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Rheumatoid arthritis (RA) is a chronic erosive arthritis. Early diagnosis, standardized treatment and regular monitoring of the disease will effectively mitigate disease progression and reduce the disability rate. Currently, traditional synthetic disease-modifying antirheumatic drugs (DMARDs) are used alone or in combination with new biological DMARDs or targeted synthetic DMARDS in the treatment of RA, resulting in effective remission in some refractory patients. However, the efficacy and toxicities of different treatments varies. With the development of proteomic and epigenetic technologies, some proteins, non-coding RNAs, and anti-drug antibodies (ADA) have been identified as potential markers for early diagnosis, concomitant diagnosis and disease assessment of RA. We summarized and analyzed the application prospects of novel RA diagnosis markers, including serum proteins, cell membrane proteins, non-coding RNAs, and ADA, with the aim of promoting the application of new markers that allow more precise diagnosis and treatment of RA.
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Autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc.) are diseases characterized by local or systemic abnormal inflammatory immune response. At present, the treatment drugs of autoimmune diseases mainly include nonsteroid anti-inflammatory drugs, steroid anti-inflammatory drugs and disease modifying anti-rheumatic drugs (chemical medicine, natural medicine and biological agents), etc. With the pathological mechanism of autoimmune diseases to be clarified deeply and the discovery of new drug targets, new biological agents targeting cytokines and cell surface molecules have been developed rapidly. In recent years, multiple small molecule drugs targeting Janus kinase/ signal transducers and activators of transcription signaling pathway have been developed and applied in clinic. Soft regulation of inflammatory immune response drugs are the drugs with anti-inflammatory and immunomodulatory effects, as well as less adverse reactions. To develop this type of drug will be a new strategy and one of the main directions for the treatment of autoimmune diseases. The research progress of medicines to treat autoimmune diseases has been reviewed in this paper.
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Background: Drugs used in the treatment of rheumatoid arthritis show significant toxicity and morbidity. The objective of the study was to evaluate the nature and incidence of adverse drug reaction in patients with rheumatoid arthritis on anti-rheumatic drugs and to assess the causality and severity of the documented adverse drug reactions.Methods: The prospective observational study was done for two months in rheumatology outpatient department. All patients were interviewed for basic details, treatment history and adverse drug reactions and were recorded. Causality assessment and severity assessment of the recorded adverse drug reactions were done.Results: About 283 patients attended the rheumatology out-patient department during the two months period out of which 57 patients had one or more adverse drug reaction. The incidence of adverse drug reaction observed in rheumatology out-patient department to anti rheumatic drug was 20.14%. A total of 145 adverse drug reactions were noted in 57 patients. The most common adverse drug reaction reported was epigastric pain (6.89%) followed by headache and dyslipidemia (6.25%). The most common system associated with adverse drug reaction was gastrointestinal system (29.66%) followed by central nervous system and cardiovascular system (15.86%). Reported adverse drug reactions were assessed for causality and maximum belonged to probable (66.9%). Severity assessment revealed that most of the adverse drug reactions were mild (74.48%) in nature.Conclusions: Active surveillance for adverse drug reactions to anti rheumatic drug in patients with rheumatoid arthritis will allow early detection of adverse drug reactions and timely intervention to provide maximum benefit to the patients.
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Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.
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ResumenJustificación y objetivos:el uso de fármacos antagonistas del factor de necrosis tumoral alfa se asocia a infecciones severas en artritis reumatoide, con una alta morbi-mortalidad en la práctica clínica. No existe casuística publicada respecto al tema en nuestro país. Se pretende aportar información relacionada con la epidemiología local de las infecciones severas e identificar factores de riesgo asociados.Métodos:estudio observacional retrospectivo, que incluyó 50 pacientes tratados al menos un año en el periodo 2006-2012. Se evaluaron las características demográficas, así como las clínicas y epidemiológicas de la(s) infección(es) severa(s) desarrollada(s) y los factores de riesgo asociados.Resultados:la mayor parte de los pacientes fueron mujeres en edad media. Solo se documentó una infección severa, que correspondió a una infección de piel y tejido blando que resolvió con terapia antibiótica intravenosa. Se registraron factores de riesgo, especialmente en uso de terapia inmunosupresora esteroidal y el antecedente quirúrgico reciente, con una baja prevalencia de comorbilidades.Conclusiones:el perfil demográfico, así como el perfil clínico de las infecciones severas es similar a otras poblaciones, la baja incidencia de éstas en la cohorte podría relacionarse a una menor prevalencia de comorbilidades, no obstante se requiere investigaciones futuras para corroborar o descartar dicha observación.
AbstractAim and objetives:the use of tumour necrosis factor alpha therapy antagonist leads to an increased risk of serious infections in rheumatoid arthritis, with a high morbi-mortality in clinical practice. There are no published data in our country. This study pretends to provide knowledge about the local epidemiology of serious infections and to identify associated risk factors.Methods:An observational and retrospective study, included 50 patients treated at least for one year between 2006-2012. Demographic characteristics, clinical and epidemiological characteristics of serious infections and risk factors associated with serious infections were described.Results:A predominant female population in middle age was detected. Just one serious infection was described, corresponding to serious skin and soft tissue infection that resolved with intravenous antibiotics. Risk factors were described including inmunosuppresive therapy with steroids and prior surgery.Conclusions:Demographic profile of analized population and their clinic profile of serious infectios are similar to others populations. Low incidence of serious infections in this cohort could be related with less comorbilities than others populations, although, this topic needs further investigations to corroborate or discard this observation.
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Humans , Female , Arthritis, Infectious , Arthritis, Rheumatoid , Tumor Necrosis Factor-alpha , Costa RicaABSTRACT
BACKGROUND & OBJECT: Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes ankylosis and deformation of axial joints. Since current medicine cannot cure the disease yet, alleviating pain and preventing deformation with medications are the main therapy for patients with AS. The key medications for these purposes include nonsteroidal anti-inflammatory drugs (NSAIDs), and tumor necrosis factor-alpha (TNF-alpha) inhibitors. This study aims to analyze prescribing patterns of AS patients in South Korea. METHOD: National Patients Sample data compiled by the Health Insurance Review and Assessment Service from 2013 was analyzed. Patients with AS were identified with Korean Standard Classification of Diseases code-6, which was M45. The rates of prescription, discontinuation, and switching ingredients were calculated for each medication during 2013. RESULTS: Total number of patients was 655, and most of them were male (n = 514, 78.5%). Of all age groups, the proportion of 30-40 year old patients was the greatest (35.1%). The most utilized drug class was NSAIDs (82.4%). Less than half of patients were prescribed TNF-alpha inhibitors (n = 212, 32.4%). Meloxicam, aceclofenac, and celecoxib were the most frequently prescribed NSAIDs. In case of TNF-alpha inhibitors, adalimumab, etanercept and infliximab were the top three most prescribed drugs. Although not recommended by the current practice guideline, significant proportions of patients were identified using disease modifying anti-rheumatic drugs (DMARDs). CONCLUSION: Considering the current practice guideline and previous studies about the efficacy, the use of DMARDs should be reduced and medical insurance term in South Korea should be re-examined.
Subject(s)
Humans , Male , Ankylosis , Anti-Inflammatory Agents, Non-Steroidal , Antirheumatic Agents , Classification , Drug Utilization , Insurance , Insurance, Health , Joints , Korea , Prescriptions , Spondylitis, Ankylosing , Tumor Necrosis Factor-alpha , Adalimumab , Celecoxib , Infliximab , EtanerceptABSTRACT
Objective To observe the effect of combination therapies with methotrexate, sulfasalazine and hydroxychloroquine on hyperlipemia of rheumatoid arthritis.Method From 2009 November to 2010 November, 68 RA inpatients and outpatients in the department of rheumatism of our hospital were randomly divided into two groups: A group and B group, 34 cases in each group. The patients in A group were given combination of methotrexate, sulfasalazine, hydroxychloroquine sulfate for the treatment of RA,patients in B group, based on A group's treatment, were treated by xuezhikang. Some indexes were observed in two group before treatment and 6 months after treatment, including cholesterolTC,low density lipoprotein cholesterol LDL-C , triglyceride TG , high density lipoprotein cholesterol HDL-C , swelling index, joint pain index, time of morning stiffness, C-reactive protein CRP , erythrocyte sedimentation rate ESR and DAS28. Results After 6 months’ treatment, the serum levels of TC, TG,, LDL-C, both in two groups of patients, were lower than those before treatment, and HDL-C was higher than that before treatment, there were significant differences (P0.05) . Conclusion RA patients have abnormal blood lipid levels, disease-modifying anti-rheumatic drugs have effect on blood lipid during remission joint disease in RA patients.
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PURPOSE: We reviewed patients with rheumatoid arthritis to evaluate the results of cementless total knee replacement and the effects of Disease Modifying Anti-Rheumatoid Drugs. MATERIALS AND METHODS: The results of 59 cementless total knee arthroplasty in 35 patients were retrospectively analyzed. Cases were divided into two groups: one was treated with Disease Modifying Anti-Rheumatic Drugs and the other without them. Clinical and radiological outcomes were evaluated using the Knee Society clinical rating system and Knee Society roentgenographic evaluation and scoring system, respectively. RESULTS: At the most recent follow-up, femoral flexion angle, tibial angle and total valgus angle in anteroposterior view were 97.1, 89.1 and was 7.6. Femoral flexion angle and tibial angle in lateral view were 3.0 and 91.0. There were no statistical differences as compared with the postoperative values. There were also no statistical differences between the two groups. Knee score and function score of all cases were 85.5 and 67.6. Those of the group treated with Disease Modifying Anti-Rheumatic Drugs were 90.9 and 78.1. Those of the group without them were 74.0 and 45.5. CONCLUSIONS: Results of the cementless total knee arthroplasty in rheumatoid arthritis are very promising and Disease Modifying Anti-Rheumatic Drugs have an effect on the postoperative clinical results.