Management Of Rheumatic Diseases Research Articles

Real World Data use and Applications in the Integrated Management of Rheumatic Disease

Real World Data use and Applications in the Integrated Management of Rheumatic Disease

Infections in the management of rheumatic diseases: An update.

Patients with inflammatory rheumatic conditions have an increased risk of infection. While this could be the result of the underlying disease, it may also be caused by the use of immunosuppressive therapies, which are needed to treat these disorders. An increasing number of patients with rheumatoid arthritis or other rheumatic diseases are using biologic therapies (biologics) in addition to the synthetic disease-modifying anti-rheumatic drugs. The side-effects and complications of these relatively new agents are unknown to many specialists (outside of rheumatology) and general practitioners. This article highlights updates on the most important infections encountered in the daily management of patients with rheumatic diseases and discusses how these may be prevented.

Intra-articular injection of cortisone

Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

10 years of therapeutic advances in the rheumatic diseases

In the past 10 years, the rheumatology community has seen an explosion in the number of new therapies licensed for use across the rheumatic diseases, many with outstanding clinical success. Here, the drugs and strategies that constitute landmarks in the management of rheumatic diseases are highlighted.

Managing elderly patients with musculoskeletal disorders warrants a different approach

Literature evidence indicates a direct association between advancing age and the incidence of musculoskeletal symptoms and limitation of movement.1 Elderly subjects, particularly after the age of 60-65, constitute a special category requiring greater attention and care.2 Various socioeconomic and age-related factors influence the quality of life in this group of subjects. The complexity of caring for elderly subjects could be grouped into three domains: medical complexities, challenges in interpersonal relationship, and administrative domain.3 The incidence of rheumatic diseases like polymyalgia rheumatica (PMR) is more in this age group. Some of the management challenges confronted are: atypical presentation due to malignancy, increased comorbidities, and variable clinical presentations due to physiological conditions like edema surrounding the inflammatory joint. This editorial for the special issue on ‘Geriatric Rheumatology’ discusses how the management of rheumatic disease in elderly should differ from the regular approach.

Real World Data use and Applications in the Integrated Management of Rheumatic Disease

Real World Data use and Applications in the Integrated Management of Rheumatic Disease

Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases.

Antimalarial drugs (e.g. chloroquine and its close structural analogues) were developed primarily to treat malaria; however, they are beneficial for many dermatological, immunological, rheumatological and severe infectious diseases, for which they are used mostly today. Chloroquine and hydroxychloroquine, two of the most fascinating drugs developed in the last 50 years, are increasingly recognized for their effectiveness in myriad non-malarial diseases. In advanced research, chloroquine and hydroxychloroquine have been shown to have various immunomodulatory and immunosuppressive effects, and currently have established roles in the management of rheumatic diseases, lupus erythematosus (different forms) and skin diseases, and in the treatment of different forms of cancer. Recently, chloroquine analogues have also been found to have metabolic, cardiovascular, antithrombotic and antineoplastic effects. This review is concerned with the lysosomotropic, anti-inflammatory and immunomodulatory mechanisms of chloroquine, hydroxychloroquine, quinacrine and related analogues, and the current evidence for both their beneficial effects and potential adverse manifestations in various diseases.

Incidence of cardiac conduction disorders in patients with rheumatic disease receiving hydroxychloroquine

Background: Hydroxychloroquine (HCQ) used for long-term management of rheumatic diseases. Prolonged use of antimalarials has been implicated in the development of conduction disorders particularly with chloroquine. Since limited data are available with HCQ, we studied electrocardiograms (ECG’s) of 122 patients with rheumatic diseases treated with HCQ. This is the first study with large cohort evaluating conduction disorders in those receiving HCQ. Methods: To evaluate cardiac conduction disorders in patients receiving HCQ as a part of their treatment, during 1-year follow-up and to note other related adverse reactions with a hypothesis to determine, how common are conduction disorders with HCQ. This is longitudinal prospective observational study over 1-year in the tertiary referral of south India. All patients who were started on HCQ (200-400 mg/day) as a part of their treatment were included. Patients with established cardiac diseases, electrolyte abnormalities and who were on drugs that cause conduction disorders were excluded. All ECG’s were cross-checked by a cardiologist. Results: A total of 276 patients were screened at baseline and 270 patients were enrolled in the study. Patients of rheumatoid arthritis, lupus, Sjogren’s syndrome, undifferentiated connective tissue disease, palindromic rheumatism were included after satisfying respective classification criteria. The mean age is 38.85 (standard deviation [SD] 8.34) years. Females are 82.8% (n=101) and males are 17.2% (n=21). The baseline mean heart rate is 81.4 beats/min (SD=11.04), PR interval is 141.5 ms (SD=13.90), QRS is 84.8 ms (SD=13.90), QTc is 421.5 ms (SD=35.65). At 6 months, mean heart rate is 80.4 beats/min (SD=9.99), PR interval is 141.9 ms (SD=16-37), QRS is 81.5 ms (SD=11.82), QTc is 427.4 ms (SD=34.56). At the end of study period, mean heart rate is 81.8 beats/min (SD=9.49), PR interval is 140 ms (SD=21.33), QRS is 84.6 ms (SD=15.72), QTc is 422.7 ms (SD=36.2). During study period four events occurred. A young girl with lupus developed ventricular ectopics on hiking dose of HCQ from 200 mg to 400 mg with a cumulative drug intake of 9.8 g, which has resolved completely on stopping drug without any other intervention. A lupus patient died at home and the cause was not known. A 36-year-old male with rheumatoid arthritis of 4 years duration developed prolonged PR interval with 6 months of drug intake with cumulative was drug intake of 30.6 g with no available follow-up data. A 30-year-old female with undifferentiated arthritis developed skin rash which is pruritic, exfoliative with tiny blisters, 3 days after starting drug. The incidence of cardiac conduction defects in 1-year of follow-up in patients started on HCQ is 0.84. Conclusion: This study highlights need for periodic cardiac evaluation of patients receiving long-term antimalarials. Reversibility of antimalarial toxicity is also highlighted in this study. Conduction disorders observed were similar to that expected in general population thus adding further evidence on safety of HCQ.

Detection of educational needs of patients with inflammatory arthritis: feasibility and results in routine care

Background: Therapeutic Patient education (TPE) is part of the disease management of inflammatory rheumatic diseases. The detection of unmet educational needs by the rheumatologist may increase the patients’ motivation for education. Objectives: (1) Assess the feasibility of a systematic procedure to detect patients educational needs in current practice. (2) Determine the type of patients’ needs. Methods: In a pragmatic prospective pilot study, the rheumatologist invited outpatients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to complete a questionnaire of educational diagnosis. The questionnaire was elaborated according to the French National Health Authority guidelines. Six domains were assessed: knowledge and beliefs about disease and treatments, impact on family and social life, impact on professional life, emotional well-being and management by the health care system. For each domain, patients were asked whether they encountered difficulties or needed more information or help. Results: The questionnaire was proposed by the rheumatologist to 68 patients of the 120 outpatients during a 4 month period in hospital or private practice. 53/68 (78%) questionnaires were completed. The reasons of non-distribution were: lack of time (27), severe medical condition (20), oversight (11), literacy or cognitive barriers (6), recent contact with a TPE program (6), other reasons (10). Some patients experiencing language or cultural barriers were subsequently helped by a hospital pharmacist to fulfill the questionnaire. Seventy-four questionnaires were finally analyzed (55 RA and 19 SpA patients, mean age 57 years (24-87)) l’sixty-four percent patients expressed at least one educational need. Patients experienced difficulties or needed information or help in relation to the disease (14% experienced difficulties/55% needed information or help), treatment (respectively 10%/39%), social and family life (33%/35%), professional life (53%/44%), health care system (11%/34%), emotional status (38%/49%).There was no statistical difference between the expression of at least one educational need and age, type of arthritis, duration of disease, hospital or private care, biologic treatment. 61% patients wished to meet another health professional or other patients. The questionnaire was considered helpful by 77% patients. Only 3 patients found the questionnaire too long and none thought it was intrusive. Conclusions: Detection of patients’ educational needs in current practice is feasible using a self-administrated questionnaire with good acceptability. This procedure is a first step in an educational process. For some patients having language or cultural barriers, the help of another professional is essential. Educational needs are high in patients with arthritis. They are widely underestimated in routine care and include major socio-professional and psychological issues.

A severe case of esophageal ulcer causing a tight stricture despite long-term D-penicillamine treatment.

D-penicillamine has long been used in the management of rheumatic diseases due to the effects on inhibition of collagen synthesis. Herein, we report a severe case of esophageal ulcer causing a tight stricture extending through the distal esophagus despite the long-term D-penicillamine treatment in a patient with Wilson's disease. D-penicillamine would theoretically be expected to contribute to the healing of an esophageal ulcer. However, the drug failed to have a favorable outcome, which is notable and worth reporting.

Share – Workpackage 4: addressing the need for health care for paediatric rheumatic diseases throughout europe

A need for evidence-based guidelines for the management of paediatric rheumatic diseases (PRD) has been recognised. In 2012 the European Agency for Health and Consumers signed the contract for a new European initiative SHARE: Single Hub and Access point for paediatric Rheumatology in Europe (project number 2011 1202).

Stem cell therapy in autoimmune rheumatic diseases: a comprehensive review.

The clinical management of autoimmune rheumatic diseases (ARD) has undergone significant changes in the last few decades, leading to remarkable improvements in clinical outcomes of many patients with mild to moderate ARD. On the other hand, severe refractory ARD patients often have high morbidity and mortality. Extensive basic research and clinical evidence has opened the door to new encouraging perspectives, such as the establishment of a role of stem cell transplantation (SCT) in the strategic management of ARD. Given the great heterogeneity of ARD, it is difficult to assign an optimal SCT regimen to all ARD patients. SCT remains a challenging mode of therapy in ARD patients from the standpoints of both efficacy and safety. As the clinical data of SCT in ARD increases and as we improve our understanding of stem cell biology and the downstream effects on the immune system, the future is promising for the development of optimal personalized SCT regimens in ARD.

AB0563 Relationship between Readmission and Corticosteroid Doses in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

BackgroundAlthough corticosteroid treatment is essential in the management of rheumatic diseases, adverse events of corticosteroids pose serious problems. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) frequently requires higher corticosteroids doses than does...

FRI0273 Reactivation of Hepatitis B Virus in Patients Treated with Anti-TNF Therapy

BackgroundAnti-TNF therapy was known to increase the risk of certain infection. There are no sufficient data about the reactivation of hepatitis B virus (HBV) after anti-TNF therapy.ObjectivesThe study was aimed...

FRI0314 Safety of the Newer Biological Dmards, TOCILIZUMAB and Abatacept, in Rheumatoid Arthritis (RA) Patients with A History of HBV Infection: A REAL Life Experience

BackgroundHBV infection represents a major issue in RA patients undergoing biological disease-modifying anti-rheumatic drugs (bDMARDs) treatment (1). While several studies deal with the risk of hepatitis reactivation under anti-TNF agents,...

SP0218 Making the CASE for Rheumatic Diseases (RMDS) at the EU Level

One of the greatest barriers to the early identification and optimal management of Rheumatic and Musculoskeletal Diseases (RMDs) is poor public and political awareness.EULAR is actively addressing this problem by...

SP0094 Patients' Needs. do We Meet Them?

Rheumatic conditions are known to be, in their majority, chronic disabling diseases with high impact on body functions, but also on daily activities and participation in society, including productivity and...

AB1034 Satisfaction and Dissatisfaction of Patients with Rheumatic Diseases Receiving Biologics

ObjectivesBiologics are medication widely applied in management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is...

OP0207-HPR Gender Differences in Educational Needs to Manage the Disease in Individuals with Spondyloarthritis

BackgroundPatient education is a recommended part of the management of rheumatic diseases but knowledge is scarce concerning what educational needs that are most important from the patient's point of view.ObjectivesThe...

Pharmacology of steroids in the musculoskeletal system

Steroids, of both plant and animal origin, are a large group of fat-soluble organic compounds. The majority have important physiological actions. In the musculoskeletal system, they regulate bone growth and muscle development. The structural modification of naturally occurring steroids has generated thousands of derivatives; many of which are used in medicine. The synthetic analogs of glucocorticoids (e.g. prednisone, cortisone, hydrocortisone), often called corticosteroids, are used clinically across many diverse therapeutic domains (e.g. rheumatology, gastroenterology, oncology and dermatology). The terms glucocorticoid and corticosteroid are used interchangeably in the published literature. This article utilizes glucocorticoids (GCs) as a general descriptor encompassing both synthetic and naturally occurring analogues. It explains the rationale behind the use of GCs in the management of rheumatic diseases and provides a balanced view of the beneficial and detrimental effects of systemic GC treatment, using rheumatoid arthritis as the predominant disease example.