The present study aims at evaluating the economic impact of the use of hyaluronic acid (Hyalubrix®60/HyalOne) as an alternative to surgery in the treatment of hip osteoarthritis, consistently with ...the therapeutic protocol envisaged in the Ortobrix study. To quantify the cost and efficacy of the treatment options under evaluation, the perspective of both the Italian NHS and the Society was considered. To this end, a decision analysis model was created over a 4-year period, to quantify the cost of treatments, procedures and adverse events, as well as the benefits expressed as survival rates and reduced lost workdays. The results show that, since the treatment with Hyalubrix® enables to avoid or delay the need for Total Hip Replacement (THR) surgery, it is possible to reduce mortality, adverse events and total costs. Hyalubrix®, given in the hip by ultrasound-guided intra-articular injection as an alternative to surgery is the most favourable option, helping preserve the survival rate over a 4-year period, of approximately 1 in 100 patients considered candidates for THR, preserve work capacity for a total differential amount of 500 days, and achieve considerable savings in economic terms, of approximately 550,000 € and 600,000€ euros from the NHS and the Societal perspectives, respectively.
Hip osteoarthritis represents a statistically relevant problem in clinical practice; previous reports showed different efficacy and safety profiles for intra-articular use of hyaluronic acid in hip ...osteoarthritis-affected patients, and in this sense, to add evidence to this topic, data regarding safety and efficacy of ultrasound-guided viscosupplementation are reported in order to establish whether such a therapeutic tool may represent a valid option. This study investigates the safety and efficacy profiles of ultrasound-guided intra-articular injections of Jointex® in hip osteoarthritis affected patients. This is a prospective multicentric study carried out in public hospitals. Adult outpatients suffering from symptomatic hip OA (Kellgren and Lawrence Grade 2, 3 or 4) were injected with one syringe of 4 ml (2 vials) of Jointex® under ultrasound guidance, repeated after six months; when clinically necessary an adjunctive injection was performed. Patients' characteristics, such as gender, age, weight, height and BMI, smoking habit, unilateral or bilateral hip OA, radiological grade for hip OA following Kellgren-Lawrence grading and duration of disease, were evaluated. Patients were assessed at baseline and at every control visit and injection time for Lequesne index as primary endpoint, pain (evaluated by VAS) and NSAID consumption (number of days patients assumed NSAID in the last month) both as secondary endpoint. A total of 180 patients entered the study, all of whom received at least one IA US-guided injection of Jointex® into the hip joint. A total of 36 drop outs were registered, and both distribution and causes of drop out were recorded. A total of 389 injections were carried out, as 18 patients were affected by bilateral hip OA and 7 patients affected by monolateral hip OA required one more injection for symptomatic relief in respect to other patients. Scores obtained for primary as well as secondary study endpoints reached statistical significance when compared with scores obtained at baseline visit. Lequesne index mean scores obtained at each control visit, when compared with baseline mean value, were significantly different (p<0.001 for all control visits vs baseline). Similarly, results obtained for secondary endpoints, such as Pain VAS and NSAID consumption, when compared with results obtained at the baseline visit, showed a statistical significance (p<0.001 for all control visits vs baseline). We also evaluated how many patients reached an improvement in Lequesne algo-functional index of at least 70% at 6- and 12-month control visits: a percentage of 21.23% of patients attending the 6-month control visit showed such improvement, while at the 12-month control the percentage was 20%. No local or systemic infectious adverse events were reported during the whole follow-up time. Twenty-seven patients out of 180 reported a transient discomfort in the treated hip for 1–3 days after injection that regressed spontaneously or with paracetamol 1 g two or three times a day. No systemic adverse events were observed. Intra-articular administration of Jointex® in hip OA-affected patients seems to be an efficacious and safe therapeutic option.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Alberto Migliore1, Francesca Giovannangeli1, Emanuele Bizzi1, Bruno Laganà2, Mauro Granata31Department of Rheumatology, S Pietro FBF Hospital, 2Department of Rheumatology, Second Medical ...School, Sapienza University, 3Rheumatology and Osteoporosis Center, San Filippo Neri Hospital, Rome, ItalyBackground: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease.Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc®) in the management of joint pain in knee osteoarthritis.Methods: Three databases were searched, ie, Medline (1970–2010), the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references.Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy.Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.Keywords: viscosupplementation, knee osteoarthritis, hyaluronic acid, hyaluronan, sodium hyaluronate, hylan G-F 20, intra-articular injection
Otkrivanje osteoartritisa u ranom stadiju, tj. u preradiološkoj
fazi obilježenoj malim brojem blagih simptoma,
omogućilo bi rane prevencijske intervencije radi promjene
tijeka bolesti. To bi moglo ...poboljšati prognozu bolesnika s
osteoartritisom te dovesti do znatnog smanjenja troškova
povezanih sa skrbi za te bolesnike. Za sada još nedostaje
jasna definicija ranih stadija osteoartritisa. OARSI inicijativa
i CHECK studija dvije su prospektivne studije u tijeku
kojima je, između ostalog, svrha identificirati rane stadije
osteoartritisa, kao i čimbenike rizika povezanih s njegovim razvojem. Talijansko društvo reumatologa nedavno je
predstavilo međunarodni konsenzus za definiciju ranog
osteoartritisa koljena. Kao prvi korak učinjen je sustavni
pregled literature radi identifikacije ranog osteoartritisa u
znanstvenoj literaturi. U drugom je koraku međunarodni
panel stručnjaka za područje osteoartritisa s pomoću
nekoliko stupnjeva evaluacije prihvatio definiciju ranoga
simptomatskog osteoartritisa koljena.
Gabriele Nicolini1, Nicola Scichilone2, Andrea Bizzi3, Alberto Papi4, Leonardo M Fabbri51Medical Department, Chiesi Farmaceutici, Parma, Italy; 2University of Palermo, DIMPEFINU, Palermo, Italy; ...3Department of Scientific Affairs, Chiesi Farmaceutici, Parma, Italy; 4Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy; 5Section of Respiratory Diseases, University of Modena, Modena, ItalyAbstract: Drugs for asthma and other chronic obstructive diseases of the lungs should be preferably delivered by the inhalation route to match therapeutic effects with low systemic exposure. Inhaled drugs are delivered to the lungs via different devices, mainly metered dose inhalers and dry powder inhalers, each characterized by specific inhaler technique and instructions for use. The patient–device interaction is part of the prescribed therapy and can have a relevant impact on adherence and clinical outcomes. The most suitable device should be considered for each patient to assure the correct drug intake and adherence to the prescribed therapy. The development of new drugs/devices in the past decades improved the compliance with inhaler and possibly drug delivery to the bronchi. The present review focuses on the recently developed beclomethasone/formoterol extrafine fixed combination and technical aspects of drug delivery to the lungs in patient’s perspective.Keywords: beclomethasone, formoterol, modulite, extrafine
Background: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis ...with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease. Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc®) in the management of joint pain in knee osteoarthritis. Methods: Three databases were searched, ie, Medline (1970–2010), the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references. Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy. Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.
Multiple chemical sensitivity (MCS) is defined by multiple symptoms, affecting multiple organs, that wax and wane in response to varying chemical exposures at or below previously tolerated levels. ...Sjögren's syndrome (SS) is a common autoimmune disease affecting 3% of women aged over 55 years. Except for keratoconjunctivitis sicca (which is associated with SS not MCS), systemic features are common between the 2 diseases, leading to considerable morbidity and, occasionally, mortality. The authors report 3 cases of association between SS and MCS. Three women who were diagnosed with SS showed MCS symptoms and also were diagnosed with MCS. Further studies are needed to understand physiopathogenic mechanisms that eventually may be revealed as common to the 2 syndromes.
Hydrocortisone (HC) reduced the macrophage content of four murine tumors to less than half of control values. Since HC causes monocytopenia and inhibits the recruitment of mononuclear phagocytes at ...sites of inflammation but does not affect the viability and proliferative capacity of macrophages, this finding suggests that the maintenance of macrophage levels in growing tumors is in part dependent upon the entry into the neoplasm of circulating monocytes. HC inhibited the growth of these tumors. The effect of HC was most marked on the mFS6 and MN/MCA1 sarcomas and 3LL carcinoma, with only marginal inhibition in the M109 carcinoma. HC augmented spontaneous and/or artificial (i.v.) metastasis in these tumor models. Cells from metastatic foci of the mFS6 sarcoma and M109 carcinoma inoculated i.m. were as susceptible to HC as cells from primary tumors. The effects of HC on macrophage content, growth and metastasis of the M109 carcinoma and mFS6 sarcoma were similar in mice with defective T-cell function (nude or thymectomized) or defective NK activity (beige or antiasialo GM1-treated) and in controls. The in vitro growth of the mFS6 and MN/MCA1 sarcomas was not modified by HC. Some inhibition of tumor-cell proliferative capacity was observed with the 3LL and M109 tumors. Tumor cell had high-affinity binding sites for glucocorticoid hormones, but these were not correlated to susceptibility in vivo. Thus it is unlikely that a direct interaction of HC with tumor cells accounts for the inhibition of tumor growth observed in vivo. To evaluate whether HC affected tumor growth by reducing the macrophage content of tumors, mFS6 sarcoma cells were transplanted, mixed with peritoneal macrophages into normal or HC-treated mice. Macrophages did not affect the growth of tumor cells in normal mice, whereas in HC-treated animals lesions from mixtures of macrophages and sarcoma cells appeared earlier and weighed more than those from tumor cells alone or tumor cells and thymocytes. However, macrophages did not reconstitute growth of the other sarcoma (MN/MCA1) in HC-treated mice. These results are consistent with the hypothesis that HC inhibited growth of some poorly immunogenic transplanted murine tumors, at least in part, by interfering with the macrophage levels in neoplastic tissues, tumor-associated macrophages providing the conditions for optimal tumor-cell proliferation at least in some neoplasms.
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