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Best Practice & Research. Clinical Rheumatology

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https://www.readbyqxmd.com/read/29224682/calcineurin-inhibitors-in-systemic-lupus-erythematosus
#1
REVIEW
Chi Chiu Mok
The calcineurin inhibitors (CNIs) belong to a group of immunosuppressive agents that block T-cell activation through the suppression of the calcium/calcimodulin-dependent phosphatase calcineurin. Agents such as cyclosporine A (CSA) and tacrolimus (TAC) have long been used in patients with systemic lupus erythematosus (SLE). TAC is preferred to CSA in SLE because of the lower frequency of cosmetic, hypertensive and dyslipidemic adverse effects. Recent randomised controlled trials have demonstrated noninferiority of TAC to mycophenolate mofetil (MMF) or cyclophosphamide (CYC) for induction therapy of lupus nephritis...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224681/role-of-interferons-in-sle
#2
REVIEW
Anders A Bengtsson, Lars Rönnblom
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects many different organ systems, with excessive production of type I interferons (IFNs) and autoantibodies against nucleic acids as hallmarks. Activation of the type I IFN system in SLE is due to continuous stimulation of plasmacytoid dendritic cells by endogenous nucleic acids, leading to sustained type I IFN production. This is reflected by an overexpression of type I IFN-regulated genes or an IFN signature. Type I IFNs have effects on both the innate and adaptive immune systems, which contribute to both loss of tolerance and the autoimmune disease process...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224680/pregnancy-in-systemic-lupus-erythematosus-and-antiphospholipid-syndrome
#3
REVIEW
Rebecca Fischer-Betz, Christof Specker
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with a high prevalence in females of childbearing age. Pregnancy in SLE nowadays has favorable outcomes for the majority of women. However, flares of disease activity, preeclampsia, fetal loss, and preterm birth are well-known risks in such pregnancies. Anti-SS-A(Ro)/SS-B(La) antibodies put fetuses at risk for congenital heart block and neonatal lupus. Several risk factors for adverse pregnancy outcomes have been identified. Women with antiphospholipid antibodies or antiphospholipid syndrome and lupus nephritis represent a group with high risk for obstetric complications...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224679/a-review-on-sle-and-malignancy
#4
REVIEW
May Y Choi, Kelsey Flood, Sasha Bernatsky, Rosalind Ramsey-Goldman, Ann E Clarke
Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224678/atherosclerosis-in-systemic-lupus-erythematosus
#5
REVIEW
Sara Croca, Anisur Rahman
Cardiovascular disease (CVD), comprising coronary heart disease and stroke, is one of the most important causes of death in patients with systemic lupus erythematosus (SLE). The risks of developing both clinical CVD and sub-clinical atherosclerosis are increased in patients with SLE. This increase is not fully explained by traditional cardiovascular risk factors such as smoking, hypertension and elevated cholesterol, and it is believed that immune dysfunction also contributes to CVD risk in SLE. In particular, recent studies have shown that abnormalities in both serum lipid profile and the autoantibody and T lymphocyte response to lipids may play a role in development of atherosclerosis...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224677/diagnostic-and-prognostic-tests-in-systemic-lupus-erythematosus
#6
REVIEW
Natalia Vasquez-Canizares, Dawn Wahezi, Chaim Putterman
Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease characterized by autoantibodies directed against numerous self-nuclear antigens. Because of the heterogeneous nature of lupus, it has been challenging to identify markers that are sensitive and specific enough for its diagnosis and monitoring. However, with the sequencing of the human genome, rapid development of high-throughput approaches has allowed for a better understanding of the etiopathogenesis of complex diseases, including SLE...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224676/treat-to-target-remission-and-low-disease-activity-in-sle
#7
REVIEW
Eric F Morand, Marta Mosca
Despite improvements in survival, outcomes of contemporary treatment of systemic lupus erythematosus (SLE) are unacceptable. Unlike in many diseases, treat-to-target (T2T) approaches have not been adopted in SLE, owing to a lack of validated targets to treat towards. Therefore, it is a key goal to validate target state definitions such as low disease activity and remission, and test their implementation in clinical practice and clinical trials. In this article, we review recent advances in T2T approaches in SLE, and emerging evidence-based consensus on definitions of remission and low disease activity that are needed to underpin such approaches...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224675/mechanisms-of-thrombosis-in-systemic-lupus-erythematosus-and-antiphospholipid-syndrome
#8
REVIEW
Philip G de Groot, Bas de Laat
The presence of antiphospholipid antibodies is one of the most common acquired risk factors for thrombosis. Antiphospholipid antibodies is a collective term for a set of autoantibodies with closely related but different specificity. Experiments in which isolated patient antibodies were injected into mice have shown that a specific subset of autoantibodies, those directed against the first domain of plasma protein β2-glycoprotein I, can explain the increased risk of thrombosis. Experiments performed with these mice have shown that autoantibodies against β2-glycoprotein I bind to and activate cells such as endothelial cells, monocytes, and platelets...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224674/drivers-of-the-immunopathogenesis-in-systemic-lupus-erythematosus
#9
REVIEW
Thomas Rose, Thomas Dörner
This review summarises a number of current insights into the pathogenesis of SLE. On the basis of the interaction of environmental factors within a predisposed host, a chronic autoimmune process gains function with a positive feed-forward loop between innate and adaptive immunity. A current focus of SLE pathogenesis is on the enhanced production of certain cytokines, such as type I interferons and BLyS/BAFF, suggesting continuous plasmacytoid dendritic and myeloid cell activity together with disturbances of B lineage cells (increased autoantibodies, including anti-dsDNA and plasmablasts, which correlate with SLE activity and memory B-cell abnormalities)...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224673/understanding-the-role-of-environmental-factors-in-the-development-of-systemic-lupus-erythematosus
#10
REVIEW
Christine G Parks, Aline de Souza Espindola Santos, Medha Barbhaiya, Karen H Costenbader
Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology. Its risk is higher among women, racial and ethnic minorities, and individuals with a family history of SLE or related autoimmune diseases. It is believed that genetic factors interact with environmental exposures throughout the lifespan to influence susceptibility to developing SLE. The strongest epidemiologic evidence exists for increased risk of SLE associated with exposure to crystalline silica, current cigarette smoking, use of oral contraceptives, and postmenopausal hormone replacement therapy, while there is an inverse association with alcohol use...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224672/sle-redefined-on-the-basis-of-molecular-pathways
#11
REVIEW
Guillermo Barturen, Marta E Alarcón-Riquelme
The implementation of precision medicine requires the recruiting of patients in statistically enough numbers, the possibility of obtaining enough materials, and the integration of data from various platforms, which are all real limitations. These types of studies have been performed extensively in cancer but barely on systemic lupus erythematosus (SLE) or other rheumatic diseases. To consider the practical use of the information obtained from such studies, we have to take into account the best biological fluid to use, the ease to perform the analysis in clinical practice, and its relevance to clinical practice...
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224671/systemic-lupus-erythematosus
#12
EDITORIAL
Richard Furie, Ricard Cervera
No abstract text is available yet for this article.
June 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224702/early-intervention-to-restore-function-and-maintain-healthy-trajectory
#13
REVIEW
Juan Jover, Lydia Abasolo
The health of the global population has undergone rapid transformation. Life expectancy and chronic conditions are increasing, and persons aged 65 years or older have become the fastest growing segment of population. The worldwide picture of disease burden is increasingly defined by disability instead of premature mortality. Population growth, ageing and sedentary lifestyles, particularly in developing countries, will result in a crisis for the population health that requires a multi-system response. The growing awareness of the diseases burden increases the need for accurate measurement and assessment of the burden and measurement of the impact of any public health action...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224701/physical-activity-in-older-people-case-studies-of-how-to-make-change-happen
#14
REVIEW
Monica Rodrigues Perracini, Marcia Rodrigues Costa Franco, Natalia Aquaroni Ricci, Catherine Blake
Enhancing physical activity (PA) is recognized as a powerful intervention for the prevention and treatment of chronic diseases and disability in older people. Furthermore, there is an agreement that increased PA in daily life is a key determinant of active and healthy ageing and should be recommended for frail and sedentary older people. Unfortunately, relatively few older people engage in regular PA or stay active in the long term. This article summarizes and discusses PA recommendations for older adults without focussing on specific diseases, presents the main barriers and facilitators for increasing PA levels, and considers the implementation of these recommendations on the basis of the existing evidence...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224700/preventing-weakness-and-stiffness-a-top-priority-for-health-and-social-care
#15
REVIEW
Muir Gray, Kenny Butler
With growing evidence that sarcopenia, disability and frailty can be prevented with physical activity, people living with pain, stiffness and weakness due to a musculoskeletal condition should be offered physical activity as a preventive strategy. By changing beliefs and attitudes towards ageing and raising the value and importance of physical activity, disability can be avoided or delayed and the costly burden of social care lessened. The effects of ageing and the effects of muscle strength loss are often confused...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224699/measuring-physical-capacity-and-performance-in-older-people
#16
REVIEW
Sarah E Lamb, David J Keene
We highlight the important differences between the concepts of capacity and performance and highlight the development of measures and their application in common conditions encountered in health care practice with older people. A number of expert consensus projects have concluded that mobility, balance, muscle strength and dexterity are core domains for capacity measurement in older people. Instruments with evidence of adequate psychometric properties for the evaluation of capacity in response to intervention programmes include the Short Physical Performance Battery, hand grip strength, mini-BEST and 9-hole pegboard test...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224698/sarcopenia
#17
REVIEW
Nicholas Fuggle, Sarah Shaw, Elaine Dennison, Cyrus Cooper
Sarcopenia is a condition that is characterized by loss of muscle mass, muscle strength and muscle functional impairment with ageing. The definition of sarcopenia has been through various permutations; however, an enormous recent breakthrough is the inclusion of the condition in the ICD-10 classification of diseases. This chapter covers the background issues regarding definition before describing the epidemiology of the disease according to human and environmental factors. It then provides a practical guide for the assessment of sarcopenia in a clinical setting and finishes with advice on present treatment and the exciting frontiers of future therapies...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224697/physiology-of-ageing-of-the-musculoskeletal-system
#18
REVIEW
Katalin Boros, Tony Freemont
This review aims to provide a summary of current concepts of ageing in relation to the musculoskeletal system, highlighting recent advances in the understanding of the mechanisms involved in the development of age-related changes in bone, skeletal muscle, chondroid and fibrous tissues. The key components of the musculoskeletal system and their functions are introduced together with a general overview of the molecular hallmarks of ageing. A brief description of the normal architecture of each of these tissue types is followed by a summary of established and developing concepts of mechanisms contributing to the age-related alterations in each...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224696/spinal-pain-and-its-impact-on-older-people
#19
REVIEW
Manuela L Ferreira, Katie de Luca
The term 'spinal pain' collectively includes the cervical, thoracic and lumbosacral regions of the spine. The majority of older people experience spinal pain, and with an increasing proportion of older people, the prevalence of spinal conditions are expected to increase in the coming decades. Musculoskeletal conditions of the spine in the older patient commonly include osteoarthritis and spinal stenosis, and the result of these degenerative diseases includes pain, stiffness and a decreased ability to engage in everyday activities...
April 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29224695/fragility-fractures-their-impact-on-older-people
#20
REVIEW
Lídia Sànchez-Riera, Nicholas Wilson
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective...
April 2017: Best Practice & Research. Clinical Rheumatology
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