Treatment Of Rheumatic Diseases Research Articles

OP0022-PARE Patient Involvement and Actions towards Affecting Government Policy on Rheumatic Diseases

BackgroundNon existence of a National Health system for treating Rheumatic diseases in a holistic way. The Lack of coordination between Health professionals as well as the lack of a strategy...

AB0387 Optimizing Treatment of Rheumatic Diseases with Biologic Agents in Our Day Hospital

BackgroundSince the development of biological therapy (BT), the patients refractory to other therapy responds favorably and a number of them with a state of remission or very low activity. These...

FRI0283 Quality Indicators for Use of Biologic Agents in Rheumatic Diseases

BackgroundBiologics are widely used for the treatment of rheumatic diseases because of the efficacy, but careful surveillance and prophylactic measures are necessary to reduce the incidence of adverse events, especially...

SP0191 Live Attenuated Vaccines in Rheumatic Diseases

Adult and paediatric patients with rheumatic diseases may be immunodeficient due to treatment with high-dose corticosteroids, immunosuppressive drugs such as cyclophosphamide or biologics. The diseases themselves may also lead to...

SP0045 What You Need to Know to Understand the Immune Targets in Biological Rheumatic Disease Treatment

Many targeted therapies employing biologicals used in the treatment of patients with rheumatic disease are directed against molecules that play a dedicated role in the induction or propagation of immune...

Pregnancy Outcome After Methotrexate Treatment for Rheumatic Disease Prior to or During Early Pregnancy: A Prospective Multicenter Cohort Study

High-dose methotrexate (MTX) exposure during pregnancy is associated with embryopathy. The teratogenic potential of MTX at dosages typically used in the treatment of rheumatic diseases remains uncertain. The aim of this study was to evaluate the risk of spontaneous abortion, major birth defects, elective termination of pregnancy, shortened gestational age at delivery, and reduced birth weight in women exposed to MTX. Pregnancy outcome in women taking MTX (≤30 mg/week) either after conception or within the 12 weeks before conception was evaluated in a prospective observational multicenter cohort study. Pregnancy outcomes in the MTX group were compared to outcomes in a group of disease-matched women and a group of women without autoimmune diseases (neither group was exposed to MTX). The study sample included 324 MTX-exposed pregnancies (188 exposed post-conception, 136 exposed pre-conception), 459 disease-matched comparison women, and 1,107 comparison women without autoimmune diseases. In the post-conception cohort, the cumulative incidence of spontaneous abortion was 42.5% (95% confidence interval [95% CI] 29.2-58.7), which was significantly higher than the incidence of spontaneous abortion in either comparison group. The risk of major birth defects (7 of 106 [6.6%]) was elevated compared to both the cohort of women without autoimmune diseases (29 of 1,001 [2.9%]) (adjusted odds ratio [OR] 3.1 [95% CI 1.03-9.5]) and the disease-matched cohort (14 of 393 [3.6%]) (adjusted OR 1.8 [95% CI 0.6-5.7]). None of the malformations were clearly consistent with MTX embryopathy. Neither the cumulative incidence of spontaneous abortion (14.4% [95% CI 8.0-25.3]) nor the risk of major birth defects (4 of 114 [3.5%]) was increased in the pre-conception cohort. Elective termination rates were increased in both of the MTX-exposed cohorts. There were no other significant differences among groups in other study end points. Post-conception administration of MTX at dosages typically used in the treatment of rheumatic diseases was associated with an increased risk of major birth defects and spontaneous abortion. Such evidence was not found among women in our pre-conception cohort.

Identification and quantitation of the ingredients in a counterfeit Vietnamese herbal medicine against rheumatic diseases

Counterfeit and/or illegally manufactured drugs and herbal medicines are becoming an increasing problem throughout the world. Internet sales simplify distribution and payment of these falsified drugs. Here we report on a Vietnamese herbal medicine, which was advertised for treatment of rheumatic disease from a religious Vietnamese healer. By means of NMR and LC/MS we found 863mg acetaminophen, 262mg sulfamethoxazole, 42mg indomethacin and less than 1% trimethoprim in a sachet of 2.617g powder content, in addition to some cinnamon bark and phosphate.

Is a Patient Questionnaire Without a Joint Examination as Undesirable as a Joint Examination Without a Patient Questionnaire?

Patient questionnaires have gained increasing prominence in the treatment of rheumatic diseases over the last few decades. Three patient self-report scores for physical function, pain, and patient global estimate are included in the rheumatoid arthritis (RA) core dataset1. These 3 scores distinguish active from control treatments in RA clinical trials involving leflunomide2, methotrexate2, anakinra3, adalimumab4, abatacept5, and certolizumab6, at levels of significance similar to formal joint counts or laboratory tests. Patient physical function scores generally are more significant than radiographic scores or laboratory test results in the prognosis of severe longterm RA outcomes such as work disability and premature mortality7,8,9,10. Routine Assessment of Patient Index Data (RAPID3), an index of only the 3 patient-reported RA Core Data Set measures, is correlated significantly with standard indices that require a formal joint count, such as DAS28 (28-joint Disease Activity Score) and CDAI (Clinical Disease Activity Index)11,12. A RAPID3 score of ≤ 3/30 with 1 or 0 swollen joints, RAPID3≤3+≤SJ1, provides remission criteria comparable to Boolean13, SDAI (Simplified Disease Activity Index), CDAI, and DAS2814 criteria in far less time than a formal joint count, in studies of the French ESPOIR early arthritis cohort15 … Address correspondence to Dr. Pincus, Division of Rheumatology, NYU Hospital for Joint Diseases, 301 East 17th St., Room 1608, New York, New York 10003, USA. E-mail: tedpincus{at}gmail.com

Potential of stem cells in the treatment of rheumatic disease

Autoimmune diseases represent the failure of normal immune regulatory processes, characterized by activation and expansion of immune cell subsets in response to nonpathogenic stimuli, that are derived from self-antigens. In the last few decades, hematopoietic stem cell transplantation emerged as a rescue therapy for different, severe, refractory autoimmune diseases. The rationale for this therapeutic strategy in autoimmune diseases is the ablation of an aberrant, self-reactive immune system by chemotherapy, and the regeneration of a new and self-tolerant immune system from by transplanted stem cells. In the last few decades, thousands of patients worldwide have received hematopoietic stem cell transplantation, mostly autologous, as treatment for a severe autoimmune disease with promising results. In this review, the authors report the recent available progresses about potential therapeutic role of stem cells in autoimmune diseases.

Epigenetic-based immune intervention for rheumatic diseases.

Rheumatic disease is a large spectrum of heterogeneous conditions affecting the loco-motor system including joints, muscles, connective tissues, and soft tissues around the joints and bones. Many rheumatic diseases have an element of autoimmunity including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Aberrant epigenetic regulation of gene expression is emerging as a major factor within rheumatic disease, and indicates potential new therapeutic avenues of approach to these debilitating conditions. Understanding the precise role of epigenetics in the development and treatment of rheumatic diseases particularly those which have an associated autoimmune element may be important for the long-term management of such conditions.

Role of laboratory biomarkers in monitoring and prediction of the effectiveness of treatment of rheumatic diseases using genetically engineered drugs

Significant progress in treating immunoinflammatory rheumatic diseases (RD) is related to the design of a novel family of drugs, genetically engineered (GE) drugs. Molecular and cellular biomarkers (antibodies, indicators of acute inflammation, cytokines, chemokines, growth factors, endothelial activation markers, immunoglobulins, cryoglobulins, T- and B-cell subpopulations, products of bone and cartilage metabolism, genetic and metabolic markers) that allow one to conduct immunological monitoring and prediction of the effectiveness of RD therapy using tumor necrosis factor α inhibitors (infliximab, adalimumab, golimumab, etanercept), anti-B-cell drugs (rituximab, belimumab), interleukin-6 receptor antagonist (tocilizumab), and T-cell costimulation blocker (abatacept) have been detected in blood, synovial fluid, urine, and bioptates of the affected tissues. In addition to the conventional uniplex immunodiagnostics techniques, multiplex analysis of marker, which is based on genetic, transcriptomic and proteomic technologies using DNA and protein microarrays, polymerase chain reaction, and flow cytometry, is becoming increasingly widespread. The search for and validation of immunological predictors of the effective response to GE drug therapy make it possible to optimize and reduce the cost of therapy using these drugs in future.

Biosimilars: how similar?

As patents expire on biological agents for the treatment of rheumatic diseases, we have the opportunity to develop non-proprietary biologic agents, biosimilars. The development and approval of these agents present novel challenges to both pharma and regulatory agencies although there is great promise of high quality, less expensive biologic agents for the treatment of rheumatic diseases. Here, we review the definitions of biosimilars, the regulatory challenges to approval of these agents and the record of approvals of biosimilars to date.

CP-069 Economic impact of biological treatments in rheumatic diseases

BackgroundEvaluation of the direct costs of chronic diseases has become an essential tool in the adequate provision of health resources, which also implies an attempt to optimise treatments. Due to...

CP-035 Cost of biological treatments in rheumatic diseases in clinical practice

BackgroundThe EULAR and ACR guidelines do not recommend any biological treatment above another in terms of efficacy. Thus financial aspects, such as the real associated cost, should be taken into...

Persisting eicosanoid pathways in rheumatic diseases

An unmet clinical need exists for early treatment of rheumatic diseases and improved treatment strategies that can better maintain remission with reduced ongoing subclinical inflammation and bone destruction. Eicosanoids form one of the most complex networks in the body controlling many physiological and pathophysiological processes, including inflammation, autoimmunity and cancer. Persisting eicosanoid pathways are thought to be involved in the development of rheumatic diseases, and targeting this pathway might enable improved treatment strategies. Several enzymes of the arachidonic acid cascade as well as eicosanoid receptors (all part of the eicosanoid pathway) are today well-recognized targets for anti-inflammatory drugs that can reduce symptoms of inflammation in rheumatic diseases. In this Review, we outline the evidence supporting pivotal roles of eicosanoid signalling in the pathogenesis of rheumatic diseases and discuss findings from studies in animals and humans. We focus first on rheumatoid arthritis and discuss the upregulation of the cyclooxygenase and lipoxygenase pathways as most data are available in this condition. Research into the roles of eicosanoids in other rheumatic diseases (osteoarthritis, idiopathic inflammatory myopathies, systemic lupus erythematosus and gout) is also progressing rapidly and is discussed. Finally, we summarize the prospects of targeting eicosanoid pathways as anti-inflammatory treatment strategies for patients with rheumatic diseases.

Malignancies Associated with Treatment of Rheumatic Diseases - to be or not to be

Malignancies associated with rheumatic diseases are more common than healthy individuals. What is actually the cause of increased malignancies in rheumatic diseases: autoimmunity, inflammation, immune regulation deficits? There was no a clear answer, but malignancies associated with rheumatic diseases is a certainty. Medication is also involved in the development of malignancies. Therefore we decided to address the involvement of rheumatic diseases medication in malignancies development.

Radiological imaging in pediatric rheumatic diseases

SummaryRadiological imaging plays a fundamental role in the diagnosis and monitoring of rheumatic diseases. The basic method of imaging is a classic X-ray picture, which for many years has been used as a single method for the recognition and evaluation of the effects of disease management. In today’s modern day treatment of rheumatic diseases, ultrasonography and magnetic resonance are more commonly performed for early detection of inflammatory changes in the region of soft tissue, subchondral bone and bone marrow. In spite of their usefulness and fundamental role in the diagnosis, X-ray still remains an essential tool in the diagnosis of rheumatoid arthritis in children and is complementary to today’s methods of imaging diagnostics. In clinical practice, X-ray imaging is still an important examination performed not only to recognize the disorders, but also to provide a differential diagnosis. It helps estimate disease progression and is used to monitor the effects of treatment and the development of possible complications. Differential diagnosis of rheumatic diseases is performed on the basis of localization and type of radiographic changes. The surrounding periarticular soft tissues, bone structures, joint space, with special attention to articular bone surfaces and epiphyses, are analyzed. The aim of this work is to describe characteristic inflammatory changes present on X-ray imaging typical for the most commonly diagnosed rheumatic diseases in children, such as juvenile idiopathic arthritis, systemic lupus erythematosus, systemic scleroderma, mixed connective tissue disease, juvenile dermatomyositis, juvenile spondyloarthropathy and systemic vascular disease.

A rapid new approach for the quality evaluation of the folk medicine Dianbaizhu based on chemometrics.

Dianbaizhu, a folk medicine from Gaultheria leucocarpa BLUME var. yunnanensis (FRANCH.) T. Z. HSU & R. C. FANG (Ericaceae) used as an antirheumatic, has multiple plant origins and officinal parts. A rapid high-performance liquid chromatography with diode array detector (HPLC-DAD) method was established for the simultaneous determination of the characteristic ingredient methyl benzoate-2-O-β-D-glucopyranosyl(1 → 2) [O-β-D-xylopyranosyl(1 → 6)]-O-β-D-glucopyranoside and seven bioactive constituents in eight Gaultheria species. This chromatographic method is precise, accurate, and stable. Kruskal-Wallis analysis, hierarchical cluster analysis, and factor analysis were used to analyze the content of reference compounds in different Gaultheria species and officinal parts. The analyses showed significant differences (p<0.05) in Gaultheria species but few differences (p>0.05) in their medicinal parts. G. leucocarpa var. yunnanensis appeared to the best among the Gaultheria species tested for the treatment of rheumatic diseases. Taken together, the results show that this simultaneous quantification of multiple active constituents using HPLC-DAD combined with chemometrics can be reliably applied to evaluate the quality of Dianbaizhu.

Simultaneous analysis of coumarin derivatives in extracts of Radix Angelicae pubescentis (Duhuo) by HPLC-DAD-ESI-MSn technique

Radix Angelicae pubescentis (Duhuo) is a traditional Chinese herbal medicine (TCM) used for the treatment of rheumatic diseases.

Case of Secondary Amyloidosis in a Patient with Ankylosing Spondylitis Refractory to TNF-α Inhibitors

Secondary amyloidosis occurs in patients with chronic inflammatory diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The major therapeutic approach to secondary amyloidosis involves controlling the underlying inflammatory disease. Tumor necrosis factor-alpha (TNF-α) inhibitors have revolutionized the treatment of rheumatic diseases; in many cases dramatic clinical improvement of secondary amyloidosis due to AS has been observed in response to treatment with these agents. However, the development of secondary amyloidosis associated with AS refractory to treatment with TNF-α inhibitors has been infrequently reported. Here, we described a case of a 37-year-old male patient with longstanding AS who was diagnosed with secondary amyloidosis due to high disease activity despite treatment with etanercept, adalimumab and infliximab. (Korean J Med 2014;87:514-519)