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Early arthritis clinic

Marine Forien, Sébastien Ottaviani
Rheumatoid arthritis (RA) is chronic rheumatic disorder leading to joint inflammation and potential structural damages. This destruction occurs early in the disease outcome leading to the concept of window of opportunity. New diagnosis RA criteria have been proposed to allow an earlier diagnosis and subsequently a better management of the disease. Moreover, tight control of the disease was able to improve the prognosis of RA. For this, rheumatologists need routinely feasible tools and ultrasound (US) appears as the ideal imaging modality...
October 21, 2016: Joint, Bone, Spine: Revue du Rhumatisme
Guillermo J Pons-Estel, Laura Andreoli, Francesco Scanzi, Ricard Cervera, Angela Tincani
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the occurrence of venous and/or arterial thrombosis and pregnancy morbidity in the presence of pathogenic autoantibodies known as antiphospholipid antibodies (aPL). APS may be associated with other diseases, mainly systemic lupus erythematosus (SLE). The presence or absence of SLE might modify the clinical or serological expression of APS. Apart from the classical manifestations, APS patients with associated SLE more frequently display a clinical profile with arthralgias, arthritis, autoimmune hemolytic anemia, livedo reticularis, epilepsy, glomerular thrombosis, and myocardial infarction...
October 21, 2016: Journal of Autoimmunity
S Møller-Bisgaard, B J Ejbjerg, I Eshed, K Hørslev-Petersen, M L Hetland, A G Jurik, H Thomsen, T Torfing, K Stengaard-Pedersen, P Junker, N S Krogh, T Lottenburger, T Ellingsen, L S Andersen, H Skjødt, A J Svendsen, U Tarp, I T Hansen, J Pødenphant, J K Pedersen, H Lindegaard, L G Hanson, A Vestergaard, D Glinatsi, M Østergaard
OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. METHOD: In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (< 6 months) were randomized to MTX, intra-articular betamethasone and CyA, or placebo CyA...
October 24, 2016: Scandinavian Journal of Rheumatology
Lukas Mangnus, Wouter P Nieuwenhuis, Hanna W van Steenbergen, Tom W J Huizinga, Monique Reijnierse, Annette H M van der Helm-van Mil
BACKGROUND: In the population a high body mass index (BMI) has been associated with slightly increased inflammatory markers. Within rheumatoid arthritis (RA), however, a high BMI has been associated with less radiographic progression; this phenomenon is unexplained. We hypothesized that the phenomenon is caused by an inverse relationship between BMI and inflammation in hand and foot joints with RA. To explore this hypothesis, local inflammation was measured using magnetic resonance imaging (MRI) in early arthritis patients presenting with RA or other arthritides and in asymptomatic volunteers...
October 22, 2016: Arthritis Research & Therapy
Johannes W G Jacobs
The history, issues and result of the development of the computer decision software tool used for the two tight control and treat-to-target CAMERA (Computer Assisted Management in Early Rheumatoid Arthritis) studies are described. The software tool is simple and can be used with various protocolled strategies and visit intervals both in clinical trials and daily practice, because it does not dictate strategy steps and is independent of visit intervals. The tool gives information on whether enough improvement since the last visit is present and whether there is remission or not...
September 2016: Clinical and Experimental Rheumatology
Piet L C M van Riel, Lisanne Renskers
In rheumatoid arthritis (RA), disease activity cannot be measured in all individual patients according to a single variable. The Disease Activity Score (DAS) and the DAS28 have been developed to measure disease activity in RA both in daily clinical practice as well as in clinical trials on a group as well as individual level. The DAS/DAS28 is a continuous measure of RA disease activity that combines information from swollen joints, tender joints, acute phase response and general health. The DAS-based EULAR response criteria were primarily developed to be used in clinical trials...
September 2016: Clinical and Experimental Rheumatology
Carla R Scanzello
PURPOSE OF REVIEW: Inflammatory changes in joint tissues can be detected by modern imaging techniques in osteoarthritis patients, but may be clinically subtle compared with many other types of arthritis. These changes associate with disease progression and clinical severity, and many inflammatory mediators may have biomarker utility. Moreover, a number of inflammatory mechanisms play a role in animal models of disease, but it is still not clear which mechanisms predominate and might be therapeutically manipulated most effectively...
October 14, 2016: Current Opinion in Rheumatology
Luis Sala-Icardo, Amalia Lamana, Ana María Ortiz, Elena García Lorenzo, Pablo Moreno Fresneda, Rosario García-Vicuña, Isidoro González-Álvaro
OBJECTIVE: To analyze the effect of single nucleotide polymorphisms (SNPs) with well-known functional impact of methylenetetrahydrofolatereductase (MTHFR; rs1801131 and rs1801133), the membrane transporter ABCB1 (rs1045642), the AICAR transformylase/IMP cyclohydrolase (ATIC; rs2372536) and folyl-polyglutamatesynthetase (FPGS; rs1544105), on liver and bone marrow toxicity of methotrexate (MTX). PATIENTS AND METHODS: We analyzed 1415 visits from 350 patients of the PEARL (Princesa Early Arthritis Register Longitudinal) study: (732 with MTX, 683 without MTX)...
October 14, 2016: Reumatología Clinica
Vedat Hamuryudan, Haner Direskeneli, Ihsan Ertenli, Murat Inanc, Yasar Karaaslan, Fahrettin Oksel, Suleyman Ozbek, Salih Pay, Ender Terzioglu, Dilara Balkan Tezer, Basak Hacibedel, Nurullah Akkoc
OBJECTIVES: To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. METHODS: In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. RESULTS: The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9...
September 18, 2016: Clinical and Experimental Rheumatology
Dimitrios A Pappas, Jeffrey D Kent, Jeffrey D Greenberg, Marc A Mason, Joel M Kremer, Robert J Holt
INTRODUCTION: The goal of this study was to evaluate how frequently rheumatoid arthritis (RA) therapy is instituted promptly and to describe the characteristics of patients who are not treated early upon diagnosis. METHODS: The percentage of patients who at the time of enrollment in the Corrona registry were not receiving any RA-directed therapy was evaluated and their characteristics were summarized. The time to subsequent initiation of any RA-directed therapy was also estimated...
December 2015: Rheumatol Ther
Dimitrios A Pappas, Ani John, Jeffrey R Curtis, George W Reed, Chitra Karki, Robert Magner, Joel M Kremer, Ashwini Shewade, Jeffrey D Greenberg
INTRODUCTION: In the United States, the recommended starting dose of intravenous tocilizumab (TCZ) is 4 mg/kg every 4 weeks, with an increase to 8 mg/kg based on clinical response for patients with moderate to severe rheumatoid arthritis; however, data on how TCZ dose is escalated in real life are missing. The objective of this analysis was to describe patterns of early intravenous TCZ dose escalation in a real-world setting using data from the Corrona registry. METHODS: All patients enrolled in the comparative effectiveness substudy (CERTAIN) nested within Corrona who initiated TCZ and completed 3- and 6-month study visits were eligible for inclusion...
June 2016: Rheumatol Ther
Satoko Hayashi, Katsuya Suzuki, Keiko Yoshimoto, Masaru Takeshita, Takahiko Kurasawa, Kunihiro Yamaoka, Tsutomu Takeuchi
INTRODUCTION: Early prognostic factors for the clinical response in patients with rheumatoid arthritis (RA) after 1 year of treatment with infliximab (IFX) as part of routine clinical practice were investigated. METHODS: Thirty-five patients with RA with an inadequate response to methotrexate were enrolled and administered IFX (3-9 mg/kg, every 4-8 weeks). Serum trough levels of IFX and levels of 9 cytokines were measured at baseline and at 3, 6 months, and 1 year...
June 2016: Rheumatol Ther
Nancy A Chauvin, Asef Khwaja
The hallmark of juvenile idiopathic arthritis is synovial inflammation, and the goal of treatment is to suppress inflammation to prevent cartilage damage and bone erosions. Ultrasound and MRI are widely used imaging modalities in evaluating disease burden and response to treatments and are superior to clinical examination alone. However, differentiating between the normal appearance of the developing skeleton and pathologic conditions can be difficult, particularly in early disease. Larger, long-term studies are needed to standardize imaging definitions and protocols and to fully understand the clinical implications of imaging findings...
November 2016: Rheumatic Diseases Clinics of North America
Neil Stewart, Kevin Karpik
Neuropathic Arthropathy or Charcot joint is a progressive, destructive arthritis that is associated with an underlying neurological disorder. We present a case of a 30 year-old male who, three years prior, had ruptured his right distal biceps tendon with subsequent development of a deep infection. At representation, the patient's clinical picture was consistent with the re-emergence of a deep elbow infection. Laboratory testing found no evidence of infection. Magnetic Resonance Imaging (MRI) of the patient's spine revealed a syringomyelia and a NA was diagnosed...
October 14, 2016: New Zealand Medical Journal
W Kievit, F A C Berden, J P H Drenth
Pharmaceutical companies are under increasing scrutiny because of their strategy for gaining market access and reimbursement authorisation for novel drugs. The tool most often used is that of a randomised controlled trial (RCT) in a highly selected population that has a high chance of responding on the treatment but a low chance of developing side effects. This population differs to a large extent from real-life patients, who have diverging characteristics that can influence effectiveness and safety; these include co-morbidity, age and disease severity...
2016: Nederlands Tijdschrift Voor Geneeskunde
Andrea Picchianti Diamanti, Milica Markovic, Giuseppe Argento, Simonetta Giovagnoli, Alberto Ricci, Bruno Laganà, Raffaele D'Amelio
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can present different extrarticular manifestations involving heart, lungs and kidneys. In recent years there has been a growing awareness of the central role played by the lungs in the onset and progression of RA. In particular interstitial lung disease (ILD) is a common pulmonary manifestation that may be related to the inflammatory process itself, infectious complications and to the treatments used. Management of patients with ILD/RA is still a challenge for clinicians, both synthetic [mainly methotrexate (MTX), leflunomide] and biologic immunosuppressors [mainly anti-tumor necrosis factor (TNF)α] have in fact been related to the onset or worsening of lung diseases with conflicting data...
October 12, 2016: Therapeutic Advances in Respiratory Disease
A-K Tausche, M Aringer
Gouty arthritis is the most common form of arthritis in men. As a consequence of persisting hyperuricemia, uric acid crystals are deposited in the intra-articular and periarticular spaces and activate the innate immune system. The clinically impressive abrupt onset monoarticular arthritis in the lower extremities is highly suggestive of a gout attack. Arthrosonography can be used for early detection of crystal deposition on joint cartilage. In synovial fluid the detection of uric acid crystals in polarization microscopy is proof of gout even without the detection of intracellular uric acid crystals...
October 11, 2016: Zeitschrift Für Rheumatologie
Martin Feuchtenberger, Axel Philipp Nigg, Michael Rupert Kraus, Arne Schäfer
The prognostic significance of early diagnosis and therapeutic intervention in inflammatory rheumatic diseases has been well documented. However, a shortage of rheumatologists often impedes this approach in clinical practice. Therefore, it is of importance to identify those patients referred for diagnosis who would benefit most from a specialist's care. We applied a telephone-based triage for appointment allocation during routine care. This retrospective, monocentric analysis evaluated the efficacy of our triage to identify patients with rheumatic disease with special regard to initial appointment category (elective, early arthritis clinic (EAC), or emergency appointment)...
2016: Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders
Serena Bugatti, Laura Bogliolo, Barbara Vitolo, Antonio Manzo, Carlomaurizio Montecucco, Roberto Caporali
BACKGROUND: Autoantibodies such as anti-citrullinated protein antibodies (ACPA) are major risk factors for articular bone destruction from the earliest phases of rheumatoid arthritis (RA). The aim of the current study was to determine whether RA-associated autoantibodies also impact on systemic bone loss in patients with early disease. METHODS: Systemic bone mineral density (BMD) was measured in the lumbar spine and the hip in 155 consecutive treatment-naïve patients with early RA (median symptom duration 13 weeks)...
October 6, 2016: Arthritis Research & Therapy
Fatemeh Javadi, Arman Ahmadzadeh, Shahryar Eghtesadi, Naheed Aryaeian, Mozhdeh Zabihiyeganeh, Abbas Rahimi Foroushani, Shima Jazayeri
OBJECTIVE: Previous studies have shown that the bioflavonoid quercetin has anti-inflammatory and anti-nociceptive effects. We investigated the effect of quercetin supplementation on inflammation, disease severity, and clinical symptoms in women with rheumatoid arthritis (RA). METHODS: The present study was a randomized, double-blind, placebo-controlled clinical trial in which 50 women with RA were allocated into a quercetin (500 mg/day) or placebo group for 8 weeks...
October 6, 2016: Journal of the American College of Nutrition
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