Arthritis Medication Research Articles

OA09 Challenging case of psoriatic arthritis: what should we do next?

Introduction/BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory enthesoarthro-osteopathy associated with extra-articular manifestations and several co-morbidities occurring in up to 42% of patients with psoriasis. The heterogeneity of PsA is the reason why the term ‘Psoriatic Disease’ (PsoD) has been proposed to reveal more precisely how the PsA patients suffer.Description/MethodWe report a case of refractory PsA presenting with a flare raising therapeutic challenges.In 2019, a 27-year-old man who was diagnosed since 2014 with PsA and psoriasis presented with flare up of psoriasis affecting almost all of his body and peripheral joints mainly MCPs. There was no uveitis or IBD history.PsArc score: Tender joint count (TJC)=5, swollen joint count (SJC)=4 and VAS= 4/5He was on methotrexate 10 mg orally once weekly that was increased to 15 mg with folic acid once weekly. Unremarkable other medical history.Drug history included: Phototherapy without response (2007), then cyclosporine 100mg BD for six weeks which stopped due to severe mood changes.Unsuccessful trials of 20 mg oral methotrexate once weekly because of elevated liver enzymes, subcutaneous form causing significant neurapraxia, adalimumab (2010-2013) stopped due to secondary failure, ustekinumab (2013-2014) stopped after three injections (primary failure), Infliximab (2014-2015) stopped due to throat swelling during transfusion, apremilast 30mg BD stopped due to complete inefficacy. Secukinumab was started by another trust for one year that helped his condition but he lost follow up, we arranged secukinumab continuation that was very effective for only six months and the patient presented severe flare of his skin in the form of widespread different sized erythematous indurated scaly plaques affecting all his body with PsArc score TJC=10 SJC=6, VAS was 5/5. PASI score 14.In 2020 ixecuzimaub was started by the dermatologists that show dramatic improvement in his skin, PASI score became 1.6 but unfortunately not working for joints with 12 tender joints and evidence of tenosynovitis in almost all small joints of hands. He tried leflunomide 20 mg orally daily but stopped due to deranged liver functions.Investigations showed fluctuating CRP levels (3-87 mg/l), normal blood counts and negative RF.Discussion/ResultsWe present a case of PsA that was treated by almost all synthetic and biologic DMARDS that show high efficacy in most of cases of PsA patients. Certolizumab or golimumab were suggested by Guys and St Thomas hospital to start on. Dual biologic therapy is recently reported in the psoriatic literature including ustekinumab plus etanercept, secukinumab plus etanercept, and apremilast with all biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to single biologics alone. But there was an increased incidence of urinary tract and upper respiratory infections, including a hospitalization for H2N1 flu in the ustekinumab plus etanercept case.Key learning points/ConclusionMost physicians are often reluctant to prescribe dual biologic therapy because of safety concerns. Very little data exist regarding the safety of dual biologic medications for concomitant psoriasis and psoriatic arthritis. Additionally, the possibility of a major adverse cardiovascular event related to combined biologic therapy has been reported. More research is warranted to explore dual therapy in refractory patients.

Promising Strategies for Transdermal Delivery of Arthritis Drugs: Microneedle Systems.

Arthritis is a general term for various types of inflammatory joint diseases. The most common clinical conditions are mainly represented by rheumatoid arthritis and osteoarthritis, which affect more than 4% of people worldwide and seriously limit their mobility. Arthritis medication generally requires long-term application, while conventional administrations by oral delivery or injections may cause gastrointestinal side effects and are inconvenient for patients during long-term application. Emerging microneedle (MN) technology in recent years has created new avenues of transdermal delivery for arthritis drugs due to its advantages of painless skin perforation and efficient local delivery. This review summarizes various types of arthritis and current therapeutic agents. The current development of MNs in the delivery of arthritis drugs is highlighted, demonstrating their capabilities in achieving different drug release profiles through different self-enhancement methods or the incorporation of nanocarriers. Furthermore, the challenges of translating MNs from laboratory studies to the clinical practice and the marketplace are discussed. This promising technology provides a new approach to the current drug delivery paradigm in treating arthritis in transdermal delivery.

685 Evaluation of racial differences in prescription rates of systemic medications for psoriasis and psoriatic arthritis

Prior studies have suggested that black patients are less likely to receive biologics compared with white patients. The objective of the study was to analyze the demographics and prescription rates of systemic medications. We conducted a review of Beth Israel Deaconess Medical Center claims database from the Jan 1, 2010–Dec 31, 2021 for patients that had ICD-9 or ICD-10 codes for psoriasis or psoriatic arthritis. The total number of patients with the diagnosis of psoriasis or psoriatic arthritis was 9,406 patients (male 49.7%; female 50.3%) with an average age of 52.5.

Ultrasound wave transports apitoxin in arthritic joint. - Experimental study

Man, in his common lore started using the toxin produced by bees, apitoxin, as a topical medication for rheumatoid arthritis in time immemorial. Systematically subjecting themselves to bee stings. In this study, we sought to use this substance, apitoxin, in an experimental model of induced arthritis. In order for the substance to be introduced through the tissue, ultrasound was used as a vehicle, this action is called phonophoresis. So that the apitoxin would reach the arthritic joint. Wistar rats were used in a model where arthritis was induced by inoculation into the knee joint with zymosan. The animals were divided into groups: GI (positive control), GII (negative control), GIII (topical apitoxin-treated group), GIV (ultrasound-treated group) and GV (phonophoresis-treated group). Inducing arthritis, once established, treatment of the groups was initiated. After 21 days of treatment, the animals were anesthetized with ketamine and xylazine, their knees were submitted to radiographic images, temperatures were collected and euthanized. The RX films were processed by Image J software to collect the intra-articular distance of the femur and tibia. The temperature of each individual in the group was collected. Space and temperature averages: Group I (0.15 mm and 35.7°C), group II (0.03 mm and 38.2°C), group III, (0.4 mm and 37.8°C), group IV (0.6 mm and 36.7°C) to group V (0.78 mm and 36.2°C). We conclude that ultrasound combined with apitoxin via phonophoresis was efficient in tissue repair and subsequent regeneration of joint contours when compared with ultrasound or topical apitoxin alone.

Needle-Warming Moxibustion plus Multirehabilitation Training to Improve Quality of Life and Functional Mobility of Patients with Rheumatoid Arthritis after Medication

Objective Patients treated with medication for rheumatoid arthritis (RA) often improve but continue to have active diseases. The study aims to investigate whether needle-warming moxibustion (NWM) plus multirehabilitation training can improve quality of life (QoL) and functional mobility of RA patients after medication. Methods Eighty-four RA patients were selected as study participants, including 42 patients receiving medication (medication group) and 42 patients receiving NWM plus multirehabilitation training (NWM + MRT group). The scores of disease symptoms, pain (visual analogue scale (VAS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), functional mobility (Fugl–Meyer assessment scale (FMAS)), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and QoL (SF-36) were compared before and after treatment. When patients were discharged from the hospital, they were given a questionnaire for treatment satisfaction. Results After treatment, decreases in the scores of the VAS, PSQI, SAS, and SDS were observed in both cohorts, especially in the NWM + MRT group (P < 0.05). The FMAS scores of upper limbs and lower limbs were increased after treatment, which were higher in the NWM + MRT group in comparison with the medication group (P < 0.05). Of note, patients in the NWM + MRT group scored higher in various dimensions of the SF-36 scale (P < 0.05), showing better QoL. The satisfaction survey showed that the NWM + MRT group had a higher proportion of patients being satisfied and a lower proportion of patients being dissatisfied (P < 0.05). Conclusion NWM plus multirehabilitation training could significantly attenuate disease symptoms, improve QoL, recover functional mobility, and reduce the risk of anxiety and depression in RA patients.

Coverage of Specialty Drugs for Psoriasis and Psoriatic Arthritis by Commercial Insurance Companies.

Specialty medications provide effective treatment with limited adverse effects to patients with psoriasis and psoriatic arthritis; however, variable coverage and high costs often create a barrier to treatment for patients with commercial health insurance. We aimed to evaluate coverage of psoriasis and psoriatic arthritis specialty medications by commercial insurance companies. We compiled data regarding specialty drug coverage for psoriasis and psoriatic arthritis using Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database and analyzed the data for any notable trends. The SPEC database lists coverage decisions for 158 specialty drugs by 17 of the largest US commercial health plans, as well as data regarding the types of evidence cited by these insurance plans when making coverage decisions. Our results showed that insurance plans tend to be more restrictive than the U.S. Food and Drug Association (FDA) label when covering medications for psoriasis and psoriatic arthritis. Furthermore, medications for psoriatic arthritis tended to be less restricted than for psoriasis, and medications were most commonly approved as second line agents for both indications. Our analysis confirms that variability in insurance coverage exists for the indications of psoriasis and psoriatic arthritis.

P072 Audit on the uptake of COVID-19 vaccination in biologic patients with autoimmune conditions

Background/AimsCoronavirus-2 (SARS-CoV-2) has become a disastrous pandemic since its first outbreak in December 2019. Until 8th of October, 2021, more than 239 million people were infected by COVID-19 leading to over 4.8 million deaths. While vaccines and drugs are two arms in controlling the pandemic, safe and effective vaccines are one of the most reliable interventions to suppress viral transmission. Patients with specific immunological deficits, such as patients with autoimmune diseases or those receiving immunosuppressive need special attention. Besides, vaccination in these patients is problematic due to the probable suppression or over-activation of the immune system. However, there still remain questions about the efficacy and safety of vaccination in immunocompromised patients. Studies are ongoing into the safety and immunogenicity of approved of SARS-CoV-2 vaccines, with regards to immuno-deficient individuals. The aim of this audit was to check the uptake and side effects of the BNT162b2 and ChAdOx1 vaccines.MethodsWe collected data on 352 patients from routine clinics which included diagnosis, type of vaccine, number of doses, side effects of the vaccines and flare up of arthritis or underlying autoimmune condition. Descriptive statistics were used to analyse the data.ResultsOf the 352,174 (49%) were Males and 178 (51%) Females. Most common diagnosis was Rheumatoid Arthritis 181 (51%), Axial spondyloarthropathy, 80(23%), Psoriatic Arthritis 65 (18%), GCA 10 (3%), Non-Radiographic Axial Spondyloarthropathy 5 (1.4%), JIA 3 (0.9%), Sarcoidosis 1 (0.3%), and overlap 6 (2%). Medications: 227(65%) patients were on Biosimilars, 26 (7%) on Biologics, 28 (8%) Certolizumab pegol, 21 (6%) Secukinumab, 2 (0.6%) Baricitinib, 3 (0.8%) Abatacept, 29 (8%) Tocilizumab and 16 (4.5%) on Tofacitinib. Vaccination uptake: 329 patients received double dose and 8 received single dose. 15 (4.3%) patients didn’t take vaccine. Reasons for not taking vaccine were severe reactions to Arthritis medication and biologics, concerned they may have severe reaction with the vaccine. Some were worried that vaccine may trigger flares, COVID-19 vaccine potentially has tracking chips, didn’t trust the vaccine as not gone through enough clinical trialling, lack of any statistics on side effects of the vaccines in immunocompromised patients. Side effects: 146 patients experienced mild side effects based on CTAE5 criteria. Only 3 (2.1%) had severe side effects Grade 3 or above, this included Pulmonary embolism, Stroke, and symptomatic pleural effusion. 15(10%) reported Arthritis flare. Most common side effects were Headache 50(34%), Fatigue 32(22%, Myalgia 32(22%), Fever 30(21%), Chills 30(21%), Injection site pain 28(19%), Rhinorrhoea 11(7.5%), Lethargy 11(7.5%) and maculopapular rash 5(3.4%).ConclusionThis audit highlights both the ChAdOx1 and BNT162b2 are safe for use in immune-deficient patients. Immunocompromised patients should be encouraged to take vaccines as benefits of the COVID-19 vaccination outweigh the risks and might reduce the risk of developing severe complications due to COVID-19.Disclosure G.M. Koduri: None.

Current Medication Practices and Preferences Among Patients With Psoriatic Arthritis.

The aim of this study was to evaluate real-world psoriatic arthritis (PsA) medication use and patient medication preferences. This is a cross-sectional survey of Classification for Psoriatic Arthritis criteria defined PsA patients recruited from a single-center PsA registry from June to September 2020. Preferences were ranked on a 5-point Likert scale ranging from "not at all important" to "extremely important." One hundred thirty-seven patients (29%) responded. The median duration (years) of PsA skin and joint symptoms was 19 (interquartile range, 10-34) and 12 (interquartile range, 8-21), respectively. The most common initial immunomodulatory medications were anti-tumor necrosis factor α (35%), methotrexate (19%), and anti-phosphodiesterase 4 (anti-PDE4) (12.4%). At survey administration, the most common immunomodulatory therapies were anti-tumor necrosis factor α (30%), anti-interleukin 17 (IL-17) (20.4%), and methotrexate (10.2%). After 2018, when updated guidelines from the American College of Rheumatology/National Psoriasis Foundation were published, a significantly higher percentage of patients' first medication was an anti-IL-17 compared with 2018 or earlier (30% vs 3.5%, p < 0.001), a pattern also seen with anti-PDE4 (40% vs 11.5%, p < 0.012). Medication preferences most ranked as "extremely" important were prevention of joint damage (80%), ability to perform daily activities (71%), prevention of pain (70.1%), rheumatologist recommendation (63%), and medication adverse effects (62%). The significant increase of anti-IL-17 and anti-PDE4 medications as initial treatment after 2018 may reflect their inclusion as potential initial therapy in updated guidelines, along with the importance placed by patients on medication adverse effects. Given the expanding armamentarium of PsA medications, it is increasingly important to align patient preferences and therapeutic options to ensure durable use of effective therapy.

Rates and predictors of methotrexate-related adverse events in patients with early rheumatoid arthritis: results from a nationwide UK study.

ObjectivesTo estimate prevalence rates and identify baseline predictors of adverse events (AEs) over the first year of treatment in patients with RA starting MTX.MethodsData came from the UK Rheumatoid Arthritis Medication Study (RAMS), a prospective cohort of patients with RA starting MTX. This analysis included patients aged ≥18 years with physician diagnosed RA and symptom duration ≤2 years, who were commencing MTX for the first time. AEs were recorded by interviewing patients at 6- and 12-month follow-up visits. The period prevalence rates of AEs are reported for 0–6 months, 6–12 months and 0–12 months of follow-up. The associations between baseline characteristics and AEs were assessed using multivariable logistic regression.ResultsA total of 1069 patients were included in the analysis. Overall, 77.5% experienced at least one AE. The most commonly reported AEs were: gastrointestinal (42.0%), neurological (28.6%), mucocutaneous (26.0%), pulmonary (20.9%), elevated alanine transaminase (18.0%) and haematological AEs (5.6%). Factors associated with increased odds of AEs were: women vs men (gastrointestinal, mucocutaneous, neurological) and alcohol consumption (nausea, alopecia, mucocutaneous). Older age, higher estimated glomerular filtration rate and alcohol consumption were associated with less reporting of haematological AEs.ConclusionsAEs were common among patients over the first year of MTX, although most were not serious. Knowledge of the rates and factors associated with AE occurrence are valuable when communicating risks prior to commencing MTX. This can help patients make informed decisions whether to start MTX, potentially increasing adherence to treatment.

TNF inhibitors for the prevention of Alzheimer’s disease: Preliminary findings from the rheumatoid arthritis medication and memory study (RESIST)

AbstractBackgroundA raised level of serum TNFα observed in patients with Alzheimer’s disease has been associated with an increased rate of neurodegeneration and risk of conversion from mild cognitive impairment (MCI) to AD dementia. This led to the hypothesis that reduction in peripheral TNFα via TNF inhibitors (TNFi) may reduce the rate of neurodegeneration and may protect against development of AD.MethodThe rheumatoid arthritis medication and memory study (RESIST) is an 18‐month observational study which aims to compare the rate of cognitive decline between TNFi and conventional synthetic disease modifying anti‐rheumatic drugs (csDMARDs) in patients with both rheumatoid arthritis (RA) and MCI. Participants ≥ 55 years of age were recruited from rheumatology clinics in both Northern Ireland and Southampton and were cognitively assessed using the Free and Cued Selective Reminding Test (FCSRT) and Montreal Cognitive Assessment (MoCA). At the time of analysis n=130 participants had completed a 6‐month assessment and n=69 had completed a 12‐month assessment. ANCOVA analysis was conducted to calculate the difference in mean (and 95% CI) FCSRT and MoCA scores at both 6‐ and 12‐month timepoints between TNFi and csDMARD treatment groups, adjusting for baseline cognitive scores. Further adjustments were made for age, gender, RA disease activity and other confounding variables.ResultThere was no evidence of a difference between TNFi and csDMARD treatment in cognitive outcomes measured by FCSRT (6‐month cohort (mean difference 0.58, 95% CI ‐ 1.40, 2.56, p = 0.565); 12‐month cohort (mean difference ‐1.09, 95% CI ‐3.57, 1.38, p = 0.381)) or MoCA (6‐month cohort (mean difference ‐1.09, 95% CI ‐3.57, 1.38, p = 0.381); 12‐month cohort (mean difference ‐0.04, 95% CI ‐1.06, 0.98, p = 0.940)) after adjustment for baseline cognitive scores nor was there a difference in cognitive outcomes between treatment groups after adjustment for additional confounders.ConclusionThis preliminary analysis found little evidence of a relationship between TNFi and better cognitive performance however analysis was limited by lack of power and short follow‐up periods. This analysis will be repeated once RESIST has ended to determine if there is any statistically significant cognitive benefit of TNFi treatment after 18‐months.

Green mediated synthesis of silver nanoparticles using Ipomoea quamoclit to explore the potential antimicrobial activity against human pathogens

Ipomoea quamoclit, a medicinal plant, known as a common medication for stomach ache, hemorrhoids and rheumatoid arthritis, has been employed for the biosynthesis of silver nanoparticles in the current study. The phytochemical analysis of this plant revealed that it is rich in phenolics, flavonoids, steroids, saponins, carbohydrates, triterpenes compounds. The present study has demonstrated an ecofriendly and safer method for developing a simple and cost effective production of silver nanoparticles using Ipomoea quamoclit flowers, leaves and seeds. The formation of nanoparticles was supported by color change and UV-Vis spectroscopy, showed maximum absorption peak at the range of 400-450 nm. X-ray diffraction, Fourier transform-Infrared spectroscopy and Scanning electron microscope, demonstrated spherical and oval shaped nanoparticles in the sizes ranging between 25 and 45 nm. The phytosynthesized silver nanoparticles have shown a remarkable antimicrobial activity against tested gram negative and gram positive pathogenic organisms such as Pseudomonas aeruginosa PAO1, Salmonella typhimurium, Serratia marcescens and Micrococcus luteus by conventional agar well diffusion in a dose dependent manner. The observations of the present investigation appear to be promising and offer a valuable agent for antimicrobial and antibiofilm activities. Among the various nanoparticles, the silver nanoparticles synthesized using the flower extract of Ipomoea quamoclit had a notably marked reduction in biofilm formation against Salmonella typhimurium. This paves the way in designing a new alternative therapeutic management of biofilm associated infections in future.

Evaluation of analgesic (in vivo) activity of Ariflex liniment in comparison with diclofenac gel by acetic acid induced writhing model

Background: Adverse effects of available medications for osteoarthritis (OA) and rheumatoid arthritis (RA) necessitate development of safer and effective alternative medicinal substitutes. The present study was conducted to evaluate analgesic activity of Ariflex liniment (conceptualized and developed by Ari Healthcare Pvt. Ltd.) in comparison with diclofenac gel by using acetic acid induced writhing model.Methods: Albino mice of either sex weighing 20-25 g were taken and divided into 3 groups with 5 animals in each group, i.e., group 1 (control group), group 2 (diclofenac gel) and group 3 (Ariflex liniment). After 1 hour of topical application of study drugs writhing was induced in mice using intra-peritonial injection of 1% acetic acid in volume of 0.1 ml/10 g body weight. Then the writhing episodes were recorded for 30 minutes and results were noted.Results: In the control group, the total number of writhes were 260±29.73 (mean±S. E. M.). The total number of writhes was 12.17±11.81 (mean ± S. E. M.) in diclofenac group. In Ariflex liniment group, not a single animal felt pain, hence there were no writhes recorded. When compared to control group, the difference in number of writhes was statistically significant. The analgesic activity of Ariflex liniment was found to be superior to that of diclofenac gel used as standard drug.Conclusions: It can be concluded that Ariflex liniment possesses analgesic activity.

Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample

BackgroundThe use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use.AimsTo explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects.MethodsA self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose.ResultsThe final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by ‘hash, pot or skunk’ (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM.ConclusionCaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.

Phototherapies in the management of an ulcerative lip lesion in a patient taking multiple medications for rheumatoid arthritis

The treatment of rheumatoid arthritis (RA), an inflammatory autoimmune disease of chronic nature, consists of medications, exercises, patient education on the disease, and rest. Unfortunately, many drugs used for RA have been recently recognized to induce oral manifestations due to either immunosuppression or antiproliferative effects. Thus, the present study reports a case of a patient who was receiving multiple medications (methotrexate, leflunomide, and sodium risedronate) for RA and developed an extensive lip ulcerative lesion not responsive to previous treatments. The lesion management was performed using only a combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT), totalizing three laser sessions. Within 4 days, the patient no longer complained of pain and the lesion presented an advanced healing aspect. According to the current case, the combination of PBMT and aPDT seems to be a suitable alternative for the management of oral lesions in patients taking medications for RA.

Intra-articular Injection of a Dextran Polymer Combined with Antibiotic Medications for Bacterial Infective Arthritis in Dogs: 14 Cases

Abstract Objectives The aim of this study was to describe the use of an intra-articular delivery of a dextran polymer (IADP) for bacterial infective arthritis in dogs. Materials and Methods Cases of bacterial infective arthritis treated with IADP were reviewed. Resolution of infection was based on joint fluid cytology. Lameness scores, total nucleated cell counts, and per cent neutrophils were monitored throughout treatment. Results There were 14 dogs included in the study. The stifle was the most commonly affected joint. The median number of injections per dog was 3 with a median of 2 weeks between injections. Amikacin was combined with the dextran polymer in 13 cases and imipenem was used in 1 case. Concurrent oral antimicrobials were used in 12/14 cases, and surgery for infection was performed in 10/14 cases. Cytological evidence of infection resolved in 11/14 cases. Median lameness scores throughout treatment decreased from severe (grade ¾) at initial presentation to mild (grade ¼) at the final recheck. Median total nucleated cell counts and per cent neutrophils decreased from 40,000 white blood cell/µL and 91% to 2,200 white blood cell/µL and 4% respectively. A transient worsening of lameness was the main side effect documented in 5/14 cases. Conclusion Intra-articular dextran polymer combined with antimicrobials was generally well tolerated; however, the efficacy of IADP was unknown in this population since most dogs received concurrent oral antimicrobials and/or surgery.

Tough Choices: Exploring Medication Decision‐Making During Pregnancy and Lactation Among Women With Inflammatory Arthritis

ObjectiveThis study explored how women’s beliefs about drug safety and interactions with their health care providers influenced their decisions to continue arthritis medications during pregnancy and lactation.MethodsWe collaborated with ArthritisPower, a patient‐powered research network, and CreakyJoints, its partner online community, to develop and disseminate a survey among members with inflammatory arthritis who had at least one pregnancy after diagnosis. Participants’ free‐text responses were evaluated by using thematic analysis.ResultsWomen in the sample were 40 years old on average (N = 66). Nineteen of their pregnancies had ended in fetal loss. Fifteen percent of all pregnancies were exposed to methotrexate. Among women who used safe arthritis medications, up to 80% discontinued treatment either in preparation for pregnancy or during pregnancy or lactation. Women’s decisions to continue medications during pregnancy were influenced by their perceptions of safety and advisement from health care providers, although they often described that advice about medication safety was inconsistent between providers.ConclusionWomen often chose to endure active inflammatory arthritis rather than to use disease‐modifying antirheumatic drugs because of concerns about medication safety during pregnancy and lactation. Conflicting medical advice from health care providers undermined patients’ trust in their providers and in the safety of their medications. The high rate of peripartum exposure to methotrexate, a fetotoxic drug, underscores the need for better family planning care for women with childbearing potential.

Knowledge of disease, diagnosis, adherence and impact of research in an Irish cohort of patients with inflammatory arthritis

Background: Patient engagement with clinicians results in shared decision making and increased adherence to medication. However, in order for strong patient: clinician partnerships to be achieved, communication barriers need to be identified. Therefore, the aim of this study was to examine the level of understanding of inflammatory arthritis patients and the need for strong patient-partnership in research. Methods: An online anonymous survey was distributed to patients living with inflammatory arthritis which addressed questions about diagnosis, routine tests, medications and how they work, medication adherence, disease flare, heredity, pregnancy, and patient involvement in research. Results: There were 1,873 respondents, 1416 of which had inflammatory arthritis (IA)- rheumatoid arthritis (RA) (65.8%) and psoriatic arthritis (PsA) (34.2%). They were predominantly female (RA 86%, PsA 85 %), aged 55±13 and 50±12 years. Less than 35% of patients had an understanding of diagnostic tests, what was measured and the implication for disease, with 75.5% also concerned about heredity. There was a high level of understanding of how specific medications treat inflammatory arthritis (72.9%). Adherence was also very high (&gt;87%), with the main reasons for stopping medication without the advice of their clinician, ‘feeling better’ and ‘side effects’ however a significant proportion of patients (69.9%) reported a disease-flare following cessation of medication. Patients (31%) were also concerned that inflammatory arthritis reduced their chances of getting pregnant, with only 8% believing arthritis medications were safe to take during pregnancy. Finally, only 9% of patients had ever been asked to participate in a research study. Conclusions: This study demonstrates a need for the development of stronger patient-partnerships with clinicians and researchers in relation to patient education and engagement with research, to create a platform where patients can have meaningful input and involvement in future research studies.

Clinical effect and mechanism of moxibustion combined with western medication for rheumatoid arthritis of liver-kidney deficiency

To observe the clinical effect of moxibustion combined with western medication for rheumatoid arthritis (RA) of liver-kidney deficiency, and explore the mechanism of moxibustion for RA. A total of 60 patients with RA of liver-kidney deficiency were randomly divided into an observation group and a control group, 30 cases in each group. In the control group，leflunomide tablets were taken orally, once a day. On the base of the treatment as the control group, moxibustion was applied at Sanyinjiao (SP 6), Shenshu (BL 23), Zusanli (ST 36) and ashi points in the observation group, once every other day, three times a week. Totally 8 weeks were required in both groups. Before and after treatment, the TCM syndrome score, health assessment questionnaire (HAQ) score, 28-joint disease activity score (DAS-28) and serum levels of calcium ion (Ca2+), erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP) and rheumatoid factors (RF) were compared, and the clinicial efficacy was evaluated in the two groups. After treatment, the TCM syndrome scores, HAQ scores and DAS-28 scores were decreased in the two groups (P<0.01), and those in the observation group were lower than the control group (P<0.01). After treatment, the serum levels of Ca2+ were increased (P<0.01), ESR and hs-CRP were decreased in the two groups (P<0.01), and the serum level of RF was decreased in the observation group (P<0.01). The serum level of Ca2+ in the observation group was higher than the control group (P<0.01), ESR and RF were lower than the control group (P<0.01). The total effective rate was 83.3% (25/30) in the observation group，higher than 60.0% (18/30) in the control group (P<0.05). Moxibustion combined with western medication can effectively relieve clinical symptoms, improve quality of life in RA patients, the curative effect is better than simple western medication. And its mechanism may be related to the regulation of serum level of Ca2+ and immune inflammatory response to inhibit bone destruction.

EVALUASI PENGGUNAAN OBAT ASAM URAT DAN POLA PERESEPANNYA PADA PASIEN GOUT ARTRITIS DI INSTALASI RAWAT INAP DI RSUD DELI SERDANG LUBUK PAKAM TAHUN 2020

Uric acid is a disease that arises due to excess purine in the body caused by uric crystals in the joint tissue that attacks the fingers, elbows, knees, toes, toes and heels. Gouty arthritis is a progressive disease caused by deposition of monosodium urate crystals (MSU) found in the joints, kidneys, and other connective tissue due to chronic hyperuricemia. The incidence of gouty arthritis is common in men as many as 25 patients (65.8%) and women as many as 13 patients (34.2%). The incidence of gouty arthritis continues to increase with age, at the age of 21-35 years (7.9%), ages 36-55 years (36.7%), age 56-65 years (28.9%), and at the age of 66 -75 years (26.3%). The purpose of this study was to examine the use of uric acid and its prescription patterns in arthritis patients in Deli Serdang Lubuk Pakam Hospital in 2020 in terms of the right parameters according to the indications, the right patients, the right drugs, and the right dosages. This research is a non-experimental study, data retrospective retrieval was done by looking at the medical record data of arthritis gout patients and analyzed descriptively. Sampling as many as 38 patients with puposive sampling method. Inclusion criteria in this study were patients who were diagnosed with gout and given arthritis medication with complete medical record data. The results of the study evaluated the use of gout and its prescribing patterns in 38 patients at Deli Serdang Lubuk Pakam Regional Hospital in 2020, which were 100% correct, 100% right, 100% right, and 96% right.

Anncaliia algerae

Anncaliia algerae belongs to the microsporidia, a group of obligate intracellular pathogens originally classified as early branching 'primitive' protozoa but now understood to be related to the Cryptomycota as a basal branch in the fungal kingdom. A. algerae has emerged as a rare opportunistic human pathogen in immune compromised patients such as those taking immune suppressive medications for arthritis, hematologic malignancy, or organ transplantation. It was originally identified as a pathogen of mosquitoes and is probably transmitted to humans by food or water through ingestion, inhalation, or contamination of ocular tissue or wounds with environmental spores. A. algerae infection primarily causes myositis; however, vocal cord, skin, corneal (in immune competent hosts), and disseminated infections have been reported. Human infection has also been reported with other members of the Anncaliia genus: Anncaliia vesicularum in a HIV patient, and Anncaliia connori in an infant with thymic dysplasia.