ABSTRACT
Therapy of Psoriasis Arthritis Taking into Account New Treatment Options Abstract. Psoriatic arthritis occurs in about 20-30 % of patients with psoriasis. The disease is heterogeneous and can involve a variety of the distinct anatomical sites. The choice of medication depends on the type and the severity of clinical features. The recommendations of EULAR and GRAPPA serve as a guide for the choice of medication, which is used in sequential treatment steps. This is presented in our review in usable, simplified terms. Potential comorbidities leading to contraindication for certain treatments are considered. We present new and highly effective treatments, based on the pathogenesis of psoriasis and psoriatic arthritis, targeting the IL-23/IL-17 pathway.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Psoriatic/drug therapy , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/adverse effects , Comorbidity , Contraindications , Drug Therapy, Combination , Humans , Interleukin-17/antagonists & inhibitors , Methotrexate/adverse effects , Methotrexate/therapeutic use , Phosphodiesterase 4 Inhibitors/adverse effects , Phosphodiesterase 4 Inhibitors/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Ustekinumab/adverse effects , Ustekinumab/therapeutic useSubject(s)
Arthritis, Reactive , Chlamydia Infections , Chlamydia trachomatis , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis, Reactive/complications , Arthritis, Reactive/diagnosis , Arthritis, Reactive/drug therapy , Arthritis, Reactive/etiology , Arthritis, Reactive/genetics , Arthritis, Reactive/therapy , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia trachomatis/isolation & purification , Diagnosis, Differential , Female , HLA-B27 Antigen , Haplotypes , Humans , Magnetic Resonance Imaging , Male , Polymerase Chain Reaction , Prognosis , Rifampin/administration & dosage , Rifampin/therapeutic use , Sulfasalazine/administration & dosage , Sulfasalazine/therapeutic use , Time Factors , Urine/microbiologyABSTRACT
OBJECTIVE: To assess and compare the impact of medication treatments on health-related quality of life (HRQOL), family function, and medical status in children with juvenile idiopathic arthritis (JIA). METHODS: Fifty-seven children diagnosed with JIA were assessed by a pediatric rheumatologist and placed into one of three treatment groups: (1) non-steroidal anti-inflammatory; (2) methotrexate; or (3) steroids via IV methylprednisolone. Questionnaires were administered at baseline and 4-month follow-up. The attending pediatric rheumatologist provided additional medical information. RESULTS: Data document the impact of JIA on HRQOL, particularly on physical and pain domains. Steroid patients experienced improved HRQOL at follow-up relative to other groups, despite reporting more problems with side effects. CONCLUSION: These results demonstrate positive benefits of steroids in treating JIA children, despite the greatest incidence of adverse side effects.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Juvenile/drug therapy , Glucocorticoids/therapeutic use , Methotrexate/therapeutic use , Methylprednisolone/therapeutic use , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Antirheumatic Agents/adverse effects , Child , Child, Preschool , Female , Follow-Up Studies , Glucocorticoids/adverse effects , Health Status , Humans , Infant , Male , Methotrexate/adverse effects , Methylprednisolone/adverse effects , Multivariate Analysis , Quality of LifeABSTRACT
This article compares the structure and process of rehabilitation for stroke patients at 2 internationally recognized rehabilitation hospitals, Klinik Valens ("Valens") in Switzerland and the William Donald Schaeffer Rehabilitation Hospital at Kernan ("Kernan") in the United States. Although the patient mix, structure, and process of rehabilitation were similar in many regards, there were some important differences. Most notably, on average, patients at the U.S. hospital were discharged from rehabilitation at approximately the same day poststroke that rehabilitation began in Switzerland. Patients remained in an inpatient setting an average of 40 days longer in Switzerland (for the combination of acute care and rehabilitation) and had significantly higher levels of functioning at discharge when compared to their U.S. counterparts. The authors' findings suggest that Europe may offer opportunities for rehabilitation research that would be difficult to duplicate in the United States and highlight policy-relevant questions for future studies aimed at developing efficient managed care systems for stroke survivors.
