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Rheumatoid Arthritis

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34 papers 0 to 25 followers
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
Louise K Mercer, James B Galloway, Mark Lunt, Rebecca Davies, Audrey L S Low, William G Dixon, Kath D Watson, Deborah P M Symmons, Kimme L Hyrich
OBJECTIVES: Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may conversely reduce the risk of lymphoma by decreasing the burden of inflammation. The aim of this study was to compare the risk of lymphoma in subjects with RA treated with TNFi with those treated with non-biological therapy...
August 8, 2016: Annals of the Rheumatic Diseases
Yvette Meissner, Angela Zink, Jörn Kekow, Karin Rockwitz, Anke Liebhaber, Silke Zinke, Kerstin Gerhold, Adrian Richter, Joachim Listing, Anja Strangfeld
BACKGROUND: The aim was to estimate the impact of individual risk factors and treatment with various disease-modifying antirheumatic drugs (DMARDs) on the incidence of myocardial infarction (MI) in patients with rheumatoid arthritis (RA). METHODS: We analysed data from 11,285 patients with RA, enrolled in the prospective cohort study RABBIT, at the start of biologic (b) or conventional synthetic (cs) DMARDs. A nested case-control study was conducted, defining patients with MI during follow-up as cases...
2016: Arthritis Research & Therapy
Patrick Verschueren, Diederik De Cock, Luk Corluy, Rik Joos, Christine Langenaken, Veerle Taelman, Frank Raeman, Isabelle Ravelingien, Klaas Vandevyvere, Jan Lenaerts, Elke Geens, Piet Geusens, Johan Vanhoof, Anne Durnez, Jan Remans, Bert Vander Cruyssen, Els Van Essche, An Sileghem, Griet De Brabanter, Johan Joly, Sabrina Meyfroidt, Kristien Van der Elst, Rene Westhovens
OBJECTIVES: Combining disease-modifying antirheumatic drugs (DMARDs) with glucocorticoids (GCs) is an effective treatment strategy for early rheumatoid arthritis (ERA), yet the ideal schedule and feasibility in daily practice are debated. We evaluated different DMARD combinations and GC remission induction schemes in poor prognosis patients; and methotrexate (MTX) with or without GC remission induction in good prognosis patients, during the first treatment year. METHODS: The Care in ERA (CareRA) trial is a 2-year investigator-initiated randomised pragmatic open-label superiority trial comparing remission induction regimens in a treat-to-target approach...
July 18, 2016: Annals of the Rheumatic Diseases
T M Kuijper, J J Luime, P H P de Jong, A H Gerards, D van Zeben, I Tchetverikov, P B J de Sonnaville, M V van Krugten, B A Grillet, J M W Hazes, A E A M Weel
OBJECTIVES: With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up. METHODS: Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used...
June 9, 2016: Annals of the Rheumatic Diseases
Helga Midtbø, Anne Grete Semb, Knut Matre, Tore K Kvien, Eva Gerdts
OBJECTIVES: Disease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors. METHODS: Echocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3...
June 7, 2016: Annals of the Rheumatic Diseases
2016-08-13 15:39:32
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