Treatment Of Rheumatic Conditions Research Articles

Development of active tuberculosis in patients treated with biological disease-modifying antirheumatic drugs

Background. Biological disease-modifying antirheumatic drugs (bDMARDs) have been shown to be highly effective in the treatment of rheumatic conditions, but may increase the risk of infections. Development of tuberculosis (TB) while on bDMARD therapy is of particular concern in high TB burden settings such as Western Cape Province, South Africa. Objectives. To describe the diagnosis, management and outcome of patients who developed active TB while receiving a bDMARD. Results. Ten patients who screened negative for TB prior to initiation of a bDMARD subsequently developed active TB. TB was diagnosed between 10 months and 9 years from bDMARD initiation, suggesting new infection, and included 6 cases of extrapulmonary TB. All patients required multiple tests to confirm the diagnosis of TB, and all were successfully treated. Conclusions. TB can occur in patients on bDMARD therapy despite initial screening, and may have unusual, extrapulmonary manifestations that pose a diagnostic challenge.

Effect of listing strategies on utilization of antitumor necrosis factor biologics infliximab and etanercept: a cross-sectional analysis from Ontario, Canada

BACKGROUND: Use of costly biologic drugs for the treatment of chronic inflammatory diseases has increased significantly in recent years. However, biosimilar drugs offer an opportunity to ensure health system sustainability with robust uptake. OBJECTIVE: To study the effect of formulary listing strategies on the use of infliximab and etanercept innovator and biosimilar biologics. METHODS: This is a cross-sectional study of individuals in Ontario, Canada, dispensed a biologic prescription for infliximab or etanercept through Ontario's public drug program between January 1, 2010, and June 30, 2019. Quarterly utilization and costs were forecasted using Holt-Winters' exponential smoothing models to the second quarter (Q2) of 2022. Secondary analyses explored utilization for rheumatic conditions (RC) and inflammatory bowel disease (IBD). RESULTS: From Q1 2010 to Q2 2019, infliximab and etanercept users increased by 75.7% (n = 4,073 to 7,158), with a forecasted increase of 13.7% (n = 8,142; 95% CI = 7,438-8,847) by Q2 2022. Biosimilar users represented 13.8% (n = 539 of 3,905) of total infliximab users in Q2 2019, although this differed by indication with 6.9% for IBD (n = 187 of 2,712) and 26.6% for RC (n = 203 of 764). Etanercept biosimilar users represented 20.2% (n = 659 of 3,256) of total etanercept users for RC in Q2 2019. Biologics expenditures increased 109.7% during the study, amounting to $49.9 million in Q2 2019. CONCLUSIONS: Despite differing reimbursement restrictions between innovator infliximab and etanercept biologics, the uptake of their biosimilars was low and not noticeably different in the treatment of RC. Dynamic policy strategies are needed to improve the uptake of biosimilars, particularly for IBD. DISCLOSURES: Funding for this study was contributed by the Ontario Ministry of Health. The authors have no conflicts of interest to disclose.

Phenylbutazone (Bute, PBZ, EPZ): one drug across two species

In this article we explore the different trajectories of this one drug, phenylbutazone, across two species, humans and horses in the period 1950–2000. The essay begins by following the introduction of the drug into human medicine in the early 1950s. It promised to be a less costly alternative to cortisone, one of the “wonder drugs” of the era, in the treatment of rheumatic conditions. Both drugs appeared to offer symptomatic relief rather than a cure, and did so with the risk of side effects, which with phenylbutazone were potentially so severe that it was eventually banned from human use, for all but a few diseases, in the early 1980s. Phenylbutazone had been used with other animals for many years without the same issues, but in the 1980s its uses in veterinary medicine, especially in horses, came under increased scrutiny, but for quite different reasons. The focus was primarily the equity, economics, and ethics of competition in equine sports, with differences in cross-species biology and medicine playing a secondary role. The story of phenylbutazone, a single drug, shows how the different biologies and social roles of its human/animal subjects resulted in very different and changing uses. While the drug had a seemingly common impact on pain and inflammation, there were inter-species differences in the drug’s metabolism, the conditions treated, dosages, and, crucially, in intended clinical outcomes and perceptions of its benefits and risks.

Knee osteoarthritis - effectiveness of mud therapy in clinical and functional improvement

Introduction: Osteoarthritis is one of the pathologies which most limits the quality of life and functionality, having a negative impact on the level of participation of the individual and, consequently, in socio-economic terms. The mud therapy has been used in the treatment of rheumatic conditions since ancient times. However, there are few studies that evaluate the therapeutic effect and its application in knee osteoarthritis.

Safety of etoricoxib, a specific cyclooxygenase-2 inhibitor, in asthmatic patients with aspirin-exacerbated respiratory disease

Treatment of rheumatic conditions is limited in patients with asthma owing to concerns of nonsteroidal anti-inflammatory drugs potentially provoking asthma. Cross-sensitivity to all anti-inflammatory drugs that inhibit cyclooxygenase enzymes occurs in these individuals. To study the safety of etoricoxib, a specific cyclooxygenase-2 inhibitor, and to determine whether it cross-reacts with asthma in patients with aspirin-exacerbated respiratory disease (AERD). This study included 77 patients who had experienced asthma induced by aspirin and at least 1 other nonsteroidal anti-inflammatory drug. Baseline evaluation included blood pressure measurement, nasal examination, spirometry, and peak expiratory flow rate measurement. Patients were given placebo the first day and then were challenged with once-daily etoricoxib in 3 different doses: 60 mg on day 2, 90 mg on day 3, and 120 mg on day 4. If no evidence of intolerance was seen, each patient was rechallenged with 60 or 90 mg of etoricoxib once daily (according to the rheumatic condition) 7 days later. Reassessment of the baseline measurements was performed daily from day 1 to day 4 after the initial challenge, on day 7 after rechallenge, and after 1 month of drug intake. If the patient developed any mucosal or skin reaction, hypotension, upper or lower airway obstruction, conjunctival reaction, or laryngeal edema during the challenge test, it was considered a positive response. Etoricoxib was well tolerated, without any signs of immediate or delayed hypersensitivity in aspirin- and nonsteroidal anti-inflammatory drug-induced asthmatic patients. None of 77 study patients experienced any symptoms or developed dyspnea, change in nasal examination, significant variation in peak expiratory flow rate greater than 20%, or decline in forced expiratory volume in 1 second greater than 15% during etoricoxib challenge. The exact 1-sided confidence interval for the probability of etoricoxib inducing cross-reactions in patients with AERD was 0% to 2%. These results confirm the lack of cross-reactivity between specific cyclooxygenase-2 inhibitors and aspirin in AERD. Etoricoxib was safe for treating inflammation in patients with AERD.

Aspirin versus the non-acetylated salicylates

Bitter im Mund, gesund im Korper German proverb (Strauss, 1968) Historically, it was salicylate--as the acid, sodium salt, aldehyde alcohol or glucoside--that found application in the treatment of rheumatic conditions (for review see Rainsford, 1984). These forms were present in plant-derived extracts which were employed from ancient times until the middle of the last century. With the development of organic chemistry in Germany and France at that time came first the purified compounds, then later synthetic methods (chiefly the Kolbe and Lautermann procedure) for the synthesis of salicylic acid. While no clinical trials of the type and standard employed today were then undertaken to establish the efficacy of salicylic acid or its salts (collectively salicylates) in the relief of pain and soft tissue swelling in various rheumatic conditions, the mere fact that salicylates found such wide use and acceptance in the treatment of rheumatic fever, gout and other arthritides in the latter part of the last century is evidence of a kind for their efficacy. Aspirin (acetylsalicylic acid) really only came into popular use through (a) recognition of the need to obtain a drug which was more palatable and less upsetting to the gastrointestinal tract than sodium salicylate, (b) the powerful competitive forces operating at the time, and (c) clever marketing approaches (Rainsford, 1984). Evidence supporting claims for the reduced gastric irritancy of aspirin over salicylate were initially based on a series of cleverly contrived experiments notably featuring a model of epithelial injury in fish tails immersed into acidic solutions of the two drugs (Rainsford, 1984). The biological relevance of this model with respect to mucosal injury in the gastrointestinal tract must be considered remote, let alone the deductive reasoning for the lack of injury from aspirin (Rainsford, 1984). These and other earlier studies were the basis upon which the marketing of aspirin and especially its claims for superiority over salicylate were based. In contrast, it was less than a decade after aspirin was introduced that the first reports of gastric ulceration in dogs appeared (Chistoni and Lapresa, 1909). This was followed in 1912 by reports of 'gastralgia' from aspirin in

Tenoxicam milk formulation in the treatment of rheumatic conditions.

Tenoxicam milk formulation is a new galenical form of a non-steroidal anti-inflammatory drug (NSAID). It is especially suitable for patients having compliance problems or difficulty in swallowing tablets. This formulation has proved to be a useful alternative oral treatment in various rheumatic conditions. Combining rapid onset of action and maintenance of active plasma levels, tenoxicam achieved good clinical efficacy and tolerability in the vast majority of the patients studied.

Naproxen

Naproxen, a propionic acid derivative, is a nonsteroidal anti-inflammatory, antipyretic and analgesic agent which has been widely used in the treatment of rheumatoid arthritis, degenerative joint disease, ankylosing spondylitis, acute gout, and periarticular diseases such as bursitis, tendinitis and tenosynovitis since 1973. It has also proved effective in the treatment of patients with painful states and with dysmenorrhoea. Pharmacology. Its activity in animal models of inflammation is presumed to be mediated through its demonstrated ability to inhibit prostaglandin synthesis although other actions of the drug may play a role. Its administration effectively blocks the erosion of cartilage and bone occurring in the adjuvant arthritis syndrome in the rat. It interferes with platelet aggregation both in animals and man. It blocks yeast-induced hyperpyrexia in the rodent and suppresses fever in man. Pharmacokinetics. The pharmacokinetics of naproxen in man are relatively simple. It is essentially completely absorbed after oral or rectal administration and reaches peak plasma concentrations in about two hours. The sodium salt is absorbed more rapidly than naproxen acid. Naproxen is extensively bound to plasma proteins. Its metabolic half-life averages 13 hours, justifying a loading dose regimen when acute effects are desired, and twice-daily administration for maintenance. Naproxen is excreted almost entirely in the urine as the native molecule, its oxidative 6-desmethyl metabolite and their respective conjugates. Its kinetics are dose dependent. As the dose is increased above one gram a day, plasma level increments are less than proportional to dose. Therapeutic trials. Naproxen, in doses of 500–700 mg daily, has been evaluated in comparative trials with aspirin and indomethacin in rheumatoid arthritis and degenerative joint disease. Its therapeutic efficacy has been similar to and sometimes superior to these agents; in most cases naproxen was better tolerated. In more limited trials it has also compared favourably to the newer NSAIs: ibuprofen, fenoprofen and ketoprofen. Initial results in patients with ankylosing spondylitis and gout showed efficacy comparable to phenylbutazone. Comparative trials against a wide variety of control agents have shown naproxen to be an effective analgesic in patients with moderate pain resulting from orthopaedic, dental, and other surgical procedures; it has been particularly useful in pain associated with uterine contractions. Side effects. Naproxen has been well tolerated in short and long term studies. Adverse effects necessitated the discontinuance of less than six per cent of a large cohort of rheumatoid arthritis patients in one year of treatment. Gastrointestinal side effects such as heartburn, nausea and dyspepsia have been most frequently reported; these occur significantly less frequently than when therapeutically equivalent doses of aspirin are administered. Potentially serious events such as gastrointestinal bleeding have been uncommon but a few fatalities have been reported. Other rare reactions reported include angioneurotic oedema, thrombocytopenia, agranulocytosis, and jaundice. Dosage. The usual adult dose in the treatment of rheumatic conditions is 500–750 mg daily, usually in two divided doses. Dosage may be adjusted according to individual requirements and response. Increasing the dose to one gram daily may provide a greater therapeutic effect without loss of tolerance. Doses over one gram a day have been used primarily in the treatment of acute gout and for the control of pain.

A General Practice Assessment of Alrheumat(R)(Ketoprofen) in the Treatment of Rheumatic Conditions

A General Practice Assessment of Alrheumat(R)(Ketoprofen) in the Treatment of Rheumatic Conditions

A General Practice Assessment of ®Alrheumat (Ketoprofen) in the Treatment of Rheumatic Conditions

International Journal of Clinical PracticeVolume 31, Issue 9 p. 127-134 Clinical Trial A General Practice Assessment of ®Alrheumat (Ketoprofen) in the Treatment of Rheumatic Conditions J. Mason MB, ChB, DRCOG, J. Mason MB, ChB, DRCOG Bayer U.K. Ltd., Pharmaceutical Division, Haywards Heath, SussexSearch for more papers by this authorM. S. Bolton MA (Oxon), M. S. Bolton MA (Oxon) Bayer U.K. Ltd., Pharmaceutical Division, Haywards Heath, SussexSearch for more papers by this author J. Mason MB, ChB, DRCOG, J. Mason MB, ChB, DRCOG Bayer U.K. Ltd., Pharmaceutical Division, Haywards Heath, SussexSearch for more papers by this authorM. S. Bolton MA (Oxon), M. S. Bolton MA (Oxon) Bayer U.K. Ltd., Pharmaceutical Division, Haywards Heath, SussexSearch for more papers by this author First published: 01 September 1977 https://doi.org/10.1111/j.1742-1241.1977.tb07406.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume31, Issue9September 1977Pages 127-134 RelatedInformation

Butacote and Ibuprofen: A Comparative Assessment in Rheumatic Diseases in General Practice

A multicentre double-blind trial in general practice compared Butacote (enteric-coated phenylbutazone) 300 mg daily, ibuprofen 1200 mg daily, and a placebo in the treatment of rheumatic conditions. Each patient received two of the three treatments for one month each. Twenty-nine doctors admitted 193 patients. One hundred and sixty-eight patients (sixty-four with inflammatory polyarthritis, and sixty-three with osteoarthrosis) completed the study, which showed that Butacote was significantly better than both ibuprofen and placebo for the relief of pain and morning stiffness, and improvement of function. Butacote was significantly preferred to both ibuprofen and placebo by patients and doctors, to placebo by the patients. Ibuprofen was significantly better than placebo for relief of morning stiffness and for reducing the amount of supplementary analgesics. All three preparations were well tolerated and showed a similar incidence of gastric side-effects. It is concluded from this study that Butacote is more effective and as well tolerated as ibuprofen in the treatment of rheumatic conditions in general practice.

Butacote: The First Assessment in General Practice

A double-blind crossover trial in the treatment of rheumatic conditions in general practice compared the effect and tolerance of 100 mg t.d.s. standard phenylbutazone (Butazolidin) with enteric-coated phenylbutazone (Butacote), each preparation being given for one week to fifty patients. There was no difference in effectiveness. Nine patients complained of dyspeptic symptoms, three during the first week, six during the second week, but none during treatment with Butacote. This, together with the significant 17:7 patient preference, clearly demonstrated the superiority of Butacote.

The treatment of rheumatic conditions in general practice

The treatment of rheumatic conditions in general practice

Butacote and Brufen in the Treatment of Rheumatic Diseases. A Multi-Centre Study of Effectiveness and Tolerability

A multi-centre double-blind trial in general practice compared Butacote (enteric-coated phenylbutazone) 300 mg daily, Brufen (ibuprofen) 1200 mg daily, and a placebo in the treatment of rheumatic conditions. Each patient received two of the three treatments for one month each. Twenty-nine doctors admitted 193 patients. 168 patients (sixty-four with inflammatory polyarthritis, and sixty-three with osteoarthrosis) completed the study, which showed that Butacote was significantly better than both Brufen and placebo for the relief of pain and morning stiffness, and improvement of function. Butacote was significantly preferred to both Brufen and placebo by patients and doctors, to placebo by the patients. Brufen was significantly better than placebo for relief of morning stiffness and for reducing the amount of supplementary analgesics. All three preparations were well tolerated and showed a similar incidence of gastric side-effects. It is concluded from this study that Butacote is more effective and as well tolerated as Brufen in the treatment of rheumatic conditions in general practice.

Treatment of Rheumatic Conditions

Treatment of Rheumatic Conditions

Treatment of rheumatic conditions

Treatment of rheumatic conditions

Treatment of rheumatic conditions

Treatment of rheumatic conditions