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Rheumatoid Arthritis

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39 papers 0 to 25 followers
Graham J Fent, John P Greenwood, Sven Plein, Maya H Buch
This review assesses the risk assessment of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and how non-invasive imaging modalities may improve risk stratification in future. RA is common and patients are at greater risk of CVD than the general population. Cardiovascular (CV) risk stratification is recommended in European guidelines for patients at high and very high CV risk in order to commence preventative therapy. Ideally, such an assessment should be carried out immediately after diagnosis and as part of ongoing long-term patient care in order to improve patient outcomes...
November 28, 2016: Annals of the Rheumatic Diseases
Johannes W J Bijlsma, Frank Buttgereit
Glucocorticoids have now been used for >65 years in the treatment of RA. There is good evidence for their disease-modifying effect, especially in early RA. When used in a dosage of 7.5-10 mg/day, most adverse effects can be handled quite well, although monitoring for and awareness of infections are important. Adverse events may have been overreported, due to bias by indication, but pose an important drawback in the use of these very effective anti-inflammatory and immune-modulatory drugs. Daily dosages >7...
December 2016: Rheumatology
Gulsen Ozen, Sofia Pedro, Marie E Holmqvist, Michael Avery, Frederick Wolfe, Kaleb Michaud
OBJECTIVE: To investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments. METHODS: We studied patients with RA and ≥1 year participation in the National Data Bank for Rheumatic Diseases without baseline DM from 2000 through 2014. DM was determined by self-report or initiating DM medication. DMARDs were categorised into four mutually exclusive groups: (1) methotrexate monotherapy (reference); (2) any abatacept with or without synthetic DMARDs (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate; along with separate statin, glucocorticoid and hydroxychloroquine (yes/no) variables...
November 11, 2016: Annals of the Rheumatic Diseases
Jasvinder A Singh, Alomgir Hossain, Elizabeth Tanjong Ghogomu, Amy S Mudano, Peter Tugwell, George A Wells
BACKGROUND: We performed a systematic review, a standard meta-analysis and network meta-analysis (NMA), which updates the 2009 Cochrane Overview, 'Biologics for rheumatoid arthritis (RA)'. This review is focused on biologic monotherapy in people with RA in whom treatment with traditional disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX) had failed (MTX/other DMARD-experienced). OBJECTIVES: To assess the benefits and harms of biologic monotherapy (includes anti-tumor necrosis factor (TNF) (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or non-TNF (abatacept, anakinra, rituximab, tocilizumab)) or tofacitinib monotherapy (oral small molecule) versus comparator (placebo or MTX/other DMARDs) in adults with RA who were MTX/other DMARD-experienced...
November 17, 2016: Cochrane Database of Systematic Reviews
Lindsay B Kelmenson, M Kristen Demoruelle, Kevin D Deane
While the primary manifestation of rheumatoid arthritis (RA) is articular disease, extra-articular disease may also occur. In particular, pulmonary disease is a frequent extra-articular manifestation of seropositive RA and a leading cause of morbidity and mortality in this population. This review will highlight studies published in the last several years and will, in particular, discuss the relationship of antibodies to citrullinated protein/peptide antigens (ACPA) and lung disease in patients with RA. We will also review the data regarding the potential role of the lung and generation of RA-related autoantibodies in a period of disease development termed "preclinical RA...
November 2016: Current Rheumatology Reports
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
Jon T Giles
Rheumatoid arthritis (RA) is associated with a heightened risk of cardiovascular disease (CVD) events, presumably related to a greater burden of atherosclerosis, as well as atherosclerotic plaques that tend to be inflamed and rupture prone. Many of the inflammatory pathways underlying the pathobiology of RA are also recognized contributors to atherosclerosis. Immunomodulation is the mainstay for RA therapy, and a variety of biologic and non-biologic pharmacotherapies are used either singly or in combination to control articular and systemic inflammation and prevent joint destruction...
May 2016: Current Rheumatology Reports
Raquel López-Mejías, Santos Castañeda, Carlos González-Juanatey, Alfonso Corrales, Iván Ferraz-Amaro, Fernanda Genre, Sara Remuzgo-Martínez, Luis Rodriguez-Rodriguez, Ricardo Blanco, Javier Llorca, Javier Martín, Miguel A González-Gay
Cardiovascular disease (CV) is the most common cause of premature mortality in patients with rheumatoid arthritis (RA). This is the result of an accelerated atherosclerotic process. Adequate CV risk stratification has special relevance in RA to identify patients at risk of CV disease. However, current CV risk screening and management strategies underestimate the actual CV risk in RA. Consequently, the search for additional tools that may help to identify those patients at high CV risk has become a key objective in the last years...
August 1, 2016: Autoimmunity Reviews
Jackie L Nam
PURPOSE OF REVIEW: Early effective treatment has led to major improvements in patients with rheumatoid arthritis. This review aims to address the treatment of early rheumatoid arthritis, in particular the different therapeutic strategies evaluated in clinical trials to achieve optimal disease control. RECENT FINDINGS: The use of biological disease-modifying antirheumatic drugs (bDMARDs) has significantly improved patient outcomes. Overall, studies using bDMARD induction have shown early clinical improvements, with high proportions achieving remission with minimal radiographic progression...
May 2016: Current Opinion in Rheumatology
Eleonora Bellucci, Riccardo Terenzi, Giuliana Maria Concetta La Paglia, Stefano Gentileschi, Alessandra Tripoli, Chiara Tani, Alessia Alunno
Rheumatoid arthritis (RA) is an autoimmune disease characterised by chronic synovial inflammation leading to joint destruction and bone erosions. Although the pathogenic mechanisms underlying the disease are not fully elucidated, it is known that genetic susceptibility and environmental factors trigger an abnormal autoimmune response. Potentially, any organ and tissue could be affected by RA and the increased cardiovascular (CV) risk represents the major complication responsible for a worse prognosis. In this setting, the shared pathogenic mechanisms between RA pathogenesis and accelerated atherosclerosis further strengthen the rationale for a treat-to-target strategy with synthetic and biologic disease modifying anti-rheumatic drugs...
September 2016: Clinical and Experimental Rheumatology
Elizabeth Salt, Amanda T Wiggins, Mary Kay Rayens, Brent J Morris, David Mannino, Andrew Hoellein, Ryan P Donegan, Leslie J Crofford
OBJECTIVE: Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i...
August 24, 2016: Seminars in Arthritis and Rheumatism
R Agca, S C Heslinga, S Rollefstad, M Heslinga, I B McInnes, M J L Peters, T K Kvien, M Dougados, H Radner, F Atzeni, J Primdahl, A Södergren, S Wallberg Jonsson, J van Rompay, C Zabalan, T R Pedersen, L Jacobsson, K de Vlam, M A Gonzalez-Gay, A G Semb, G D Kitas, Y M Smulders, Z Szekanecz, N Sattar, D P M Symmons, M T Nurmohamed
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base...
October 3, 2016: Annals of the Rheumatic Diseases
Jacques-Eric Gottenberg, Olivier Brocq, Aleth Perdriger, Slim Lassoued, Jean-Marie Berthelot, Daniel Wendling, Liana Euller-Ziegler, Martin Soubrier, Christophe Richez, Bruno Fautrel, Arnaud L Constantin, Xavier Mariette, Jacques Morel, Melanie Gilson, Gregoire Cormier, Jean Hugues Salmon, Stephanie Rist, Frederic Lioté, Hubert Marotte, Christine Bonnet, Christian Marcelli, Jeremie Sellam, Olivier Meyer, Elisabeth Solau-Gervais, Sandrine Guis, Jean-Marc Ziza, Charles Zarnitsky, Isabelle Chary-Valckenaere, Olivier Vittecoq, Alain Saraux, Yves-Marie Pers, Martine Gayraud, Gilles Bolla, Pascal Claudepierre, Marc Ardizzone, Emmanuelle Dernis, Maxime A Breban, Olivier Fain, Jean-Charles Balblanc, Ouafaa Aberkane, Marion Vazel, Christelle Back, Sophie Candon, Lucienne Chatenoud, Elodie Perrodeau, Jean Sibilia, Philippe Ravaud
Importance: One-third of patients with rheumatoid arthritis show inadequate response to tumor necrosis factor α (TNF-α) inhibitors; little guidance on choosing the next treatment exists. Objective: To compare the efficacy of a non-TNF-targeted biologic (non-TNF) vs a second anti-TNF drug for patients with insufficient response to a TNF inhibitor. Design, Setting, and Participants: A total of 300 patients (conducted between 2009-2012) with rheumatoid arthritis, with persistent disease activity (disease activity score in 28 joints-erythrocyte sedimentation rate [DAS28-ESR]  ≥ 3...
September 20, 2016: JAMA: the Journal of the American Medical Association
Mark C Genovese, Joel Kremer, Omid Zamani, Charles Ludivico, Marek Krogulec, Li Xie, Scott D Beattie, Alisa E Koch, Tracy E Cardillo, Terence P Rooney, William L Macias, Stephanie de Bono, Douglas E Schlichting, Josef S Smolen
BACKGROUND: In phase 2 studies, baricitinib, an oral Janus kinase 1 and 2 inhibitor, reduced disease activity in patients with rheumatoid arthritis who had not previously received treatment with biologic disease-modifying antirheumatic drugs (DMARDs). METHODS: In this phase 3 study involving 527 patients with an inadequate response to or unacceptable side effects associated with one or more tumor necrosis factor inhibitors, other biologic DMARDs, or both, we randomly assigned the patients in a 1:1:1 ratio to baricitinib at a dose of 2 or 4 mg daily or placebo for 24 weeks...
March 31, 2016: New England Journal of Medicine
Ernest Choy, Daniel Aletaha, Frank Behrens, Axel Finckh, Juan Gomez-Reino, Jacques-Eric Gottenberg, Florian Schuch, Andrea Rubbert-Roth
Current EULAR guidelines state that biologic DMARD (bDMARD) therapy should be administered in combination with MTX or other conventional synthetic (cs) DMARD in RA. Nonetheless, a third of patients for whom a bDMARD agent is prescribed take it in the absence of concurrent csDMARD therapy. While the reasons underlying the low uptake of bDMARD-csDMARD combination therapy in clinical practice have not been well delineated, they may include poor adherence, contraindication to csDMARD therapy and adverse effects, as well as csDMARD withdrawal following remission...
August 21, 2016: Rheumatology
Pascal H P de Jong, Johanna M Hazes, Leander R Buisman, Pieternella J Barendregt, Derkjen van Zeben, Peter A van der Lubbe, Andreas H Gerards, Mike H de Jager, Peter B J de Sonnaville, Bernard A Grillet, Jolanda J Luime, Angelique E A M Weel
OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97)...
August 30, 2016: Rheumatology
Glen S Hazlewood, Cheryl Barnabe, George Tomlinson, Deborah Marshall, Daniel J A Devoe, Claire Bombardier
BACKGROUND: Methotrexate is considered the preferred disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis, but controversy exists on the additional benefits and harms of combining methotrexate with other DMARDs. OBJECTIVES: To compare methotrexate and methotrexate-based DMARD combinations for rheumatoid arthritis in patients naïve to or with an inadequate response (IR) to methotrexate. METHODS: We systematically identified all randomised controlled trials with methotrexate monotherapy or in combination with any currently used conventional synthetic DMARD , biologic DMARDs, or tofacitinib...
2016: Cochrane Database of Systematic Reviews
Philip Hamann, Richard Holland, Kimme Hyrich, John D Pauling, Gavin Shaddick, Alison Nightingale, Neil McHugh
OBJECTIVES: Anti-tumour necrosis factor antibody (anti-TNF) has revolutionised the treatment of rheumatoid arthritis (RA) and remission is now a realistic possibility for patients. Despite widespread use of anti-TNFs, predicting which patients are most likely to attain a sustained good response to these treatments remains challenging. Our objective was to undertake a systematic review of the literature to evaluate existing evidence for demographic and clinical factors associated with the achievement of sustained remission in individuals with RA treated with anti-TNF...
August 26, 2016: Arthritis Care & Research
Sofie H M Manders, Wietske Kievit, Tim L T A Jansen, Jan N Stolk, Henk Visser, Annemarie M Schilder, Harald E Vonkeman, Eddy Adang, Mart A F J van de Laar, Piet L C M van Riel
OBJECTIVE: To analyze and compare the effectiveness and drug survival in patients with rheumatoid arthritis, as measured by 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI), of tumor necrosis factor inhibitor (TNFi) monotherapy, TNFi + leflunomide (LEF), TNFi + sulfasalazine (SSZ), TNFi + other conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and TNFi + methotrexate (MTX) therapy, in daily practice. METHODS: Data were collected from the DREAM registry...
October 2016: Journal of Rheumatology
B I Gavrilă, C Ciofu, V Stoica
UNLABELLED: Rheumatoid arthritis (RA) is a chronic inflammatory disease with autoimmune pathogenesis. It affects mainly small joints (of the hands and feet) and has many systemic manifestations. Studying biomarkers in rheumatology intensely appeared from the need to understand the mechanisms underlying some rheumatic diseases. Discovering new biomarkers with key roles in various stages of evolution, remains a subject of interest for RA. Currently, according to the EULAR 2010 criteria, the rheumatoid factor (RF) and the anti-cyclic citrullinated peptide (anti-CCP) are used for RA diagnosis...
April 2016: Journal of Medicine and Life
2016-08-14 15:54:45
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