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.
In this study, we compare the prevalence of arterial hypertension (HT) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, exposed to high- and low-grade chronic inflammation, ...respectively, to assess the possible association between chronic inflammation and HT. A total of consecutive 627 RA and 352 OA patients were enrolled in this multicentric study. HT was defined as a systolic blood pressure (BP) ≥ 140 and/or diastolic BP ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index (BMI) ≥ 25, and patients ≥65 years were considered elderly. The prevalence of HT was higher in the OA group than in the RA group 73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively. When the results were adjusted for age and BMI, the HT prevalence was similar in both groups RA 59 % (95 % CI, 55.1, 63.8) OA 60 % (95 % CI, 58.4, 65.0). In both groups, the prevalence of HT was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (BMI ≥ 25) and age ≥65 were independent predictors of HT in multivariate logistic regression model, which showed no association between HT and the disease (RA or OA). The results indicate a robust association of age and BMI with HT prevalence in both RA and OA. The difference in HT prevalence between RA and OA is due rather to age and BMI than to the features of the disease, putting into question specific association of HT with RA.
Liječenje mišićno-koštane boli Babić-Naglić, Đurđica
Medicus (Zagreb, Croatia : 1992),
09/2014, Letnik:
23, Številka:
2. Liječenje boli
Journal Article
Recenzirano
Odprti dostop
Kronična mišićno-koštana bol globalni je javnozdravstveni problem s porastom prevalencije unatoč brojnim istraživanjima, sve većem broju farmakoloških i nefarmakoloških postupaka i osnivanju klinika ...za liječenje boli. Među rizicima od razvoja kronične boli u više su radova izdvojeni: trajanje i intenzitet boli do prvog pregleda, broj bolnih mjesta/regija, depresivno raspoloženje i životna dob. Već u akutnoj fazi valja prepoznati bolesnike s rizikom od kronične boli. Paracetamol, NSAR i tramadol standardna su farmakološka terapija boli. Formalna fizikalna terapija ima ulogu edukacije bolesnika, a kod rezistentne kronične mišićno-koštane boli indicirano je multidisciplinarno rehabilitacijsko liječenje. Mišićno-koštane bolesti najčešći su uzrok kronične nemaligne boli i nesposobnosti, a politopna distribucija boli direktno je povezana s gubitkom funkcionalne sposobnosti i kakvoće života.
The purpose of the study was to examine whether rheumatoid arthritis (RA) patients have higher prevalence of metabolic syndrome (MetS) than osteoarthritis (OA) patients in association with a higher ...level of chronic systemic inflammation in rheumatoid arthritis. A total of 583 RA and 344 OA outpatients were analyzed in this multicentric study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A 1.6-fold higher prevalence of MetS was found in patients with OA compared with the RA patients. Among the parameters of MetS, patients with OA had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose and triglycerides, whereas HDL cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) in MetS than in non-MetS patients and higher prevalence of MetS in patients with CRP level ≥5 mg/L in both RA and OA patients were found. In multivariate logistic regression analysis, significant predictors of MetS were type of arthritis (OA vs. RA; OR 2.5 95 % CI 1.82–3.43), age (OR 1.04 95 % CI 1.03–1.06) and ESR (OR 1.01; 95 % CI 1.00–1.01). The significant association between OA and MetS was maintained in the regression model that controlled for body mass index (OR 1.87 95 % CI 1.34–2.61). The present analysis suggests that OA is associated with an increased risk of MetS, which may be due to a common underlying pathogenic mechanism.
Danas je cilj liječenja reumatoidnog artritisa remisija aktivnosti bolesti koju bi trebalo postići kroz prvih šest mjeseci liječenja konvencionalnim sintetskim lijekovima koji mijenjaju tijek bolesti ...i redovitim učestalim kontrolama bolesnika na kojima se terapija prilagođava statusu bolesnika. Ako izostane remisija ili niska aktivnost bolesti, primjenjuju se biološki lijekovi. Prekid terapije ovisi o procjeni liječnika i bolesnika, a dolazi u obzir tek nakon najmanje šest mjeseci stabilne remisije.
Spondiloartritisi (SpA) su heterogena skupina HLA-B27 asociranih muskuloskeletnih bolesti koje zahvaćaju aksijalni i periferni skelet, a većina ima i ekstraskeletne manifestacije. Ove godine ...objavljeni su zadnji klasifikacijski kriteriji za SpA koje je izradila ASAS (Assessment of SpondyloArthritis International Society) radna skupina. U novim kriterijima respektiraju se tipična klinička i laboratorijska obilježja svih entiteta iz spektra SpA što omogućava ranu dijagnozu i planiranje optimalne strategije liječenja.
A 44-year-old diabetic man with isolated septic arthritis of the left acromioclavicular joint (A-C) caused by Staphylococcus aureus is described. He was admitted to the Department of Rheumatology ...with clinical symptoms of left shoulder arthritis and fever. Laboratory findings showed leukocytosis, elevated levels of erythrocyte sedimentation rate and C-reactive protein, all indicating septic arthritis. Blood culture was positive for Staphylococcus aureus. Left A-C joint x-ray and ultrasonography, and whole body scintigraphy with 99 mTc radiolabeled autologous leukocytes pointed to septic arthritis of the A-C joint. The patient was treated for six weeks with antibiotics successfully. Infection of the A-C joint is uncommon, even in conditions such as immunodeficiency, renal dialysis and intravenous drug abuse which are associated with unusual joint infections, and can be differentiated from shoulder joint infection, by maximal tenderness over the A-C joint on examination, and findings of A-C joint widening, effusion, and bony erosions on imaging studies.
Reumatske bolesti su vodeći uzrok kronične nesposobnosti. Fizikalna terapija i rehabilitacija dio su strategije liječenja reumatskih bolesti sa ciljem održanja funkcije sustava za kretanje. Rano ...otkrivanje nesposobnosti omogućava efikasniju primjenu svih mjera fizijatrijskog liječenja. Vježbe su najvrijedniji oblik fizikalne terapije. Dugoročni efekt vježbi moguć je samo ako se postigne adherencija bolesnika za program. Upitnici aktivnosti svakodnevnog života ocjenjuju funkcionalni status bolesnika, mogu biti vodič za planiranje rehabilitacijskog programa i pokazatelj djelotvornosti terapijske intervencije. Metode fizikalne i rehabilitacijske medicine navedene su u svim objavljenim smjernicama za liječenje reumatoidnog artritisa, spondiloartritisa, osteoartritisa, osteoporoze, kronične križobolje, kronične nemaligne boli i fibromijalgije kao dio složenog terapijskog pristupa.
Seronegativni spondiloartritisi su skupina upalnih reumatskih bolesti dominantno obilježenih upalom sakroilijakalnih zglobova i/ili kralježnice, enteza i perifernih zglobova. Prema ASAS ...klasifikacijskim kriterijima, magnetska rezonancija (MR) je radiološka metoda za analizu sakroilijakalnih zglobova i kralježnice u bolesnika sa seronegativnim spondiloartritisima. MR-om se mogu prikazati akutne upalne i morfološke promjene u tijeku bolesti, bez izlaganja ionizirajućem zračenju. MR-om vidljive promjene karakteristične za akutnu upalu su edem medularne kosti i nakupljanje kontrastnog sredstva u paraartikularnim dijelovima zgloba. Kronične promjene u seronegativnim spondiloartritisima su erozije, zone skleroze, periartikularno nakupljanje masti, rubne apozicije i ankiloza. MR ima veću osjetljivost u usporedbi s drugim radiološkim metodama i najvažnija je slikovna metoda za postavljanje pravovremene dijagnoze te procjenu aktivnost bolesti.
