Objective
To evaluate the 12-month efficacy and safety profile of adalimumab and etanercept in patients with ankylosing spondylitis (AS) and total spinal ankylosis (TSA).
Type of study design
...Case-series follow-up study.
Design
Twenty-eight patients (26 men and 2 women) with active AS (BASDAI > 4) and TSA were treated as follows: 19 patients receiving adalimumab and 9 patients receiving etanercept. Twelve-month data related to the efficacy and safety of these two TNF-alpha inhibitors were evaluated. The primary endpoint was ASAS 20 (the ASsessment in AS International Working Group criteria for 20% improvement) at weeks 12 and 52. Other measures that were evaluated were function (BASFI), disease activity (BASDAI), patient’s and physician’s global disease assessment on visual analogue scale (VAS) and C-reactive protein.
Results
In both adalimumab and etanercept groups, there was a significant improvement in all observed variables (baseline compared to weeks 12 and 52). This improvement was sustained for the whole follow-up period. In the adalimumab group, at week 12, ASAS 20 was achieved in 18/19 patients and at week 52 in 17/19 patients. In the etanercept group, at week 12 ASAS 20 was achieved in all patients and at week 52 in 6/9 patients.
Conclusion
In patients with active AS and TSA, adalimumab and etanercept treatment showed significant improvement in function and disease activity. No serious side effects or adverse effects were observed in our cohort.
Key Points
• TNF-alpha inhibitors can be effective treatment options for patients with AS and having total spinal ankylosis.
• Patients with advanced AS should not be disregarded as good candidates for treatment with biologic disease-modifying antirheumatic drugs.
Vestibularna rehabilitacija jest planirani, individualno prilagođen sustav vježbi kojima se ubrzava proces središnje kompenzacije oštećenoga vestibularnog sustava. U medicinu ju uvode Cawthorne i ...Cooksey sredinom prošloga stoljeća. Godinama su postojali prijepori o značenju i učinkovitosti ovoga načina liječenja. Provedene su brojne randomizirane prospektivne kliničke studije, koje su dokazale važnost vestibularnih vježbi, kao i njihov povoljan učinak na brzinu i stupanj oporavka bolesnika, tako da one posljednjih desetljeća zauzimaju sve značajnije mjesto u liječenju vrtoglavica. Vestibularna hipofunkcija, bilo da je riječ o akutnome ili kroničnom poremećaju, ili pak o jednostranome ili obostranom oštećenju, predstavlja dosta čest problem za liječnika praktičara, osobito onoga koji se bavi problemima vrtoglavica. Premda je vestibularna rehabilitacija za većinu poremećaja ravnoteže metoda izbora u liječenju, ona je kod nas još uvijek podosta zapostavljena i neopravdano podcijenjena. Cilj ovih Smjernica za kliničku praksu jest pomoći liječnicima i fizioterapeutima pri ujednačavanju pristupa pacijentima s jednostranim i obostranim vestibularnim oštećenjima, izbjegavajući nepotrebne varijacije u primjeni vestibularnih vježbi. One nisu udžbenik niti jedini i neupitni izvor znanja, već pružaju okvir za strategiju kod donošenja odluka, ne zamjenjujući pritom značenje kliničke prosudbe. Vestibularnim vježbama značajno se ubrzava oporavak bolesnika s vestibularnom hipofunkcijom i njihov povratak uobičajenim životnim aktivnostima. Svrha ovih Smjernica jest utvrditi koga, kada, kako i koliko dugo liječiti, kao i kako otkloniti nepotrebne varijacije u pristupu rehabilitaciji pacijenata s vestibularnom hipofunkcijom. One se zasnivaju na dokazima dobivenim metaanalizom podataka iz dostupne medicinske literature, oslanjajući se pored toga i na naše dugogodišnje iskustvo u radu s vertiginoznim pacijentima.
Background: Access to biologic treatment diff er in EU countries and is influenced by different factors. In CEE countries 1%–5% of all RA patients are treated with biological therapy. Factors ...influencing prescriptions of biologics in CEE are mostly macroeconomic conditions and restrictive treatment guidelines but also shortage of specialist prescribers, administrative hurdless and availability of care. 1. There are published data on access to biologic treatment in Central and Eastern EU countries but there currently is no data in Croatia. Objectives: Th e aim of this study was to assess and compare patient care and access to biologic therapy for rheumatoid arthritis (RA) treated in secondary and tertiary institutions in Croatia. Methods: Non-interventional, multicenter study with retrospective chart review to collect demographics and clinical characteristics from patient’s history and a cross-sectional study on date of visit to the rheumatologist with evaluation of DAS28 score and therapeutic interventions taken at this cross-sectional visit. Study was conducted in 398 RA patients from Balkan region and this subanalysis is showing results on 130 RA patients from 8 sites in Croatia. Results: Results here are obtained from Non-interventional, Multicenter, Cross-sectional Study to Estimate Disease Activity and Treatment Patterns in Patients with Rheumatoid Arthritis in the Balkan Region and assesing information about cros sectional status of DAS28 score and access to biologic therapy in 130 patients from 8 sites in Croatia. Average age was 56.4 years,and 85.4% were female. Results of the DAS28 cross-sectional status showing that 34,6% of patients are in status of moderate and 16% are in active disease. (Fig. 1) Mean time to introduction of biological therapy was 8.2 years. In a total of 28 (21.5%) subjects who had biologic treatment the mean DAS28 score at the time of start of biologic treatment was 5.5 (median 5.45; range 2.7–7.9). The mean time to introduction of biologic terapy was 8.2 years. Conclusions: In this study, a half of patients despite treatment had moderate to active disease. The time to introduction of biologic therapy is very long. Th is clearly show a treatment gap regarding timely introduction of biologic therapy.
References:
1. Orlewska E, Ancuta I, Anic B et al. Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE)
countries. Med Sci Monit 2011; 17(4): 1–13
Spondiloartritisi (SpA) grupa su upalnih reumatskih bolesti koje dijele zajednička etiopatogenetska, radiološka i klinička obilježja. Te su bolesti znatan teret za bolesnika i za društvo. Posljednjih ...godina dogodile su se velike novosti u klasifi kaciji, dijagnostici i liječenju SpA. Stoga je Hrvatsko reumatološko društvo Hrvatskoga liječničkog zbora ažuriralo
prijedlog primjene bioloških lijekova (referentnih ili biosličnih) i novouvedenih ciljanih sintetskih molekula u algoritam liječenja odraslih bolesnika sa SpA. Prijedlog preporuka usklađen je s preporukama uglednih europskih i drugih međunarodnih organizacija iz ovog područja. Nadamo se da će standardizirani, sveobuhvatni i aktualni pristup u ispunjavanju kriterija, odabiru lijekova, praćenju i evaluaciji ishoda koji smo primijenili u cijelom spektru bolesnika sa SpA pomoći kliničarima i drugim zainteresiranima u postizanju optimalnih rezultata liječenja ovih bolesnika.
Reumatoidni artritis sustavna je upalna reumatska bolest koja, osim zglobova, zahvaća i unutarnje organe, kožu,
osjetilni i živčani sustav, a znatno povisuje i rizik od kardiovaskularnih bolesti. ...Posljednjih godina znatno se promijenio
pristup u dijagnostici i liječenju bolesnika s reumatoidnim artritisom. Rana dijagnoza i pravodobno započinjanje
liječenja sintetskim i biološkim lijekovima iznimno su važni da bi se spriječile ireverzibilne posljedice ove teške bolesti.
Hrvatsko reumatološko društvo Hrvatskoga liječničkog zbora u skladu s novijim spoznajama u reumatologiji
obnovilo je preporuke za liječenje reumatoidnog artritisa.
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