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A B S T R A C T Objective: The objective of this study was to establish recommendations for the reduction and discontinuation of biological disease-modifying antirheumatic drugs, with the aim of becoming a guide document for health professionals involved in the management of patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Materials and methods: The recommendations were established through consensus by a panel of experts in rheumatology, and based on the analysis of available scientific evidence obtained from systematic reviews and the clinical experience of the panellists. Results: A total of 33 rheumatoid arthritis related studies were included, with 6 psoriatic arthritis related, and 9 ankylosing Spondylitis related. The recommendations for the reduction of biological therapies were made by establishing a plan to determine when and how to reduce the biological disease-modifying antirheumatic drugs in patients with these 3 diseases, and in some cases lead to the discontinuation of these treatments. Conclusion: The recommendations established in this document will serve as a guide to improve the efficiency of biological therapy in these diseases, reduce the variability in clinical practice, and establish an adequate risk/benefit ratio.
RESUMEN Objetivo: El objetivo de este estudio fue establecer recomendaciones para la disminución y descontinuación de la terapia biológica con el fin de que se convierta en un documento guía para los profesionales de la salud involucrados en el manejo de pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica. Materiales y métodos: Las recomendaciones fueron establecidas mediante consenso desarrollado a través de un panel de expertos en reumatología, basado en el análisis de la evidencia científica disponible obtenida de revisiones sistemáticas y sobre la experiencia clínica de los panelistas. Resultados: Se incluyeron 33 estudios relacionados con artritis reumatoide, 6 de artritis psoriásica y 9 de espondilitis anquilosante. Las recomendaciones para la disminución de las terapias biológicas se realizaron estableciendo un plan para determinar cuándo y cómo reducir los fármacos biológicos modificadores de enfermedades reumáticas en pacientes con estas 3 enfermedades y en algunos casos conducir a la descontinuación de estos tratamientos. Conclusión: Las recomendaciones establecidas en este documento servirán de guía para mejorar la eficiencia de la terapia biológica en estas enfermedades, reducir la variabilidad en la práctica clínica y establecer de manera adecuada una relación riesgo/beneficio.
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Humanos , Artritis Reumatoide , Espondilitis Anquilosante , Terapia Biológica , Artritis Psoriásica , Productos Biológicos , ConsensoRESUMEN
RESUMEN Objetivos: Revisar definiciones, factores asociados a adherencia, métodos para medición y determinación de adherencia a medicamentos modificadores de la enfermedad orales en artritis reumatoide. Métodos: Se realizó una búsqueda de la literatura en las bases de datos de Pubmed hasta diciembre de 2017 mediante términos MeSH (((«Arthritis, Rheumatoid¼ [Mesh] AND «Medication Adherence¼ [Mesh]) OR «Patient Compliance¼ [Mesh]) AND «Antirheumatic Agents¼ [Mesh]) de artículos que estuvieran en idioma espafñol o inglés e incluyeran solo población adulta. Resultados: De un total de 387 artículos encontrados, 43 se incluyeron para la revisión general, con información sobre definiciones de adherencia, cumplimiento, concordancia y persistencia, componentes, clasificación y dimensiones, factores de riesgo relacionados con la no adherencia al tratamiento, descripción de los métodos de medición. Solo 9 artículos midieron adherencia e incluyeron información sobre factores relacionados con adherencia a medicamentos orales en artritis reumatoide. Conclusiones: La adherencia al tratamiento farmacológico en artritis reumatoide es subóptima y se relaciona con menor efectividad en el control de la actividad inflamatoria. Los principales factores relacionados con baja adherencia incluyen problemas de acceso y disponibilidad del medicamento, mayor actividad y duración de la enfermedad, polifarmacia, uso de medicamentos por periodos prolongados, bajo estrato socioeconómico, etnia, reacciones adversas por medicamentos, percepción de inefectividad de la medicación y enfermedades concomitantes. Es necesario incorporar de forma sistemática la medición de adherencia farmacológica dentro de la práctica clínica rutinaria y la identificación de los factores de riesgo más frecuentes asociados a una baja adherencia con el fin de diseñar estrategias encaminadas a mejorar la adherencia de los pacientes y lograr mejores desenlaces clínicos.
ABSTRACT Objectives: To review the definitions, associated factors, as well as the methods for the measurement and determination of adherence to oral disease modifying drugs in rheumatoid arthritis. Methods: A search of the literature was carried out in the PUBMED databases up to December 2017 using MeSH terms: ((("Arthritis, Rheumatoid" [Mesh] AND "Medication Adherence" [Mesh]) OR "Patient Compliance" [Mesh]) AND "Antirheumatic Agents" [Mesh]). Only articles that included an adult population and were in Spanish or English were reviewed. Results: From the 387 articles found, 43 were included for general review (definitions of adherence, compliance, concordance and persistence, components, classification and dimensions of adherence, risk factors related to non-adherence, description of direct and indirect methods for measuring adherence). Only 9 articles measured adherence and included information about risk factors related to non-adherence to oral treatment in rheumatoid arthritis. Conclusions: The adherence to pharmacological treatment in rheumatoid arthritis is sub-optimal and is associated with less effectiveness in the control of inflammatory activity. The main factors related to low adherence include problems of drug access and availability, increased activity and duration of the disease, polypharmacy, use of medications for prolonged periods, socioeconomic stratum, ethnicity, adverse drug reactions, perception of ineffectiveness of the medication, and concomitant diseases. It is necessary to incorporate the systematic measurement of pharmacological adherence within clinical practice. It is also important to identify the most frequent risk factors associated with low adherence, in order to design strategies aimed at improving patient adherence and achieve better clinical outcomes.
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Artritis Reumatoide , Enfermedades Autoinmunes , Cumplimiento y Adherencia al Tratamiento , Efectividad , Efectos Colaterales y Reacciones Adversas Relacionados con MedicamentosRESUMEN
OBJECTIVE:To provide reference for clinical rational use and purchase of TCM decoction pieces for rheumatism. METHODS:Using Excel software,the application of TCM decoction pieces for rheumatism in our hospital during 2010-2014 was analyzed statistically in respects of drug type,consumption quantity and consumption sum,etc. RESULTS:The consumption quan-tity of TCM decoction pieces for rheumatism increased from 46 026 kg to 79 139 kg in our hospital during 2010-2014,and annual growth rate was 14.68%;consumption sum increased from 3 851 300 yuan to 6 403 800 yuan,with annual growth rate was 15.46%;consumption quantity ratio was 2.48%-2.85%. Among antirheumatic drug subtype,the quantity of drugs for antirheumatic and dissipating cold was the largest (accounting for 51.43%-58.42%),followed by drugs for antirheumatic and strengthening the bones and muscles(accounting for 23.05%-28.42%)and drugs for antirheumatic and clearing heat(accounting for 18.53%-21.08%). Top 3 TCM decoction pieces for rheumatism in the list of annual quantity were Viscum coloratum,Cynanchum paniculatum and Clematis chinensis/Chaenomeles sinensis during 2011-2014. Top 3 TCM decoction pieces for rheumatism in the list of consumption sum were Zoacys dhumnades,C. paniculatum and V. coloratum during 2011-2014. CONCLUSIONS:Both consumption quantity and consumption sum of TCM decoction pieces for rheumatism have increased year by year in our hospital,but the ratio of total quantity to total amount and medication structure keep stable,and TCM for expelling wind-damp and dispelling cold is the greatest in consumption quantity which is in line with clinical drug use characteristics. Purchasing staff can purchase drugs predictably ac-cording to the results.
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Objective To investigate the effect of DMARDs on the prevention of early-onset atherosclerosis in rheumatoid arthritis ( RA) patients for exploring an appropriate schedule to reduce cardiovascular events. Methods Seventy-two patients with early RA were included in this study. Erythrocyte sedimentation rate ( ESR) and high sensitivity C reactive protein ( hs-CRP) were detected before and after treatment to evaluate inflammation. Carotid intima-media thickness ( cIMT) and endothelium-dependent flow-mediated vasodilatation (ED-FMD) were monitored. Disease Activity Score in 28 Joints (DAS28) and health assessment questionnaire-disability index ( HAQ-DI) was used to assess severity degree of RA and life quality of the patients, respectively. The patients were treated with methotrexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSZ) alone or combined based on severity of RA. Results After 1 year of treatment, ESR, hs-CRP, DAS28 and HAQ-DI were significantly improved (all P<0. 01). At the same time, the serum lipid levels also had obvious changes. However, there was no obvious difference in body mass index ( BMI) after 1 year. The cIMT ratio value was significantly decreased compared to baseline (0. 43±0. 08 mm vs. 0. 50±0. 16 mm, P=0. 002), and FMD% also significantly improved from basic value of 5. 26 to 7. 57 after treatment (P=0. 041). Conclusion Early intervention of RA by using DMARDs can effectively control the disease and slow the progression of atherosclerosis, but also reduce cardiovascular mortality.
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Serum rheumatoid factor (RF) is important in the diagnosis and prognosis of rheumatoid arthritis (RA). The purpose of this study is to compare the clinical characteristics and treatment patterns of RA according to the presence of RF in Korean patients. A retrospective analysis was performed on the records of 109 patients who were followed for at least 2 years, among 230 RA patients who visited at the rheumatology clinic in Ajou University Hospital and who fulfilled the 1987 revised American College of Rheumatology criteria for RA. Sixty-four patients were RF positive (58.7%) and 91 patients were female (83.5%). There was no significant difference in demographic characteristics, joint involvements, or percentage of morning stiffness between seropositive and seronegative groups. Antinuclear antibody was detected more frequently in the seropositive group (p < 0.05). At initial diagnosis, the seropositive group had higher white blood cell and platelet counts than the seronegative group (p < 0.01). However, the difference was disappeared at the last follow-up. Inflammatory markers such as ESR and CRP were also higher at diagnosis in the seropositive group (p < 0.01). These inflammatory markers were still greater than the seronegative group at the last follow-up (p < 0.01). There was no significant difference in the use of disease modifying antirheumatic drug (DMARD) and steroid dosage between groups. However, DMARD combination therapy was more commonly used in the seropositive group (p < 0.05), especially triple DMARD combination. These results suggest that disease activity is more severe in the seropositive than the seronegative group, and more aggressive treatments are needed in the seropositive group.
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Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anticuerpos Antinucleares/sangre , Antirreumáticos/uso terapéutico , Artritis Reumatoide/sangre , Biomarcadores , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Factor Reumatoide/sangreRESUMEN
Rheumatoid arthritis (RA) is a chronic progressive disease, affecting an estimated 1% of the population worldwide. Although the optimal care of RA patients requires various modalities, pharmacotherapy remains the cornerstone of treatment for RA. Clinical studies in patients with RA have broadened understanding of its pathogenesis and have fundamentally changed the therapeutic approach to this disease in the last 10 years. It has become clear that early suppression of RA disease activity is important in preventing progressive joint destruction and functional decline. There has been a complete remodeling of the traditional "therapeutic pyramid" by rheumatologists, who now treat RA earlier and more aggressively than ever before, using combinations of classic disease-modifying antirheumatic drugs or new drugs. Although a cure remains elusive, remission is an approachable goal.
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Humanos , Antirreumáticos , Artritis Reumatoide , Quimioterapia , ArticulacionesRESUMEN
The past decade has greatly enhanced our understanding of rheumatoid arthritis (RA). Not only have new drug therapies become available, but this period has witnessed dramatic changes in treatment strategies as well. Since 1989, when the proposal on reversing the pyramid approach (the step-down bridge concept) was published, the concept of early and aggressive treatment of RA has become the leading paradigm. The theory underlying this approach is based on a bet-ter understanding of the devastating long term consequences of RA in most patients, and the logical tenet that irreversible damage must be prevented before it occurs. Evidence has shown the irreversible joint damage in RA occurs early in the disease, making a "wait and see" approach unacceptable. Thus, it appears logical to begin treatment as soon as a diagnosis of RA is confirmed, to slow disease progression by treatment with disease modifying antirheumatic drugs. This review will address the evidence supporting the benefit and the principles of early treatment, as well as the current update on pharmacological management in early RA.
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Humanos , Antirreumáticos , Artritis Reumatoide , Diagnóstico , Progresión de la Enfermedad , Quimioterapia , Articulaciones , LógicaRESUMEN
Rheumatoid arthritis is a chronic inflammatory disease and afflicts approximately 1% of general population. Once considered as a benign non-fatal disease, rheumatoid arthritis is a debilitating condition with a serious physical, emotional, and economic consequences. Life expectancy is reduced among patients with rheumatoid arthritis, and survival rates are comparable to those for three-vessel coronary disease Hodgkin's disease, and diabetes mellitus. For the past 20 years the treatment of rheumatoid arthritis has been developed on pyramid approach, which has had limited success. This led to a move towards using disease modifying antirheumatic drugs early in the disease. Future of rheumatoid arthritis tensive induction therapy, and treatment for resistant disease. This review will be focused on current principles and general guidelines of drugs for the treatment of rheumatoid arthritis.