Treatment Of Chronic Rheumatic Diseases Research Articles

Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

Background . Despite the progress in diagnosis and treatment of chronic rheumatic diseases in children, the choice of anti-inflammatory drugs in case of the onset of oligoarticular juvenile idiopathic arthritis (JIA) still remains relevant. Till present, pediatric rheumatologists have not reached a consensus on this issue yet. The aim of this study was to search for predictors of early failure of local steroid therapy and assessment of its feasibility in patients with oligoarticular JIA. Materials and methods. In a retrospective study, 92 children aged 11 months – 9 years with chronic oligoarticular JIA without extra-articular manifestations were monitored. The features of the clinical, instrumental and laboratory diagnosis during the disease onset were studied, along with the dynamics of the articular syndrome and the effectiveness of intra-articular administration of corticosteroid drugs. Results and discussion. The data on 92 children with 164 active joints who received 218 local intra-articular injections of triamcinolone acetonide at the onset of the disease were analyzed. Intra-articular injections of triamcinolone acetonide at a dose of 20–40 mg were performed with an interval of 3, 6, and 12 months, depending on the intensity of the disease. In about one third of children with oligoarticular JIA, arthritis became inactive on average after two intra-articular injections of triamcinolone acetonide. The study did not reveal the predictors of early ineffective topical corticosteroid monotherapy in children. No clinical, instrumental, and laboratory signs were identified that would directly indicate the need for early therapy with methotrexate. Conclusion . Triamcinolone acetonide is an effective and safe drug for children with oligoarticular JIA. Despite the widespread use of biological, gene, and other innovative therapies, application of local corticosteroids as the firstline therapy in children with oligoarticular JIA should not be neglected.

Efficacy and safety of interleukin-17 inhibitors in the treatment of chronic rheumatic diseases: A combined and updated meta-analysis.

To assess the efficacy and safety of interleukin-17 inhibitors (ixekizumab, secukinumab, bimekizumab, netakimab and brodalumab) in chronic inflammatory rheumatic diseases, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA). A comprehensive search for randomized controlled trials (RCTs) evaluating efficacy and safety of interleukin-17 inhibitors was performed through PubMed, Embase and Cochrane Library databases. Quality assessment was performed using the Cochrane Collaboration risk of bias tool. Data were pooled using the fixed or random-effects models. Twenty RCTs were identified: of these 9 studies on patients with AS and 11 studies on patients with PsA. Concerning clinical efficacy, a pooled analysis showed interleukin-17 inhibitors had a higher response rate for the primary endpoint (p<0.05) and secondary endpoint (p<0.05) at the treatment endpoint for AS/PsA patients. Moreover, an increased risk of treatment-emergent adverse events and infection was found in AS patients (p<0.05). In contrast, no increased risk of any adverse events was reported in PsA patients. In this meta-analysis, our findings found interleukin-17 inhibitors had a significant clinical benefit in the management of AS/PsA patients.

Patient-Report-Outcome-Measure and Incentives for Inpatient Chronic Care in Germany

INTRODUCTION: In general, incentive tools like pay for performance (P4P) have positive effects regarding treatment quality and financial outcomes. As they are applicable to the clinical management of chronic conditions like asthma and diabetes, this article analyses their potential for multimodal complex treatment of chronic rheumatic diseases. &#x0D; &#x0D; METHODS: Cost data for chronic rheumatic diseases with and without specified complex treatments and their respective remuneration are compared to permit specific statements regarding incentive aspects in a DRG setting. Moreover, several standardized Patient-Report-Outcome-Measures (PROMs) are considered in the context of complex treatment to allow not only for efficiency, but also effectiveness evaluation. &#x0D; &#x0D; RESULTS: In total, 375 patients with complex treatment for rheumatic conditions were surveyed from 2013 to 2018. The incentive is slightly below (4,821.05 &amp;euro;) the costs incurred for complex treatments (4,972.44 &amp;euro;). The results of the used PROMs are positive as pain intensity decreased considerably (p &amp;lt;.001, r=0.75) and mental state complaints were reduced (p &amp;lt;.001). &#x0D; &#x0D; CONCLUSIONS: PROMs are valid instruments to capture changes in patient well-being. They also help to improve clinical operations and can be used for benchmarking. The P4P approach should cover the costs incurred to ensure the incentive structure.

AB1416 Fears and beliefs about biologic agents in moroccan patients

BackgroundThe introduction of biological therapies has significantly improved the treatment of chronic rheumatic diseases. In our routine clinical management of patients, varying ideas and fears are expressed by patients concerning...

Acupuncture in the treatment of rheumatic diseases.

Acupuncture has been used for millennia in traditional Chinese medicine as a technique believed to restore the balance of energy in the body caused by disease through the use of needles inserted into specific points or energy channels. This energy is called the de qi. The use of acupuncture for the treatment of pain in musculoskeletal disorders is increasing. Some patients seek alternative therapies because of lack of improvement with conventional treatments. The potential physiological effects of acupuncture on pain relief have been attributed to biochemical processes, such as the release of endorphins into the limbic structures, subcortical areas and brain stem, mechanisms that are also present in placebo-induced analgesia. In addition, pain relief with acupuncture is also associated with patient expectations, beliefs, and interactions with their acupuncturists. In this review, we summarize the latest evidence on the treatment of musculoskeletal conditions including rheumatoid arthritis, fibromyalgia, neck pain, shoulder pain, low back pain, and knee pain with traditional Chinese acupuncture (TCA), electroacupuncture (EA), and the use of moxibustion. Acupuncture is relatively safe, but there are still reports of serious and fatal side effects that must be taken into account when recommending this therapy. Many of the latest trials assessing the benefits of acupuncture in rheumatic diseases found that acupuncture was not better than sham acupuncture, implying that the analgesic effects observed are related to a strong placebo response. While the literature on this topic is extensive, many of the studies lack methodological rigor, and additional large, well-controlled, high quality trials are still needed to determine if acupuncture might be useful in the treatment of chronic rheumatic diseases.

Nitric oxide and cyclooxygenase may participate in the analgesic and anti-inflammatory effect of the cucurbitacins fraction from Wilbrandia ebracteata

Wilbrandia ebracteata is a medicinal plant from South America used in folk medicine for the treatment of chronic rheumatic diseases. We have shown that the high performance liquid chromatography-characterized (HPLC) dichloromethane fraction isolated from Wilbrandia ebracteata (WEDC) inhibits the parameters observed in experimental models of inflammation in vivo and in vitro. In the present study, we extend our previous observations on the analgesic effects of WEDC by investigating its actions using the hot plate test and zymosan-induced writhing test in mice, as well as zymosan-induced arthritis in rats evaluating articular inflammatory pain, cell migration and determination of NO release into the joint exudate. The effect of WEDC on the activity of COX-1 and COX-2 in vitro and its ulcerogenic capacity in vivo were also investigated. The oral treatment of the animals with WEDC (1–10 mg/kg) produced a significant, dose-dependent reduction of articular incapacitation and abdominal contortions in the writhing test. The same effect was not observed in the hot plate and rota-rod tests. WEDC also reduced nitrite release into the zymosan-inflamed joints. In the evaluation of COX activity, we observed that WEDC was able to selectively inhibit COX-2 but not COX-1 activity in COS-7 cells. Moreover, WEDC treatment did not show gastrointestinal toxicity. Our data confirm the anti-nociceptive activities of the WEDC and indicate that this effect could be associated with inhibition of cyclooxygenase-2 (COX-2) and nitric oxide release. The effects could be attributed to cucurbitacins since several of these were isolated from the WEDC.

Chronic Rheumatic Diseases

Nonsteroidal anti-inflammatory drugs (NSAIDs) play an important role in alleviating pain, restoring function and improving quality of life in patients with chronic rheumatic diseases. Unfortunately, use of NSAIDs for long periods is associated with an increased risk of gastrointestinal adverse effects. Piroxicam-β-cyclodextrin is a new NSAID which is absorbed rapidly and thus achieves an early analgesic effect. A second potential advantage of more rapid absorption is that the drug is less likely to irritate the gastrointestinal mucosa and cause local adverse effects. Indeed, clinical studies of long term use of piroxicam-β-cyclodextrin have shown that this agent is at least as effective as other NSAIDs, with good gastrointestinal tolerability This favourable risk-benefit profile of piroxicam-β-cyclodextrin supports its use in the long term treatment of chronic rheumatic diseases.

A Note on the Diagnosis and Treatment of Chronic Rheumatic Diseases in Soldiers

A Note on the Diagnosis and Treatment of Chronic Rheumatic Diseases in Soldiers