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https://www.readbyqxmd.com/read/29762203/preparing-patients-for-biologic-medications-for-dermatologic-and-rheumatic-diseases
#1
Benjamin J Smith, Brigitta C Nuccio, Katelyn Y Graves, Victor M McMillan
Psoriasis, psoriatic arthritis, and rheumatoid arthritis are prevalent conditions that often require a team of primary care and specialist healthcare professionals for the most optimum patient outcomes. Primary care providers can facilitate referrals to dermatology and rheumatology specialists by obtaining the needed screening workup for patients who need treatment with immunosuppressive therapies. This article reviews tuberculosis screening, hepatitis screening, and vaccinations to be administered before patients begin biologic medications...
May 8, 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/29735171/high-rates-of-tuberculin-skin-test-positivity-due-to-methotrexate-therapy-false-positive-results
#2
Miguel Arias-Guillén, Marta M Sánchez Menéndez, Mercedes Alperi, Sabino Riestra-Menéndez, María Teresa González Budiño, Marta María García-Clemente, Susana Martínez-González, Ana Isabel Enríquez, Rebeca Alonso-Arias, Juan José Palacios Gutiérrez, Miguel Santibáñez, Pablo Coto-Segura, Pablo Martínez Camblor, Lucía García-Alfonso, Isla Morante, Patricio Escalante
RATIONALE: The tuberculin skin test (TST) and interferon γ release assays (IGRAs) are commonly used for latent tuberculosis infection (LTBI) screening. Unexpectedly high TST positivity rates have been reported in patients with rheumatic diseases, and methotrexate is frequently used in this population. We hypothesized that methotrexate use could be associated with false-positive TST results. OBJECTIVES: To investigate whether treatment with methotrexate and other factors are associated with false-positive TST results in patients with rheumatic diseases...
March 29, 2018: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/29717163/in-patient-outcomes-of-hematopoietic-stem-cell-transplantation-in-patients-with-immune-mediated-inflammatory-diseases-a-nationwide-study
#3
Kathan Mehta, Palashkumar Jaiswal, Farren Briggs, William A Faubion, James H Tabibian, Fabio Cominelli, Maneesh Dave
The impact of underlying immune-mediated inflammatory diseases (IMID) in patients undergoing hematopoietic stem cell transplant (HSCT) is unclear. Hematopoietic cell transplantation co-morbidity index (HCT-CI) is gaining acceptance as a reliable clinical method to score pre-transplant co-morbidities. Higher HCT-CI from a co-morbid IMID implies higher NRM. However, HCT-CI integrates many IMIDs with different pathogenesis and treatment together which may lead to spurious results. We performed a cross-sectional study using Nationwide Inpatient Sample dataset from 1998 to 2011 to compare the outcomes of HSCT in patients with different co-morbid IMIDs with patients without any co-morbid IMIDs...
May 1, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29671563/rheumatoid-arthritis-common-questions-about-diagnosis-and-management
#4
Amy Wasserman
Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis, with a lifetime prevalence of up to 1% worldwide. Women, smokers, and those with a family history of the disease are most often affected. Rheumatoid arthritis should be considered if there is at least one joint with definite swelling that is not better explained by another disease. In a patient with inflammatory arthritis, the presence of a rheumatoid factor and/or anti-citrullinated protein antibody, elevated C-reactive protein level, or elevated erythrocyte sedimentation rate is consistent with a diagnosis of rheumatoid arthritis...
April 1, 2018: American Family Physician
https://www.readbyqxmd.com/read/29668129/-tuberculosis-in-the-era-of-anti-tnf-alpha-therapy-why-does-the-risk-still-exist
#5
John-Leonardo Torres-Castiblanco, Jorge Alberto Carrillo, Daniel Hincapié-Urrego, Adriana Rojas-Villarraga
Rheumatoid arthritis is an autoimmune systemic disease characterized mainly by inflammatory compromise of diarthrodial joints. Multiple drug therapies have been developed to control the activity of rheumatoid arthritis, among them, the first line of disease-modifying antirheumatic drugs (DMARD), and novel drug therapies such as the anti-TNF alpha therapy, with satisfactory clinical outcomes.Despite this positive fact, the use of this therapy implies the risk of producing negative effects due to its mechanism of action, which has been associated with multiple infections, especially tuberculosis, making it necessary to use screen tests before resorting to this kind of drugs...
March 15, 2018: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/29668128/tuberculosis-associated-with-tumor-necrosis-factor-%C3%AE-antagonists-case-description-and-analysis-of-reported-cases-in-colombia
#6
Leandro Galvis, Ángel Y Sánchez, Leonardo F Jurado, Martha I Murcia
Tumor necrosis factor-α (TNF-α) is an important fundamental cytokine during the immune response against cancer and infections such as tuberculosis. This molecule also plays a key pathogenic role in complex and difficult-to-treat diseases such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, psoriasis and ulcerative colitis. The treatment of these diseases frequently needs TNF-α antagonists, which has been related to an increased risk of developing tuberculosis, mycoses, and other severe infections...
March 15, 2018: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/29551126/role-of-mda-7-il-24-a-multifunction-protein-in-human-diseases
#7
Mitchell E Menezes, Praveen Bhoopathi, Anjan K Pradhan, Luni Emdad, Swadesh K Das, Chunqing Guo, Xiang-Yang Wang, Devanand Sarkar, Paul B Fisher
Subtraction hybridization identified genes displaying differential expression as metastatic human melanoma cells terminally differentiated and lost tumorigenic properties by treatment with recombinant fibroblast interferon and mezerein. This approach permitted cloning of multiple genes displaying enhanced expression when melanoma cells terminally differentiated, called melanoma differentiation associated (mda) genes. One mda gene, mda-7, has risen to the top of the list based on its relevance to cancer and now inflammation and other pathological states, which based on presence of a secretory sequence, chromosomal location, and an IL-10 signature motif has been named interleukin-24 (MDA-7/IL-24)...
2018: Advances in Cancer Research
https://www.readbyqxmd.com/read/29529307/opportunistic-infections-in-rheumatoid-arthritis-patients-exposed-to-biologic-therapy-results-from-the-british-society-for-rheumatology-biologics-register-for-rheumatoid-arthritis
#8
Andrew I Rutherford, Eunice Patarata, Sujith Subesinghe, Kimme L Hyrich, James B Galloway
Objectives: This analysis set out to estimate the risk of opportunistic infection (OI) among patients with RA by biologic class. Methods: The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis is a prospective observational cohort study established to evaluate safety of biologic therapies. The population included adults commencing biologic therapy for RA. The primary outcome was any serious OI excluding tuberculosis (TB). Event rates were compared across biologic classes using Cox proportional hazards with adjustment for potential confounders identified a priori...
February 26, 2018: Rheumatology
https://www.readbyqxmd.com/read/29526956/rhabdomyolysis-induced-by-isoniazid-in-a-patient-with-rheumatoid-arthritis-and-end-stage-renal-disease-a-case-report-and-review-of-the-literature
#9
Toshihiko Komai, Shuji Sumitomo, Shuzo Teruya, Keishi Fujio
A 76-year-old man complicated with end-stage renal disease had latent tuberculosis infection (LTBI), and isoniazid (INH) 300 mg daily was started to prevent reactivation of LTBI before using biologic agents for rheumatoid arthritis. On the 8th day after administration of INH, he presented with a fever, petechiae, and myalgia. Serological studies revealed elevated myogenic enzymes and creatinine level. Based on the exclusion of other etiologies, rapid improvement with cessation of INH, and the recurrence of the fever and myalgia with re-administration of a reduced dose of INH, we diagnosed him with INH-induced rhabdomyolysis...
March 9, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29520131/the-conundrum-of-indeterminate-quantiferon-tb-gold-results-before-anti-tumor-necrosis-factor-initiation
#10
Shahrad Hakimian, Yevgeniy Popov, Abbas H Rupawala, Karen Salomon-Escoto, Steven Hatch, Randall Pellish
Background: Tumor necrosis factor alpha (TNFα) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFα medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI. Methods: We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications...
2018: Biologics: Targets & Therapy
https://www.readbyqxmd.com/read/29514712/sirukumab-in-rheumatoid-arthritis-refractory-to-sulfasalazine-or-methotrexate-a-randomized-phase-3-safety-and-efficacy-study-in-japanese-patients
#11
Tsutomu Takeuchi, Hisashi Yamanaka, Masayoshi Harigai, Ryo Tamamura, Yuichi Kato, Yoshifumi Ukyo, Toshikazu Nakano, Benjamin Hsu, Yoshiya Tanaka
BACKGROUND: Sirukumab, a high-affinity human monoclonal antibody that selectively binds to interleukin-6, has demonstrated efficacy in the treatment of rheumatoid arthritis (RA) in global phase 1 and phase 2 studies. The present study evaluated the safety and efficacy of sirukumab, as monotherapy in Japanese patients with RA refractory to methotrexate or sulfasalazine. METHODS: In this phase 3, double-blind study, 122 patients (age ≥ 20 years) were randomized (1:1, 61 patients in each arm) to sirukumab administered subcutaneously: 50 mg once every 4 weeks (q4w) or 100 mg once every 2 weeks (q2w) through 52 weeks...
March 7, 2018: Arthritis Research & Therapy
https://www.readbyqxmd.com/read/29485786/quantiferon-tb-gold-in-tube-test-in-the-diagnosis-of-latent-tuberculosis-infection-in-arthritis-patients-treated-with-tumor-necrosis-factor-antagonists
#12
Denis Baričević, Sanja Popović Grle, Jadranka Morović Vergles, Silvija Čuković Čavka, Marko Jakopović, Gzim Redžepi, Zagorka Boras, Marinka Baričević, Miroslav Samaržija
The aim of this study was to investigate the role of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) in detecting latent tuberculosis in immunocompromised patients before introducing tumor necrosis factor (TNF-α) antagonists. The study included 300 subjects of similar age. The study group comprised of 150 QuantiFERON (QFT) positive subjects with rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis and psoriatic arthritis, while control group comprised of 150 QFT negative respondents with the same diseases...
June 2017: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29478790/cost-effectiveness-analysis-of-strategies-using-new-immunological-diagnostic-tests-of-latent-tuberculosis-infection-before-tnf-blockers-therapy
#13
MULTICENTER STUDY
Romain Freund, Benjamin Granger, Cécile Francois, Guislaine Carcelain, Philippe Ravaud, Xavier Mariette, Bruno Fautrel
Several tests have been proposed to detect latent tuberculosis (LTB). OBJECTIVE: To evaluate the cost-effectiveness of different interferon-gamma release assays based strategies used to screen LTB before tumour necrosis factor (TNF) blockers initiation. METHODS: Consecutive patients with rheumatoid arthritis, spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were recruited in 15 tertiary care centres. All were screened for LTB with tuberculin skin test (TST), QuantiFERON TB Gold® in tube (QFT) and T-SPOT...
February 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29466690/safety-and-efficacy-of-etanercept-methotrexate-combination-therapy-in-patients-with-rhupus-an-observational-study-of-non-glucocorticoid-treatment-for-rheumatic-diseases
#14
Bei-Bei Yang, Hua Xiao, Xiao-Jie Li, Min Zheng
OBJECTIVES: To evaluate the safety and efficacy of etanercept (ETN) plus methotrexate (MTX) in patients with rhupus without using corticosteroids. METHODS: Twenty rhupus patients [meeting the criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)] who had never been treated with corticosteroids, DMARDs, or biological agents with a 28-joint Disease Activity Score (DAS28) >3.2 and lupus nephritis determined from histopathological specimens were enrolled...
January 2018: Discovery Medicine
https://www.readbyqxmd.com/read/29445869/guidelines-for-management-of-rheumatic-diseases-in-developing-countries-from-basics-to-real-world-situation-relevance-need-and-processes-for-development
#15
REVIEW
Durga Prasanna Misra, Aman Sharma, Vikas Agarwal
Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions...
April 2018: Rheumatology International
https://www.readbyqxmd.com/read/29399706/differential-diagnostic-perspectives-provided-by-en-face-microscopic-examination-of-articular-surface-defects
#16
Bruce M Rothschild
Surface defects have a central position in diagnosis of articular pathology. Recognizing the limitations of standard radiologic techniques and those imposed by positioning and averaging artifacts on CT evaluation, direct visualization of surface defects was pursued to identify disease characteristics that would facilitate interpretation of radiologic findings. Epi-illumination surface microscopy was utilized to examine macroscopically recognized articular surface defects in individuals in the Hamann-Todd, Terry, and Huntington human skeletal collections with previously verified diagnoses of rheumatoid arthritis, spondyloarthropathy, juvenile inflammatory arthritis (JIA), calcium pyrophosphate deposition disease (CPPD), gout, metastatic cancer, multiple myeloma, septic arthritis, tuberculosis, fungal arthritis, histiocytosis and sickle cell anemia (Rothschild and Rothschild Clin Infect Dis 20(5):1402-1408, 1995; Rothschild et al...
March 2018: Clinical Rheumatology
https://www.readbyqxmd.com/read/29345081/screening-for-latent-tuberculosis-infection-among-patients-with-rheumatoid-arthritis-in-the-era-of-biologics-and-targeted-synthetic-disease-modifying-anti-rheumatic-drugs-in-india-a-high-burden-tb-country-the-importance-of-mantoux-and-quantiferon-tb-gold-tests
#17
Anand N Malaviya, Vishal K Aggarwal, Roopa Rawat, Sadhana Baghel, Ravita Thakran, Qamar Zaheer, Shriram Garg, Sanjiv Kapoor
AIM: To test the validity of an augmented tuberculosis skin test (a-TST) combined with Quantiferon TB-gold® (QFTG) test for the screening of latent tuberculosis infection (LTBI) in patients with rheumatoid arthritis (RA) being considered for treatment with biologic disease-modifying anti-rheumatic drugs or targeted synthetic disease-modifying anti-rheumatic drugs. METHOD: Standard TST using 1 tuberculin unit (TU) of purified protein derivative (PPD, RT23 strain) was carried out...
January 17, 2018: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/29317823/european-perspective-on-the-management-of-rheumatoid-arthritis-clinical-utility-of-tofacitinib
#18
REVIEW
Paweł Kawalec, Katarzyna Śladowska, Iwona Malinowska-Lipień, Tomasz Brzostek, Maria Kózka
Xeljanz® (tofacitinib) is an oral small-molecule inhibitor that reversibly inhibits Janus-activated kinase (JAK)-dependent cytokine signaling, thus reducing inflammation. As a result of these mechanisms, effects on the immune system such as a moderate decrease in the total lymphocyte count, a dose-dependent decrease in natural killer (NK) cell count, and an increase in B-cell count have been observed. Therefore, tofacitinib provides an innovative approach to modulating the immune and inflammatory responses in patients with rheumatoid arthritis (RA), which is especially important in individuals who do not respond to tumor necrosis factor inhibitors or show a loss of response over time...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29294598/rapid-onset-of-efficacy-predicts-response-to-therapy-with-certolizumab-plus-methotrexate-in-patients-with-active-rheumatoid-arthritis
#19
Young Mo Kang, Young-Eun Park, Won Park, Jung-Yoon Choe, Chul-Soo Cho, Seung-Cheol Shim, Sang Cheol Bae, Chang-Hee Suh, Hoon-Suk Cha, Eun Mi Koh, Yeong-Wook Song, Bin Yoo, Shin-Seok Lee, Min-Chan Park, Sang-Heon Lee, Catherine Arendt, Willem Koetse, Soo-Kon Lee
Background/Aims: The objective of this study was to determine the efficacy and safety of add-on therapy with certolizumab pegol (CZP) in active rheumatoid arthritis (RA) patients of a single ethnicity. Methods: In this 24-week, phase 3, randomized, double-blind, placebo-controlled trial, eligible patients (n = 127) were randomized 2:1 to subcutaneous CZP + methotrexate (MTX; 400 mg at week 0, 2, and 4 followed by 200 mg every 2 weeks) or placebo + MTX. Results: At week 24, the American College of Rheumatology criteria for 20% (ACR20) response rate was significantly greater with CZP + MTX than with placebo (66...
January 5, 2018: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29277097/systemic-review-agreement-between-the-latent-tuberculosis-screening-tests-among-patients-with-rheumatic-diseases
#20
Junhee Pyo, Soo-Kyung Cho, Dam Kim, Yoon-Kyoung Sung
Background/Aims: To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. Methods: The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis...
December 28, 2017: Korean Journal of Internal Medicine
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