Methotrexate (MTX) has become the first-line treatment for rheumatoid (RA) and psoriatic arthritis (PsA); however, few studies have focused on its tolerability. The objective of our analyses was to ...study RA and PsA patients in whom MTX was discontinued, the reasons for this and the duration of MTX treatment prior to withdrawal. A retrospective electronic database review was undertaken to identify all patients who had received MTX for RA or PsA. Patients who had discontinued MTX were then identified, and the reasons for this were categorised. The duration of MTX treatment was assessed in those who had stopped treatment due to intolerability. A total of 1,257 patients who had received MTX were identified 762 (61 %) RA and 193 (15 %) PsA. MTX had been stopped in 260 (34 %) patients with RA and 71 (36 %) patients with PsA most commonly due to gastrointestinal intolerability. The median duration of MTX treatment was 10 months in both groups, mean duration 21 and 18.6 months in RA and PsA groups, respectively. Overall, one third of patients with RA and PsA stop MTX most commonly due to poor tolerability. In the context of chronic disease, the median duration of treatment is short (10 months). Our analysis did not include patients who suffer from side effects but continue therapy; thus, the magnitude of the problem may be substantially greater therefore as poor tolerability impacts treatment adherence.
Biologic disease modifying anti-rheumatic drugs have transformed the management of rheumatoid arthritis (RA) since their introduction into clinical practice over a decade ago. Following large-scale ...clinical trials, a number of biologics, with different mechanisms of action, have been licensed for the condition. In this review, we will summarise the current evidence for biologic use in RA with an emphasis on their efficacy and tolerability. In addition, we will provide a commentary on the current limitations and unmet needs in this area and discuss the future of biologic intervention.
Major advances in drug development have led to the introduction of biologic disease- modifying drugs for the treatment of rheumatoid arthritis, which has resulted in unprecedented improvement in ...outcomes for many patients. These agents have been found to be effective in reducing clinical signs and symptoms, improving radiological damage, quality of life, and functionality, and have also been found to have an acceptable safety profile. Despite this, drug adherence is unknown, which has huge health care and health-economic implications. Local and national guidelines exist for the use of biologics; however, its varied use is widespread. Although this may in part reflect differences in prescribing behavior, patient preference plays a key role. In this review we will explore the factors that contribute to patient preference for, and adherence to, biologic therapy for rheumatoid arthritis with emphasis on the subcutaneous preparation of abatacept, a T-cell costimulatory molecule blocker. Overall, subcutaneous administration is preferred by patients and this may well improve drug adherence.
Case Reports [3–24] Seiber, Clare; Bawa, Sandeep; Ritchie, David ...
Rheumatology (Oxford, England),
04/2010, Letnik:
49, Številka:
suppl-1
Journal Article
Recenzirano
Background: Focal myositis is a benign inflammatory pseudotumour of skeletal muscle, that usually presents in the extremities. We present what we believe is the first published case of a patient with ...a focal myositis of the pectoral region. Methods: A previously fit and well 34 year old Caucasian gentleman presented with a 3-month history of a progressively enlarging painful mass in the right pectoral region. He denied any trauma, prior masses, muscle dysfunction, symptoms of connective tissue disease, fever, rashes, acne or pustulosis. Clinical examination revealed a palpable, tender soft tissue mass measuring 4 cm x 5 cm, antero-inferior to the right sternoclavicular joint. There was no evidence of synovitis and the overlying skin was normal in appearance. The patient displayed normal muscle power and had no cervical or axillary lymphadenopathy. Investigations revealed ESR 43 mm/h (normal range < 20 mm/h), CRP 30mg/l (normal range < 10 mg/l), CK 85 U/l (normal range 24–195 U/l). Blood chemistry, bone profile, antinuclear antibodies, ENA, dsDNA, RF, immunoelectrophoresis, hepatitis serology, CMV and EBV were all negative. Chest X-ray was normal. A T2 weighted MRI of the thorax identified an area of oedema within the upper right pectoral muscle. The sternoclavicular and manubrio-sternal joints were not affected. A muscle biopsy demonstrated skeletal muscle with an eosinophilic inflammatory infiltrate, consistent with a diagnosis of focal myositis. Malignancy and TB were excluded. Results: The patient commenced prednisolone 20 mg daily. Upon review, the mass had clinically resolved and the patient was asymptomatic. The dose of steroid was then tapered over 4 months. Methotrexate 12.5 mg once weekly was initiated due to the reoccurrence of symptoms on lower doses of prednisolone. Conclusions: Focal myositis was first identified as a distinct clinicopathologic entity by Heffner et al. in 19771. In the 16 reported cases by the authors, myositis occurred in the limbs. Cases have subsequently been reported in the abdomen, head and neck. Focal myositis has no age or sex predilection and most patients deny any weakness or systemic symptoms. Clinically it can mimic the features of a soft tissue sarcoma. It may be mistaken for early manifestations of polymyositis or connective tissue disease. The aetiology is unknown. Trauma has rarely been identified as a precipitating factor. A viral mechanism has been suggested but no organism has been identified. Focal myositis has an excellent prognosis, with a high rate of spontaneous regression without recurrence. It can be treated effectively with glucocorticoids due to the inflammatory nature of the condition. We report to the best of our knowledge the first case described in the literature of a focal myositis in the pectoral muscle. Although focal myositis is a rare condition, it should be considered as a differential diagnosis for a mass presenting in any skeletal muscle group. Disclosure statement: All authors have declared no conflicts of interest.
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