Cases Of Rheumatoid Arthritis Patients Research Articles

1960-P: Comparative Effects of TNFα and IL-6 Inhibitors on Glucose and Lipid Metabolism in Patients with Rheumatoid Arthritis (RA)

Association between TNFα and IL-6 and glucose tolerance has been reported. However, it is not clear that TNFα and IL-6 affect on glucose tolerance. Recently, biologic agents such as TNF and IL-6 inhibitors have been appeared in the treatment of RA. We have examined comparative effects of TNF αand IL-6 inhibitors on glucose tolerance and lipid metabolism in patients with rheumatoid arthritis. Registered 589 patients with RA have been screened by HbA1c level (more than 5.6%), treatment with methotrexate (MTX) and treatment with biologic agents with or without MTX. We have excluded the patients with RA who are treated with insulin, and selected 30 cases of RA patients who were able to follow-up for 12 months (M). Patients with RA were divided to 3 groups by the treatments as follows: TNF inhibitors with MTX (TNF+MTX), IL-6 with and without MTX (IL-6±MTX) and MTX alone. Body weight, HbA1c, LDL-C, HDL-C, LDL-C/HDLC(L/H) and disease activity score (DAS) were measured before and after 6 and 12 M. There were no differences of DAS between each group before and after 6 and 12 M. DAS in each group was a significantly decreased compared with before (P < 0.05-0.001). HbA1c levels in TNF+MTX were not significantly different (before 6.08%, 6 M 5.92%, 12M 5.91%), but those in MTX alone and IL-6±MTX were significantly improved (before 6.42% and 6.2%, 6M 5.87% and 5.78%, P< 0.05, 12M 5.82%, P< 0.05 and 5.81%, P< 0.01), respectively. There were no significant differences of body weight between each group. HDL-C and LDL-C in IL-6±MTX were significantly (P< 0.01) increased (before 58.2 mg/dl and 123.2 mg/dl, 6M 71.7 mg/dl and 148.5 mg/dl, 12M 63.4 mg/dl and 144.2 mg/dl), respectively. L/H in TNF+MTX was significantly (P<0.05) decreased. In conclusion, effect of glucose tolerance in IL-6 inhibitors was better than TNF inhibitors in RA patients with glucose intolerance. However, TNF inhibitor in lipid metabolism was better than IL-6 inhibitors. Disclosure T. Ishizuka: None. K. Fujioka: None. I. Mori: None. T. Takeda: None. S. Inui: None.

Effect of collaborative family nursing management mode on self-efficacy and quality of life in patients with rheumatoid arthritis

Objective To discuss the effect of collaborative family nursing management mode on self-efficacy and quality of life in patients with rheumatoid arthritis (RA). Methods A total of 88 cases of RA patients from July 2013 to December 2013 in our hospital were selected as the observation group, while 86 cases of RA patients from July 2012 to December 2012 in our hospital were selected as the control group, patients in control group received routine nursing, the observation group accepted the basis of conventional nursing cooperative family nursing management mode. Compared the self-efficacy and quality of life between two groups before and after the intervention by the Chronic disease self-efficacy table (CDSES) and quality of life scale (RAQOL). Results Intervention before and 6 months after intervention had been evaluated, respectively, two groups of patients self-efficacy scores before intervention differences had no statistical significance (P>0.05). After the intervention, the scores of every self-efficacy dimensions such as complete self-management, general self-efficacy, achieve the results, deal with problems in the observation group were(6.8±0.7), (7.4±0.9), (7.1±0.9) and (7.6±1.0), higher than these of the control group [(4.9±0.7), (5.2±0.9), (5.3±0.7), (5.1±0.9)], the differences were statistically significant (t=4.523, 3.965, 3.569, 4.102, respectively; P<0.01). The self-efficacy of patients after the intervention had improved significantly in both two groups, compared with before. In the observation group, patients in the physiological function, psychological function, social function, healthy self-awareness ability and overall quality of life scores were (19.9±3.1), (15.4±2.8), (21.9±3.2), (23.1±4.7), (80.3±11.6), higher than (16.8±2.5), (13.1±2.2), (18.9±3.0), (20.2±3.1), (69.0±6.3) in the control group, and the differences were statistically significant (t=5.264, 4.635, 4.265, 4.145, 3.958, respectively; P<0.01). Conclusions The collaborative family nursing management increases the patient′s self-efficacy, enhances the patient self-management level and the ability to adhere health behaviors, and improves the life quality of patients. Key words: Rheumatoid arthritis; Self-efficacy; Quality of life; Collaboration nursing management

A case of rheumatoid arthritis patient with interstitial pneumonia due to MTX achieved DAS remission by changing to iguratimod monotherapy

A case of rheumatoid arthritis patient with interstitial pneumonia due to MTX achieved DAS remission by changing to iguratimod monotherapy

SAT0154 Correlation between Sleep Disturbance, Fatigue and Psychological Features in Patients with Rheumatoid Arthritis

BackgroundSleep disturbance in patients with Rheumatoid arthritis (RA) seems to be multifactorial. In fact inflammatory pain, depression and anxiety could have a negative impact in sleep quality in patients with...

Tumour necrosis factor-alpha inhibitor-induced hepatic injury in patients with rheumatoid arthritis: two case reports and an analysis of the laboratory data from the Slovenian national biologicals registry

Tumour necrosis factor-alpha (TNF-α) inhibitors are widely used in the management of patients with rheumatoid arthritis (RA) and spondylarthritides. However, TNF-α inhibition may lead to adverse events, including liver injury. The RA patients are frequently treated with several potentially hepatotoxic drugs concomitantly; hence, a causative link between TNF-α inhibitors and liver injury is usually difficult to establish. We report two cases of RA patients who developed histologically manifest liver injury shortly after the introduction of treatment with two different TNF-α inhibitors. Furthermore, we present the analysis of the laboratory data from the BioRx.si registry (the Slovenian national registry of rheumatologic patients treated with biologicals) and provide evidence that elevated levels of serum aminotransferase can be observed in patients treated with TNF-α inhibitors. Additionally, our analysis suggests no significant differences between the impact of adalimumab and etanercept on aminotransferase levels. Although the use of TNF-alpha inhibitors is safe and efficient, we suggest that continuous careful monitoring of aminotransferase levels in patients treated with these agents is probably warranted.

Syndrome of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE)

Abst ract Leflunomide is a recently developed disease modifying antirheumatic drug that may cause acute diarrhea as an adverse effect. This adverse effect is usually mild and develops during the first few weeks of treatment. In this report, we present a case of rheumatoid arthritis patient with severe diarrhea treated with leflunomide for an extended period of time. (Turk J Rheumatol 2010; 25: 41-3)

Long Term Use of Leflunomide as a Cause of Severe Diarrhea?

Leflunomide is a recently developed disease modifying antirheumatic drug that may cause acute diarrhea as an adverse effect. This adverse effect is usually mild and develops during the first few weeks of treatment. In this report, we present a case of rheumatoid arthritis patient with severe diarrhea treated with leflunomide for an extended period of time. (Turk J Rheumatol 2010; 25: 41-3)

Long Term Use of Leflunomide as a Cause of Severe Diarrhea?

Leflunomide is a recently developed disease modifying antirheumatic drug that may cause acute diarrhea as an adverse effect. This adverse effect is usually mild and develops during the first few weeks of treatment. In this report, we present a case of rheumatoid arthritis patient with severe diarrhea treated with leflunomide for an extended period of time. (Turk J Rheumatol 2010; 25: 41-3)

Methotrexate-associated lymphoproliferative disorders mimicking angioimmunoblastic T-cell lymphoma

Patients affected by autoimmune diseases (rheumatoid arthritis (RA), psoriasis, and dermatomyositis) treated with methotrexate (MTX) develop lymphoproliferative disorders (LPDs). These cases have been reported to be diffuse large B-cell lymphoma, Hodgkin lymphoma, or polymorphous post-transplant LPDs. However, angioimmunoblastic T-cell lymphoma (AITL) is extremely rare in the medical literature. In this report, we describe three cases of RA patients who developed MTX-associated LPDs resembling AITL. They developed systemic lymph node swelling after initiation of MTX. The affected lymph nodes showed the histological finding of AITL: polymorphous infiltrates, mainly T-cells and arborizing high endothelial venules. Two cases showed a predominance of CD4-positive cells in proliferative T-cells, whereas the third case showed CD8-positive cells. CD10 was negative in all cases. RNA in situ hybridization of Epstein-Barr virus (EBV) demonstrated EBV-positive B-cells to be scattered in two cases, but not in one case. The lymphoadenopathy spontaneously regressed with cessation of MTX in all three cases, but one case recurred. These are interesting cases of MTX-associated LPDs mimicking AITL, and cessation of MTX is the only cure for patients with MTX-associated LPDs resembling AITL.

Efficacy and safety of tacrolimus treatment for rheumatoid arthritis patients undergoing hemodialysis

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by progressive joint destruction that requires aggressive treatment using appropriate disease-modifying antirheumatic drugs (DMARDs). RA patients with renal failure, however, are intolerant to most DMARDs due to the potential toxicity. In Japan, tacrolimus was approved for the treatment of RA in 2005. Based on its pharmacokinetics, tacrolimus may be administered to the patients undergoing hemodialysis. We report two cases of RA patients on hemodialysis treated effectively and safely with tacrolimus.

Preliminary Result of THA Using Interface Bioactive Bone Cement Technique Combined with Third Generation Cementing Technique

29 cases of primary total hip arthroplasty (THA) using interface bioactive bone cement technique (IBBC) combined with third generation cementing technique were evaluated clinically and radiologically. The present study includes 2 men 2 cases and 24 women 27 cases with an average age at operation of 63 years old (ranging 42 to 81). Mean postoperative follow up period was 17.3 months (ranging 12 to 23 months). Pre- and postoperative (1 year) evaluation using Japan Orthopaedic Association (JOA) hip score were 36.0, and 85.0 points, respectively. Postoperative cementing grade using Barrack’s classification was A in every case. At one year, radiolucent line at bone-cement interface was not observed, except one case of rheumatoid arthritis patient at zone 3 (Delee and Charnley) in the acetabular side. Neither osteolysis nor loosening was observed in every case. No major complications, such as infection, dislocation, pulmonary embolization, were observed. The present study revealed excellent short-term result was obtained by IBBC technique combined with third generation cementing technique for primary THAs.

ブシラミンの腎毒性

Bucillamine [N- (2-mercapto-2-methylpropanoyl) -L-cysteine, Rimatil (R) ] is a new slow-acting antirheumatic drug developed in Japan. The chemical structure of Bucillamine is similar to that of D-penicillamine except that it has two rather than one SH-bond in the molecule. As it is generally accepted that the SH-bond plays a role in the antirheumatic effect of D-penicillamine, the effectiveness of Bucillamine on rheumatoid arthritis has been proved in several studies.We administerd Bucillamine to 87 cases of rheumatoid arthritis patients for about 5 years, during which it became apparent that Bucillamine has the nephrotoxic potential to cause proteinuria. The frequency of bucillamine-induced proteinuria reached 12.6% in our study. Males were more susceptible to proteinuria than females (20.0% vs 11.1%), but its occurrence was not related with the dosage of bucillamine, disease duration, or the anatomical stage of disease.Other side effects, such as eruptions, itching, oral aphtha, malaise, and dysgeusia, also occurred, but no patient with proteinuria showed skin symptoms and/or dysgeusia.As bucillamine has the potential to cause proteinuria, similar to other antirheumatic drugs such as D-penicillamine and gold, special attention must be paid to renal involvement.