Analysis of clinical characteristics of 33 cases of tuberculosis complicated by tumor necrosis factor-α inhibi-tor in autoimmune diseases / 实用医学杂志

Objective To investigate the clinical characteristics,treatment and prognosis of tuberculosis in patients with autoimmune diseases after tumor necrosis factor-αinhibitors.Methods Clinical data of 33 patients with TB after biologics(tumor necrosis factor-α inhibitors)treated in Guangzhou Chest Hospital from January 2019 to March 2023 were collected,including 25 males and 8 females,with a median age of 32 years.The clinical symptoms,laboratory results,imaging and tracheoscopic features,pathological features,treatment and outcome were analyzed retrospectively.Results The common clinical manifestations were cough(26/33),sputum(23/33)and fever(17/33).The most common cases were pulmonary tuberculosis(32/33),bronchial tuberculosis(15/33),mediastinum and hilar lymph node tuberculosis(11/33).Bilateral lung spread of tuberculosis(21/33),intrapulmonary spread of tuberculosis(bronchus,mediastinal hilar lymph nodes,pleura)(19/33),extrapulmonary tuberculosis(18/33),pulmonary tuberculosis with intrapulmonary or extrapulmonary tuberculosis(26/33).Blood CD4+T lymphocyte test was normal(23/33),and blood IGRA test was positive(27/33).Pulmonary imaging miliary nodules(8/33).The histopathology of the lymph nodes showed atypical granulomatous nodules.The duration of anti-tuberculosis treatment is 8-32 months.1 case of death.Conclusion Patients with autoimmune diseases complicated with tuberculosis after the application of tumor necrosis fact-α inhibitor are more likely to have double lung lesions,which are easy to spread to lung tissues and multiple organs of the body,and have decreased immune function.Most of them need to extend the treatment course,and the prognosis is generally good after comprehensive treatment.

Chronic multifocal osteomyelitis: A case report and literature review / 北京大学学报(医学版)

A case of chronic multifocal osteomyelitis was described in terms of its clinical manifestations, serological and imaging examinations, diagnostic criteria, treatment options, and follow-up evaluation after discharge. The pathogenesis, diagnosis, differential diagnosis and treatment of chronic multifocal osteomyelitis were reviewed, and the characteristics of autoinflammatory osteopathy were reviewed. The patient with onset from youth had developed severe skin lesions, progressive arthralgia and rachialgia. The clinical manifestation and the auxiliary examination of the patient accorded with the diagnosis of chronic multifocal osteomyelitis. After poor anti-inflammatory and analgesic effects, the switch to tumor necrosis factor alpha (TNF-α) inhibitor resulted in pain relief, normalization of inflammation indexes, and significant improvement in rash and imaging examination. Chronic recurrent multifocal osteomyelitis was a kind of autoinflammatory bone disease of multiple genes in disease with low incidence, unknown mechanism and unified diagnostic criteria. It was also known as chronic nonbacterial osteomyelitis, which was a rare, noninfectious inflammatory disorder that caused multifocallytic bone lesions characterized by periodic exacerbations and remissions. The exact pathophysiology or mechanism of the sterile bone inflammation was poorly understood, although chronic nonbacterial osteomyelitis was probably an osteoclast-mediated disease. In addition, an imbalance between pro- and anti-inflammatory cytokines was suspected to play a role. The available data so far pointed to the interplay among genetics, environmental, and immunologic factors as the causes of chronic nonbacterial osteomyelitis. Infectious etiology did not seem to play a crucial role in the pathogenesis of chronic nonbacterial osteomyelitis. It was often confused with metabolic bone disease, infection, tumor and other diseases. Its clinical manifestations were bone pain, fever, rash, fracture and so on. Laboratory examination showed significant increase in inflammatory markers. Radiographic examination revealed osteolytic or sclerosing changes. Magnetic resonance imaging was very useful for identifying bone lesions and tissue edema and was more accurate than bone emission computed tomography (ECT). Most of the patients begin to use non-steroidal anti-inflammatory drugs (NSAIDs) for treatment, but they are prone to relapse and new lesions appear. Other treatment options can be selected, including glucocorticoids, TNF-α inhibitors, bisphosphonates, methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs). Early diagnosis and treatment can prevent and reduce complications and improve prognosis.

Analysis of Drug Utilization for Patients with Ankylosing Spondylitis

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.

Los anti-TNF y la progresión radiográfica en espondilitis anquilosante / The anti-TNF and the radiological progression in ankylosing spondylitis

Los agentes biológicos inhibidores del factor de necrosis tumoral alfa (anti-TNF) se constituyen en un avance muy significativo en el tratamiento de los pacientes con espondilitis anquilosante (EA), demostrando una notable mejoría de sus síntomas, de su función y de su calidad de vida. Sumado a esta excelente respuesta clínica, se ha demostrado igualmente mejoría de la inflamación, demostrada mediante pruebas de laboratorio y estudios de resonancia nuclear magnética. A pesar de esta clara evidencia, la conexión entre actividad inflamatoria y progresión estructural no está tan claramente establecida como en artritis reumatoide (AR), y la evidencia de la eficacia de los anti-TNF en la prevención de la progresión del daño radiológico crónico en EA es deficiente. Se revisan las evidencias y las teorías actuales respecto a este crucial tema y se hace mención del importante papel de la proteína DKK-1, inhibidora de la vía Wnt. Esta proteína ha emergido recientemente como un regulador fundamental en la biología ósea y se constituye en una conexión clave entre inflamación, osteoporosis y remodelación articular.

The anti-TNF biological agents constitute a major advance in the treatment of patients with ankylosing spondylitis (AS) showing a remarkable improvement in symptoms of patients, their function and quality of life. In addition to this excellent clinical response, it has also been clearly demonstrated improvement of inflammation as evidenced by laboratory tests and MRI studies. Despite this clear evidence, the connection between inflammatory activity and structural progression is not as clearly established as in rheumatoid arthritis, and the evidence of anti-TNF therapy to prevent chronic EA radiological damage is poor. We review the evidence and current theories about this crucial issue and mention the important role of DKK-1 protein, an inhibitor of the Wnt pathway. This protein has recently emerged as a key regulator in bone biology and constitutes a key link between inflammation, osteoporosis and joint remodeling.

Recomendaciones para el uso de agentes biológicos en psoriasis / Recommendations for the use of biological agents in psoriasis

La psoriasis es una enfermedad crónica que afecta al 1%-2% de la población, produce importante deterioro de la calidad de vida y puede asociarse a complicaciones metabólicas y articulares severas. Existen múltiples agentes sistémicos para el manejo de los casos moderado-severos; sin embargo, la mayoría no puede utilizarse de manera continua o prolongada y los estudios han demostrado que un alto porcentaje de pacientes está disconforme con sus tratamientos. Los agentes biológicos representan una poderosa herramienta en el tratamiento de la psoriasis; no obstante, los riesgos asociados y sus costos hacen necesario restringir su uso. Debido a estas consideraciones, diferentes sociedades dermatológicas en el mundo han desarrollado guías clínicas de consenso para el manejo de estos agentes en psoriasis. El presente artículo resume las recomendaciones de las sociedades Alemana (2007), Americana (2008), Española (2009) y Británica (2009) de Dermatología y los principales ensayos clínicos de cada uno de los agentes biológicos disponibles para el tratamiento de la psoriasis, y pretende entregar algunas directrices para la utilización de estos agentes en el medio nacional.

Psoriasis is a chronic disease that affects 1%-2% of the population, causes serious deterioration in the quality of life and may be associated with severe metabolic and joint complications. There are numerous systemic agents for the management of moderate-severe cases, however, most of them cannot be used in a continuous or prolonged way, and studies have shown a high percentage of dissatisfaction with those treatments. Biologics represent a powerful tool in the treatment of psoriasis, however, associated risks and costs make it necessary to restrict their use. Because of this, different dermatological societies around the world have developed clinical guidelines for the management of these agents in psoriasis. This article summarizes the recommendations of the German (2007), American (2008), Spanish (2009) and British (2009) Dermatology Societies, as well as the main clinical trials of biologics for the treatment of Psoriasis, and attempts to provide some guidelines for the use of these agents in our country.