Update on the Use of Steroids in Rheumatoid Arthritis García-Magallón, Blanca; Silva-Fernández, Lucía; Andreu-Sánchez, José Luis
Reumatologia clinica,
September-October 2013, 2013 Sep-Oct, 2013-09-00, Letnik:
9, Številka:
5
Journal Article
Recenzirano
Corticosteroids are a mainstay in the therapy of rheumatoid arthritis (RA). In recent years, a number of high-quality controlled clinical trials have shown their effect as a disease-modifying ...anti-rheumatic drug (DMARD) and a favorable safety profile in recent-onset RA. Despite this, they are more frequently used as bridge therapy while other DMARDs initiate their action than as true disease-modifying agents. Low-dose corticosteroid use during the first two years of disease slows radiologic damage and reduces the need of biologic therapy aimed at reaching a state of clinical remission in recent-onset RA. Thus, their systematic use in this clinical scenario should be considered.
Los glucocorticoides son un componente fundamental en el tratamiento de la artritis reumatoide (AR). En los últimos años, numerosos ensayos clínicos controlados de alta calidad metodológica han demostrado su acción como fármaco antirreumático modificador de enfermedad (FAME) y un favorable perfil de seguridad en la AR de reciente comienzo. No obstante, es frecuente que se utilicen más como terapia puente hasta que otros FAME comienzan a actuar que como auténticos agentes modificadores de enfermedad. Los glucocorticoides a dosis bajas durante los 2 primeros años de la enfermedad frenan el deterioro radiológico y reducen la necesidad de usar agentes biológicos para conseguir la remisión clínica en la AR de inicio por lo que se debería valorar su utilización sistemática en este contexto clínico.
To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD).
This was an observational, multicentre study of RA-ILD patients treated with at least one dose ...of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect.
We studied 263 RA-ILD patients 150 women/113 men; mean (s.d.) age 64.6 (10) years. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25-3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6-36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5-10) to 5 (2.5-7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2).
ABA may be an effective and safe treatment for patients with RA-ILD.
Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally ...caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited.
We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole.
Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum.
The retention rate of a biological drug (percentage of patients remaining on treatment over time) provides an index of a drug’s overall effectiveness. The golimumab retention rate as first-line ...biological therapy was high in clinical trial extensions lasting 5 years. Real-world studies also indicate good retention rates but have been of shorter duration. The probability of retention with golimumab treatment was assessed, as any line of anti-tumor necrosis factor-alpha therapy, for up to 5 years in patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA) or psoriatic arthritis (PsA), associated factors were analyzed. A retrospective database analysis of the Spanish registry of patients with rheumatic disorders receiving biological drugs (BIOBADASER) was performed. Among 353 patients, 29.8% had RA, 41.6% SpA and 28.6% PsA. Golimumab was the first biological drug in 40.1% of patients, second in 30.1% and third/later in 29.8%. The overall probability of retention of golimumab at years 1, 2, 3, 4 and 5 was 85.9% (95% confidence interval 81.4–89.5%), 73.7% (67.1–79.1%), 68.5% (60.5–75.1%), 60.6% (50.2–69.5%) and 57.1% (44.9–67.5%), respectively. Retention was similar across indications (
p
= 0.070) but was greater when golimumab was used as the first biological agent compared with later therapy lines (
p
< 0.001). Factors associated with higher retention of golimumab treatment (Cox regression) were use as a first-line biological and concomitant methotrexate treatment; corticosteroid need was associated with lower retention. The long-term probability of golimumab retention was high in this real-world study of patients with rheumatic diseases, especially when used as the first biological drug.
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