less effective over time in some patients. Using changes in disease activity and X-ray findings as indicators, we retrospectively evaluated the long-term results of the step-wise administration of DMARDs in 200 patients with RA. The patients had been treated with gold compounds, SH compounds, and methotrexate, in this order, over a total of 10 years since initially being diagnosed with the disease in its relatively early stages. The step-wise administration of DMARDs had decreased and controlled RA activity and inflammatory response over the 10 years. Although X-ray findings for the wrists worsened over time in most of the patients, no knee or hip joint destruction was observed in patients in whom disease activity had been controlled well for a long period of time. The progression of destruction of major joints can be prevented in cases in which the Lansbury activity index and C-reactive protein are maintained at levels not more than 30% and 1.5 mg/dl, respectively. Since no drugs are now available which specifically prevent the progression of joint destruction, it is important to control RA activity for as long as possible. |