Reduction In Erythrocyte Sedimentation Rate Research Articles

Guideline-Optimised Treatment in Heart Failure-Do Higher Doses Reduce Systemic Inflammation More Significantly?

Background: Chronic inflammation is a constant phenomenon which accompanies the heart failure pathophysiology. In all phenotypes of heart failure, irrespective of the ejection fraction, there is a permanent low-grade activation and synthesis of proinflammatory cytokines. Many classes of anti-remodelling medication used in the treatment of chronic heart failure have been postulated to have an anti-inflammatory effect. Methods: This retrospective study enrolled 220 patients and focused on evaluating the effect of the most used active substances from these classes in reducing the level of inflammatory biomarkers (C reactive protein, erythrocyte sedimentation rate and fibrinogen) after initiation or up-titration. Our research is evaluating if this anti-inflammatory effect intensifies while raising the dose. The evaluation was performed at two visits with an interval between them of 6 months. Results: From the beta-blockers class, carvedilol showed a reduction in erythrocyte sedimentation rate (ESR), in low (6.25 mg, bi daily) and medium (12.5 mg, bi daily) doses. At the same time, sacubitril/valsartan showed a reduction in CRP levels. This effect was obtained only in the medium (49/51 mg, bi daily) and high (97/103 mg, bi daily) doses, with the maximum reduction being observed in the high dose. Conclusions: From the classes of medication evaluated, the study showed a significant reduction in ESR levels in the low and medium doses of carvedilol and a reduction in CRP values in the cases of medium and high doses of ARNI.

LIPIDS INCREASE IN HYPERTENSIVES DURING THE FIRST YEAR STEROID TREATMENT FOR GRANULOMATOSIS WITH POLYANGIITIS (GPA)

Objective: Granulomatosis with polyangiitis (GPA) is an ANCA-associated small-vessel vasculitis. Vessel wall inflammation induces multiple vascular damages leading to accelerated atherosclerosis. Metabolic profile and cardiovascular risk are marginally known in the GPA patients. Our purpose is to evaluate lipid profile and ASCVD-risk in GPA patients. Design and method: We selected 36 patients who received GPA diagnosis (T0) and evaluated them after 1 (T1) and 2 (T2) years follow-up. All patients were treated with high-dose glucocorticoid, one-year tapered, associated with immunosuppressants. Pathological history and a complete list of drugs at different time points were recorded. Results: The study reveals noteworthy alterations in lipid profiles, with a substantial increase observed in total cholesterol during both T1 and T2 in comparison to T0. A similar trend was noted in LDLand triglycerides. Conversely, no discernible differences were identified in HDL levels. Additionally, a considerable decrease in high-sensitivity C-reactive protein was observed at T1 and T2 in relation to T0, with no significant variance between T2 and T1. Furthermore, a notable reduction in erythrocyte sedimentation rate was noted at T2 as opposed to both T1 and T0, as well as at T1 compared to T0. Moreover, an interesting observation pertains to hypertensive patients who exhibited a marked escalation in lipid levels, juxtaposed with a gradual reduction in inflammation when compared to normotensive individuals. In particular, notable distinctions emerge between the two groups at both T1 and T2 concerning total cholesterol and LDL (p=0.027), despite comparable baseline values at T0. Then, while triglyceride levels start at similar values at T0, a substantial increase is observed at T1 in hypertensive patients and, conversely, at T2, normotensive individuals experience a significant rise in triglyceride levels, accompanied by a noteworthy reduction in hypertensive subjects. Conclusions: The findings indicate that lipid profile alterations, likely influenced by glucocorticoid treatment, may not be directly linked to inflammation. Furthermore, there is a higher relation between hypertension and these alterations. Actual data doesn’t reveal increased mortality in hypertensive GPA patients but further research is required to pinpoint specific patterns characterizing cardiovascular risk and progression in this context.

The mechanism of suppression of the synthesis of toxic gases and their indirect influence on the vital signs of the animal organism with adaptive growing technologies

Relevance. Many scientists reasonably believe that disturbances in microclimatic parameters are the basis for reduced adaptation of the animal organism to environmental conditions, to aggressive stress factors affecting the immune system of animals. This leads to a violation of the barrier function of the lungs, the rapid multiplication of microflora in the mucous membrane of the upper and lower respiratory tract, the development of exudative processes and a bright leukocyte reaction.Methods. To conduct the experiment in the winter stall period of 2021–2022, calves of the Holstein breed aged 15.0± 5.0 days were selected, from which two groups were formed according to the principle of pairs of analogues of 15 heads each.Results. The authors found that the use of a «Biological inactivator of toxic gases in the litter» for animals makes it possible to achieve a significant reduction in the amount of ammonia in the air inhaled by calves of the over-lining layer. At the same time, the respiratory function of the animal organism is activated (normalization of the body's homeostasis, improvement of erythropoiesis, reduction of erythrocyte sedimentation rate, increase in the level of alkaline blood reserve, etc.).

Effect of Hydrolysable Tannins and Anthocyanins on Recurrent Urinary Tract Infections in Nephropathic Patients: Preliminary Data

Urinary tract infections (UTIs) are caused by uropathogenic microorganism colonization. UTIs often require an antibiotic therapy that can cause the selection of antibiotic-resistant bacterial strains. A natural bioactive compound may represent a valid therapeutic adjuvant approach, in combination with drug therapy. In this paper, we present a pilot study, based on the administration of an oral food supplement (OFS), containing chestnut tannins and anthocyanins, to nephropathic patients suffering from recurrent UTIs (16 treated patients with 1 cp/day and 10 untreated patients). We performed laboratory tests and quality of life and body composition assessments, at T0 (baseline) and T1 (after 6 weeks OFS assumption). The analysis of OFS was performed by HPLC-DAD-MS for its content in polyphenols and by in vitro tests for its antioxidative and anti-free radical activities. In each capsule, polyphenol content was 6.21 mg (4.57 mg hydrolysable tannins, 0.94 mg anthocyanosides, 0.51 mg proanthocyanidins, 0.18 mg quercetin derivatives). A significant reduction of erythrocyte sedimentation rate was observed only in male patients. Urinalysis showed a significant reduction of leukocytes in both genders, whereas urinary bacterial flora at T1 significantly decreased only in male subjects. Tannins seem to exert an antimicrobial action according to gender, useful to counteract the recurrence of UTIs.

Beneficial effects of fish oil and cranberry juice on disease activity and inflammatory biomarkers in people with rheumatoid arthritis

ObjectivesWe sought to determine whether cranberry juice consumption would ameliorate laboratory and clinical measurements of disease activity in people with rheumatoid arthritis receiving fish oil supplementation. MethodsA prospective study was performed with 62 people with rheumatoid arthritis. We analyzed C-reactive protein modification of the Disease Activity Score-28 (DAS28-CRP) and inflammatory markers. The first group was assigned to eat their typical diet, a second group was asked to consume 3 g of fish oil ω-3 fatty acids daily, and a third group received both 3 g of fish oil n-3 fatty acids and 500 mL of reduced-calorie cranberry juice daily. ResultsCompared with baseline values, the group receiving both fish oil and cranberry juice showed reductions in erythrocyte sedimentation rate (P = 0.033), C-reactive protein (P = 0.002), DAS28-CRP (P = 0.001), adiponectin (P = 0.021), and interleukin-6 levels (P = 0.045), whereas the fish oil group showed decreased DAS28-CRP (P = 0.0261) and adiponectin (P = 0.0239). Differences across treatments showed that the group receiving both fish oil and cranberry experienced reductions (P < 0.05) in erythrocyte sedimentation rate and C-reactive protein compared to the control group and the group treated with fish oil alone, and a reduction in DAS28-CRP was verified when the fish oil and cranberry group was compared to the control group. ConclusionsThe ingestion of cranberry juice adds beneficial effects to fish oil supplementation, decreasing disease activity and inflammatory biomarkers in people with rheumatoid arthritis.

Therapeutic and photobiomodulation effects of low-level laser irradiation on Egyptian patients with carpal tunnel syndrome: a placebo-controlled study

Background/Aim Carpal tunnel syndrome (CTS) is the most prevalent mononeuropathy, where the median nerve is entrapped in the hand; it affects women more than men and is diagnosed by clinical and electrophysiological examination. Low-level laser therapy (LLLT) was suggested for conservative treatment of CTS. The aim of this study was to evaluate the role of LLLT in the treatment of CTS. Patients and methods The study was carried out on 40 female patients with CTS. Patients were recruited from Neurology and Rheumatology clinics at National Research Centre, Egypt. The patients were randomly divided into two groups (20 patients each). The first group was subjected to active LLLT, and the second group was subjected to placebo (sham) LLLT. The patients of the first group were treated with real LLLT by gallium-aluminum-arsenide laser (905 nm) with touch sensor guide light +8 diodes of power output of 100 MW each (800 MW total), and pulsed mode of frequency of 10 000 Hz over two areas, one extends from the proximal palmer crease to the distal wrist crease and the other over the thenar area, for three times per week for 4 weeks (12 sessions). All patients were subjected to clinical and nerve conduction studies evaluations. Results LLLT showed significant reduction in erythrocyte sedimentation rate and visual analog scale and significant improvement in functional status scale and symptom severity scale (P Conclusion This study confirmed the safety and positive effects of LLLT on pain, inflammation, functional capacity, and electro-neurophysiological aspects of median nerve in patients with CTS.

Adjuvant Treatment of Crohn's Disease with Traditional Chinese Medicine: A Meta-Analysis.

The objective of the meta-analysis was to evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) in the treatment of Crohn's disease (CD). Pubmed, Embase, Medline, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature, Wanfang Database, and Cochrane Central Register of Controlled Trials were searched (through October 2018). The quality of randomized clinical trials meeting the inclusion criteria was assessed and the data were extracted according to the Cochrane Review Handbook v5.0 by two evaluators. A meta-analysis was performed using the software Stata 12.0. Twelve randomized controlled trials (RCTs) were selected. The studies were of low methodological quality. The meta-analysis indicated that treatment with TCM and Western Medicine (WM) was significantly superior compared to treatment with WM alone with regard to total effective rate, remission maintenance rate, reduction of C-reactive protein (CRP), reduction of erythrocyte sedimentation rate (ESR), clinical score reduction, and reduction of adverse events. Mucosal healing was improved in both the TCM-WM and WM groups; however, there were no significant differences between the two groups. There was a certain publication bias in the studies with regard to efficiency, adverse reactions, mucosal healing, and recurrence rate; however, there was no obvious publication bias with regard to other indicators. TCM, as an adjuvant therapy with WM, shows advantages in inducing remission in CD. The current evidence suggests that TCM-WM treatment might be more efficient in terms of total effective rate, remission maintenance rate, CRP reduction, ESR reduction, clinical score reduction, and reduction of adverse events than treatment with WM alone. Because of the low quality of the included RCTs, high quality confirmatory evidence is needed to assess the clinical value of TCM in the treatment of CD.

Feasibility study of preoperative percutaneous catheter drainage in the treatment of lumbar tuberculosis with psoas abscess

To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods. Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups. All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(P<0.05). Postoperative anal exhaust time of group A was lower than that of group B(P<0.05). Improvement degree of ESR, CRP at 3 weeks after anti tuberculosis and 1 week after operation, group A was better than group B(P<0.05), and there was no significant difference between two groups in 1 month and 6 months after operation(P>0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (P<0.05). VAS score and Cobb angle at 1 month after operation was obvious improved(P<0.05), but there was no significant difference between two groups (P>0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups. Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.

Metabolic parameters in psoriatic patients treated with interleukin-12/23 blockade (ustekinumab).

The associations between psoriasis, metabolic syndrome and cardiovascular events are increasingly recognized. Studies have shown decreased cardiovascular events with the treatment of methotrexate and anti-tumor necrosis factor, however, effects of interleukin (IL)-12/23 blockade remain debatable. Our study investigated the effect of IL-12/23 blockade on the metabolic parameters in patients with psoriasis. We performed a retrospective cohort study to assess 93 consecutive patients with moderate to severe plaque type psoriasis who received IL-12/23 blockade (ustekinumab) for 24 weeks between January 2012 and May 2016. Metabolic parameters and disease activity (Psoriasis Area and Severity Index [PASI] score) at baseline and 24 weeks of treatment were collected. At week 24, the disease activity improved significantly (P < 0.0001), with a significant reduction of erythrocyte sedimentation rate. Conversely, body mass index was significantly elevated in PASI-75 responders at week 24 of treatment and was independent of disease severity. Fasting sugar and triglyceride levels were also elevated at week 24 in both PASI-75 responders and PASI-75 non-responders. Cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) remained unchanged. These metabolic parameters were not correlated with the improvement in disease severity after ustekinumab treatment. Nonetheless, the atherogenic index, LDL/HDL ratio and cholesterol/HDL ratio remained unchanged. Male sex and cigarette smoking are predictors of elevated plasma triglyceride levels. Our results suggest that despite tremendous improvement in disease activity after ustekinumab treatment, obesity, fasting sugar and hypertriglyceridemia still present in these patients. Regular screening of lipid profile, obesity control and smoking cessation are advised during the treatment of ustekinumab especially in male psoriatic patients with predisposing cardiovascular risks.

Management of wound infection after lumbar arthrodesis maintaining the instrumentation

&lt;sec&gt;&lt;title&gt;OBJECTIVE:&lt;/title&gt;&lt;p&gt; To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;METHODS:&lt;/title&gt;&lt;p&gt; Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS:&lt;/title&gt;&lt;p&gt; Mean age was 59.31 (±13.17) years old and most patients were female (94.7%; 18/19). The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION:&lt;/title&gt;&lt;p&gt; Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.&lt;/p&gt;&lt;/sec&gt;

SAT0279 Tocilizumab in Refractory Aortitis: Study on 16 Patients and Literature Review

BackgroundNon-infectious aortitis is often refractory to standard immunosuppressive therapy. IL-6 has been implicated in the pathogenesis of aortitis.ObjectivesOur aim was to assess the efficacy of the anti-IL6 receptor monoconal antibody...

Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial

Kawasaki disease, the most common cause of acquired heart disease in developed countries, is a self-limited vasculitis that is treated with high doses of intravenous immunoglobulin. Resistance to intravenous immunoglobulin in Kawasaki disease increases the risk of coronary artery aneurysms. We assessed whether the addition of infliximab to standard therapy (intravenous immunoglobulin and aspirin) in acute Kawasaki disease reduces the rate of treatment resistance. We undertook a phase 3, randomised, double-blind, placebo-controlled trial in two children's hospitals in the USA to assess the addition of infliximab (5 mg per kg) to standard therapy. Eligible participants were children aged 4 weeks-17 years who had a fever (temperature ≥38·0°C) for 3-10 days and met American Heart Association criteria for Kawasaki disease. Participants were randomly allocated in 1:1 ratio to two treatment groups: infliximab 5 mg/kg at 1 mg/mL intravenously over 2 h or placebo (normal saline 5 mL/kg, administered intravenously). Randomisation was based on a randomly permuted block design (block sizes 2 and 4), stratified by age, sex, and centre. Patients, treating physicians and staff, study team members, and echocardiographers were all masked to treament assignment. The primary outcome was the difference between the groups in treatment resistance defined as a temperature of 38·0°C or higher at 36 h to 7 days after completion of the infusion of intravenous immunoglobulin. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00760435. 196 patients were enrolled and randomised: 98 to the infliximab group and 98 to placebo. One patient in the placebo group was withdrawn from the study because of hypotension before receiving treatment. Treatment resistance rate did not differ significantly (11 [11·2%] for infliximab and 11 [11·3%] for placebo; p=0·81). Compared with the placebo group, participants given infliximab had fewer days of fever (median 1 day for infliximab vs 2 days for placebo; p<0·0001). At week 2, infliximab-treated patients had greater mean reductions in erythrocyte sedimentation rate (p=0·009) and a two-fold greater decrease in Z score of the left anterior descending artery (p=0·045) than did those in the placebo group, but this difference was not significant at week 5. Participants in the infliximab group had a greater mean reduction in C-reactive protein concentration (p=0·0003) and in absolute neutrophil count (p=0·024) at 24 h after treatment than did those given placebo, but by week 2 this difference was not significant. At week 5, none of the laboratory values differed significantly compared with baseline. No significant differences were recorded between the two groups at any timepoint in proximal right coronary artery Z scores, age-adjusted haemoglobin values, duration of hospital stay, or any other laboratory markers of inflammation measured. No reactions to intravenous immunoglobulin infusion occurred in patients treated with infliximab compared with 13 (13·4%) patients given placebo (p<0·0001). No serious adverse events were directly attributable to infliximab infusion. The addition of infliximab to primary treatment in acute Kawasaki disease did not reduce treatment resistance. However, it was safe and well tolerated and reduced fever duration, some markers of inflammation, left anterior descending coronary artery Z score, and intravenous immunoglobulin reaction rates. US Food and Drug Administration, Robert Wood Johnson Foundation, and Janssen Biotech.

Effect of pentoxifylline and pioglitazone on rheumatoid arthritis induced experimentally in rats

ObjectiveTo investigate the effect of pentoxifylline (PTX) and pioglitazone (Pg), each alone and in combination with methotrexate (MTX), on rheumatoid arthritis (RA) induced experimentally in male albino rats.BackgroundIndividuals have long feared RA as one of the most disabling types of arthritis. It is estimated that over 46 million individuals have arthritis, ~1% worldwide.Material and methodsOne hundred and eighty adult male albino rats were used in the present study. MTX was administered intraperitoneally at a dose of 0.25 mg/kg daily. PTX was administered intraperitoneally at a dose of 150 mg/kg/rat/day, whereas Pg was administered orally at a dose of 3 mg/kg/day. All doses were administered for a period of 2 weeks. RA was induced by two methods: adjuvant-induced arthritis and pristane-induced arthritis (PIA). Adjuvant-induced arthritis was induced by an intradermal injection of 0.1 ml of complete Freund adjuvant. This type of arthritis appears about 8-12 days after injection. PIA was induced by a single intradermal injection with 0.2 ml pristane at the base of the tail. PIA develops in 2-3 weeks after injection and progresses with a relapsing course that persists for months.ResultsThe anti-inflammatory properties of these drugs were confirmed by reduction of erythrocyte sedimentation rate, serum rheumatoid factor level, serum C-reactive protein level, serum tumor necrosis factor-a level, serum nitrite level, and blood superoxide dismutase level, whereas antioxidant activities were confirmed by an increase in the blood reduced glutathione level. Our study showed that Pg alone exerts portentous effects in the treatment of RA. However, it was more active in combination with MTX.ConclusionOur study showed that Pg was the most potent drug in treating arthritic rats, followed by PTX, with lesser potency in treating arthritic rats. When comparing the two combinations, the combination of Pg with MTX was the most potent one. The second combination was the combination of PTX with MTX.

A Novel Enteral Nutrition Protocol for the Treatment of Pediatric Crohn’s Disease

Enteral nutritional therapy (EN) is an effective modality for inducing and maintaining remission in pediatric patients with Crohn's disease (CD). The standard protocol for EN provides patients with 100% of their caloric needs for induction of remission. The aim of this study was to determine the efficacy of delivering 80% to 90% of patient's caloric needs through EN, to induce remission in pediatric patients with CD. This approach allows patients to consume remaining calories from a normal diet. A retrospective review of charts from 1998 to 2010 was conducted at The Children's Hospital of Philadelphia. Remission (Pediatric Crohn's Disease Activity Index <10) and response (decrease in Pediatric Crohn's Disease Activity Index score of ≥12.5 points) were calculated before and after treatment with EN. Weight z scores and laboratory parameters were evaluated in all participants. Forty-three charts were evaluated. Mean age of participants was 12.8 years (5.1-17.4), 67% were male and 33% female patients. Remission and response were evaluated in a group of 23 participants, with no missing data. There were reductions in erythrocyte sedimentation rate (P < 0.0001) and C-reactive protein (P < 0.02), and increases in albumin (P < 0.03). Mean Pediatric Crohn's Disease Activity Index score at baseline was 26.9 and was reduced to a score of 10.2 at follow-up (P < 0.0001). Induction of remission was achieved in 65% and response in 87% at a mean follow-up of 2 months (1-4 months). This novel EN protocol seems to be effective for the induction of remission in pediatric patients with CD and contributes to increasing weight and improving laboratory markers. This protocol may result in improved EN acceptance and compliance and will be evaluated prospectively.

Response measures influence comparative effectiveness of biological drugs in rheumatoid arthritis

Background Rheumatoid arthritis (RA) is a chronic, disabling inflammatory disease. Tumor necrosis factor (TNF) and interleukin-6 (IL-6) are key elements in the disease pathway and constitute the target of the most commonly used biological drugs. Infliximab, adalimumab, etanercept and golimumab are TNF inhibitors and tocilizumab is an IL-6-receptor antagonist. The aim of this work was to assess comparative effectiveness of biological drugs for RA patients registered in Reuma.pt, using different validate tools. Methods We included RA first biological therapy users. Our primary outcome was EULAR good response at 6 months. Secondary outcomes were the proportion of patients in remission applying DAS28, CDAI and SDAI. Groups were compared using a multivariate logistic model. Results 520 RA patients. 123 treated with adalimumab, 204 etanercept, 31 golimumab, 110 infliximab and 52 with tocilizumab. Mean age at biologics start was 54.4 ± 12.5 years and disease duration of 11.2 ± 9.6 years. 86.9% were females and 83.0% were either rheumatoid factor or ACPA seropositive. Baseline DAS was 5.3 ± 1.2 for adalimumab, 5.6 ± 1.2 for etanercept, 5.4 ± 1.3 for golimumab, 5.6 ± 1.3 for infliximab and 5.7 ± 1.2 for tocilizumab groups (p=0.12 ANOVA). At 6 months, DAS was 3.7 ± 1.3 for adalimumab, 3.8±1.3 for etanercept, 3.5±1.3 for golimumab, 3.7 ± 1.4 for infliximab and 1.6 ± 0.99 for tocilizumab groups (p<0.0001 ANOVA). The probability of achieving EULAR good response at 6 months was modeled. Significantly higher rate of good response at 6 months was observed in tocilizumab compared to other groups with the exception of golimumab. DAS28 remission threshold was attained by a significantly higher number of patients treated with tocilizumab. Remission rates assessed by CDAI and SDAI did not show significant differences between groups. Conclusions Tocilizumab demonstrated the best efficacy, but the difference varied with the disease activity tool chosen. These results reflect the importance of the tool used in the assessment of treatment response and may be explained by the pronounced effect of tocilizumab on the reduction of erythrocyte sedimentation rate, considered only by DAS28 and not by the other scores.

Leflunomide in monotherapy of rheumatoid arthritis: meta‑analysis of randomized trials

Rheumatoid arthritis (RA) is a chronic systemic disease of the connective tissue that leads to progressive joint destruction, disability, withdrawal from occupational activity, and premature death. The aim of the paper was to evaluate the efficacy and safety of leflunomide compared with placebo, methotrexate, and sulfasalazine in monotherapy of RA. A systematic search of databases (MEDLINE, EMBASE, Cochrane CENTRAL) was performed. Only randomized blind trials were included into the analysis. The quality of the trials was assessed by the Jadad scale. A quantitative synthesis of the results was performed (meta-analysis). The analysis included 7 trials involving 2861 patients (1432 on leflunomide, 312 on placebo, 922 on methotrexate, and 133 on sulfasalazine). Leflunomide, compared with placebo, increased the probability of the American College of Rheumatology 20% improvement (ACR20) response 2-fold (relative risk [RR], 2.02; 95% CI, 1.46-2.80) and the probability of ACR50 response 4-fold (RR, 4.36; 95% CI, 2.33-8.17), after 1 year of treatment. Efficacy of leflunomide did not differ from that of methotrexate with reference to the majority of endpoints. Leflunomide showed partial superiority over methotrexate in the percentage of patients obtaining ACR50 and ACR70 response, doctor's assessment of the disease activity, reduction in C-reactive protein (CRP) levels, and improvement of the quality of life (assessed with the modified health assessment questionnaire [HAQ]). Sulfasalazine showed partial superiority in the reduction of erythrocyte sedimentation rate, while leflunomide was superior to sulfasalazine the ACR20 and ACR50 clinical response, quality of life (assessed with the HAQ), doctor's and patient's assessment of the disease activity, and reduction in CRP levels. There were no significant differences between the effects of treatment with leflunomide and methotrexate or sulfasalazine, but leflunomide monotherapy proved more effective than placebo in relieving symptoms and signs of RA.

Comparing treatment outcome of infliximab and adalimumab in patients with severe hidradenitis suppurativa

Background: Hidradenitis suppurativa (HS) is a chronic relapsing skin disease. Recent studies have shown promising results of anti-tumor necrosis factor-alpha treatment. Objective: To compare the efficacy and safety of infliximab and adalimumab in the treatment of HS. Methods: A retrospective study was performed to compare 2 cohorts of 10 adult patients suffering from severe, recalcitrant HS. In 2005, 10 patients were treated with infliximab intravenous (i.v.) (3 infusions of 5 mg/kg at weeks 0, 2, and 6). In 2009, 10 other patients were treated in the same hospital with adalimumab subcutaneous (s.c.) 40 mg every other week. Both cohorts were followed up for 1 year using identical evaluation methods [Sartorius score, quality of life index, reduction of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), patient and doctor global assessment, and duration of efficacy]. Results: Nineteen patients completed the study. In both groups, the severity of the HS diminished. Infliximab performed better in all aspects. The average Sartorius score was reduced to 54% of baseline for the infliximab group and 66% of baseline for the adalimumab group. Conclusions: Adalimumab s.c. 40 mg every other week is less effective than infliximab i.v. 5 mg/kg at weeks 0, 2, and 6.

The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission

Exclusive enteral nutrition (EEN) achieves variable remission rates in patients with Crohn's disease (CD). To describe our experience of treating CD with an 8-week course of primary EEN and to study factors affecting treatment outcome. All CD patients treated with EEN in our centre between 2004 and 2007 were included in the study. Remission was determined by a combination of clinical parameters. Disease phenotype was assigned using published classifications. Inflammatory markers and anthropometry (Z-scores) were calculated before and after treatment. A total of 114 children were treated (four were excluded). Median age at diagnosis was 11.6 years. Fifty-seven (51.8%) were fed orally whilst 53 (48.2%) were fed by tube. Eighty-eight (80%) achieved remission with consequent reductions in erythrocyte sedimentation rate and C-reactive protein (P < 0.001). Patients in remission had comparative improvements in weight (-1.04 cf. -0.40) and BMI Z-scores (-0.98 cf. -0.03) by the end of treatment (P < 0.001). Individuals with isolated terminal ileal disease (n = 4) had lower remission rates than other locations (P = 0.02). No other significant differences in remission rates for any other disease locations were found. Exclusive enteral nutrition induces clinical remission, normalization of inflammatory markers and improves weight/BMI Z-scores in most patients. This study demonstrates that disease phenotype should not influence clinicians when commencing patients on EEN.

Molecular effects of exercise in patients with inflammatory rheumatic disease

Exercise is now known to be beneficial for patients with inflammatory rheumatic disease. In patients with rheumatoid arthritis, exercise can improve physical performance, cardiorespiratory fitness and muscle strength, and reduce disease activity and systemic inflammation, as evidenced by reductions in erythrocyte sedimentation rate and other systemic markers of inflammation. Similar effects on physical performance and cardiorespiratory fitness have been observed in patients with polymyositis and dermatomyositis. Improved muscle performance in these patients is associated with an increased ratio of type I : type II muscle fibers and increased cross-sectional area of type II muscle fibers, suggesting that myositis-affected muscle retains the ability to respond to exercise. In addition, resistance exercise training can reduce the expression of genes involved in inflammation and fibrosis in patients with myositis, and in vitro mechanical loading of chondrocytes can suppress the expression of proinflammatory cytokines, indicating that exercise can also reduce inflammation in the local tissue environment. Further studies of the systemic and local responses underlying exercise-associated improvement in muscle performance, soft tissue integrity and health outcomes are warranted.

The Effects of the Non-Volatile Anaesthetic Agents, Propofol and Thiopental, on Erythrocyte Sedimentation Rate

Objectives. The reduction of erythrocyte sedimentation rate (ESR) induced by general anaesthesia was demonstrated in our previous study. The purpose of the present study was to investigate whether the type of induction agent (propofol or thiopental) used for general anaesthesia had any effects on ESR.Methods. Sixty-four patients (ASA Physical Status Classification, I-II) scheduled for elective surgery under general anaesthesia were randomly assigned into two groups. In Group I, propofol and in Group II, thiopental were used as induction agents. Two blood samples were obtained before induction and 10 minutes after endotracheal intubation for ESR measurements.Results. The ESR values of the second samples from both groups were significantly lower than the values of the first samples, but there were no statistically significant differences in ESR values between the values of the two groups.Conclusion. The results showed that general anaesthesia decreased ESR values regardless of the type of agents being used for induction of anaesthesia. The reason might be related to other drugs used in both groups, or to a common effector mechanism of the two induction agents. The underlying mechanism needs to be investigated.