- Chikungunya: A rheumatologist's perspective. [Review]
- IJInt J Rheum Dis 2018 Feb 12
- Chikungunya (CHIK), a viral infection, is transmitted by Aedes mosquitoes. It is characterized by a phase of acute infection, which is sometimes followed by chronic rheumatisim in the form of arthral...
Chikungunya (CHIK), a viral infection, is transmitted by Aedes mosquitoes. It is characterized by a phase of acute infection, which is sometimes followed by chronic rheumatisim in the form of arthralgia or myalgia that can last for months and even years. Several studies have been conducted to understand the mechanisms underlying inflammation associated with CHIK infection, persistence of viruses in monocytes-macrophages, and their relationship to the chronic symptoms. Chronic arthritis is one of the serious complications of CHIK infection, which is characterized by swelling and acute pain that poorly responds to treatment with analgesics. Such debilitating chronic joint pain mimics that of rheumatic arthritis and significantly compromises the quality of life. Diagnosis is primarily based on the initial viral detection using molecular methods or the use of virus culture, and on the basis of an immune response in the later stages. In the absence of published guidelines, physicians are often limited to prescribing analgesics and steroids for symptomatic care, as there is no accurate approach for the treatment and management of pain. This review aims to focus on the need for appropriate guidelines that will aid in developing suitable pharmacologic treatment to manage pain associated with post-CHIK chronic inflammatory rheumatism.
- Gout: A Disease of Kings. [Journal Article]
- CNContrib Nephrol 2018; 192:77-81
- As a disease of kings, and the king of diseases, gout is one of the oldest joint diseases known to humans. First described as far back as 2640 B.C., gout is still the most common form of inflammatory...
As a disease of kings, and the king of diseases, gout is one of the oldest joint diseases known to humans. First described as far back as 2640 B.C., gout is still the most common form of inflammatory arthritis haunting humans in the 21st century. The disease is caused by the chronic elevation of serum uric acid levels above the saturation point for monosodium urate crystal formation. Its incidence is progressively rising even today, but there are also regional and ethnic variations. Finally, the role of genetics is only beginning to be unraveled.
- Cancer risk associated with chronic diseases and disease markers: prospective cohort study. [Journal Article]
- BMJBMJ 2018 01 31; 360:k134
- CONCLUSIONS: Chronic disease is an overlooked risk factor for cancer, as important as five major lifestyle factors combined. In this study, chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death. Physical activity is associated with a nearly 40% reduction in the cancer risk associated with chronic diseases.
- Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. [Journal Article]
- JPJ Pain Res 2018; 11:111-117
- CONCLUSIONS: Although both ozone and HA can be effectively used for improving function and reducing pain in selected knee OA patients, neither of the two showed any superiority at 6-month follow-up.
- Harm, benefit and costs associated with low-dose glucocorticoids added to the treatment strategies for rheumatoid arthritis in elderly patients (GLORIA trial): study protocol for a randomised controlled trial. [Journal Article]
- TTrials 2018 Jan 25; 19(1):67
- CONCLUSIONS: Pragmatic trials minimise impact on daily practice and maximise clinical relevance of the results, but analysis and interpretation of the results is challenging. We expect that the results of this trial are of importance for all rheumatologists who treat elderly patients with RA.
- Interferon regulatory factor 5 is a potential target of autoimmune response triggered by Epstein-barr virus and Mycobacterium avium subsp. paratuberculosis in rheumatoid arthritis: investigating a mechanism of molecular mimicry. [Journal Article]
- CEClin Exp Rheumatol 2018 Jan 15
- CONCLUSIONS: IRF5 is a potential autoimmune target of RA. Our results support the hypothesis that EBV and MAP infections may be involved in the pathogenesis of RA, igniting a secondary immune response that cross-reacts against RA self-peptides.
- Effect of Multidisciplinary, Team-Based Rehabilitation, Including Education, in Rheumatoid Arthritis [BOOK]
- BOOKKnowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH): Oslo, Norway
- Rheumatoid arthritis (RA) is a chronic rheumatic, autoimmune disease that causes inflammation of the joints and connective tissues. International research estimates that RA affects between 0.5% and 1...
Rheumatoid arthritis (RA) is a chronic rheumatic, autoimmune disease that causes inflammation of the joints and connective tissues. International research estimates that RA affects between 0.5% and 1% of the adult population. Although there have recently been large advances in pharmacological treatments, many patients still have a need for follow-up and rehabilitation. To best organize future rehabilitation service for patients with RA, there is a need for evaluating and comparing the effect of a specialised, multidisciplinary treatment with a non-multidisciplinary approach. The aim of this systematic review is to compare the effect of a multidisciplinary, team-based rehabilitation program, including education, specialised for patients with RA with treatment/training without a multidisciplinary team, or with no special follow-up. We included eleven studies. Six studies were about patient education as sole intervention, and five studies were about multidisciplinary team-based rehabilitation. The main findings from these studies were:Patient education delivered as sole intervention, gives an improvement in symptoms, self-efficacy and knowledge about RA at one year follow-up in favour of the intervention group. For other outcomes, patient education showed small or no effects. Multidisciplinary team-based rehabilitation showed, for HAQ physical function, an improved score in favour of the control group at one year follow-up. At two years follow-up there still was a tendency towards better scores in the control group, but the difference was no longer significant. For other outcomes, multidisciplinary, team-based rehabilitation showed small or no effect. The documentation about the effect of multidisciplinary team-based rehabilitation is insufficient, and the conclusions are based on findings from small studies with unclear or high risk of bias. It is important to emphasize that no evidence of effect is not the same as evidence of no effect.
- Biologics for Early Rheumatoid Arhritis [BOOK]
- BOOKKnowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH): Oslo, Norway
- Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. The disease affects 0.5% to 1% of the adult population, and causes severe pain and disability. Direct...
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. The disease affects 0.5% to 1% of the adult population, and causes severe pain and disability. Direct costs related to treatment, and indirect costs associated with occupational disability, is significant. RA is treated with an interdisciplinary approach, in which disease modifying anti-rheumatic drugs (DMARDs) are an important component. The recommended first choice is one or more DMARDs. In the absence of treatment effect, a biologic drug may be added. The purpose of this systematic review was to investigate the efficacy and safety of biologics, compared with DMARDs in patients with early (≤ 3 years) RA. The commisioner is the Norwegian Rheumatism Association, whose members are concerned with good treatment at the early stages of RA. We included a total of 12 randomised controlled trials that examined the effect of biologics infliximab, adalimumab, etanercept and abatacept. The results suggest that, compared with DMARDs alone, biologicals in combination with DMARDs give:more patients in remission; neither more or less serious adverse events; more patients who achieved a 50% improvement; improved physical function; less joint destruction. Due to methodological weaknesses in the included studies most results contain some degree of uncertainty.
- [An atypical case of systemic juvenile idiopathic arthritis]. [Case Reports]
- RMRev Med Brux 2017; 38(6):511-514
- The systemic juvenile idiopathic arthritis (SJIA) is a rare, auto-inflammatory and chronic childhood disease. Arthritis of at least one joint is associated with a daily fever lasting more than two we...
The systemic juvenile idiopathic arthritis (SJIA) is a rare, auto-inflammatory and chronic childhood disease. Arthritis of at least one joint is associated with a daily fever lasting more than two weeks and with one of the following signs: lymphadenopathy, hepatomegaly, serositis, or skin rash. Systemic symptoms are often initially preponderant, in the absence of arthritis than can occur weeks or months later. The typical rash is maculopapular discrete, fleeting and dew. We present an unusual SJIA case, where the rash, like urticaria, presents itself as persistent, itchy hives. An arthritis of the elbow appeared only one month after the onset of the disease. This case illustrates the difficulty of diagnosis, which can only be made after the exclusion of more common (infectious) and severe (hematooncology) diseases.
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- Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. [Review]
- CDCochrane Database Syst Rev 2017 12 22; 12:CD011535
- CONCLUSIONS: Our review shows that compared to placebo, the biologics ixekizumab, secukinumab, brodalumab, guselkumab, certolizumab, and ustekinumab are the best choices for achieving PASI 90 in people with moderate to severe psoriasis on the basis of moderate- to high-certainty evidence. At class level, the biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha were significantly more effective than the small molecules and the conventional systemic agents, too. This NMA evidence is limited to induction therapy (outcomes were measured between 12 to 16 weeks after randomisation) and is not sufficiently relevant for a chronic disease. Moreover, low numbers of studies were found for some of the interventions, and the young age (mean age of 44 years) and high level of disease severity (PASI 20 at baseline) may not be typical of patients seen in daily clinical practice.Another major concern is that short-term trials provide scanty and sometimes poorly reported safety data and thus do not provide useful evidence to create a reliable risk profile of treatments. Indeed, we found no significant difference in the assessed interventions and placebo in terms of SAEs. Methotrexate appeared to have the best safety profile, but as the evidence was of very low to moderate quality, we cannot be sure of the ranking. In order to provide long-term information on the safety of the treatments included in this review, it will be necessary to evaluate non-randomised studies and postmarketing reports released from regulatory agencies as well.In terms of future research, randomised trials comparing directly active agents are necessary once high-quality evidence of benefit against placebo is established, including head-to-head trials amongst and between conventional systemic and small molecules, and between biological agents (anti-IL17 versus anti-IL23, anti-IL23 versus anti-IL12/23, anti-TNF alpha versus anti-IL12/23). Future trials should also undertake systematic subgroup analyses (e.g. assessing biological-naïve patients, baseline psoriasis severity, presence of psoriatic arthritis, etc.). Finally, outcome measure harmonisation is needed in psoriasis trials, and researchers should look at the medium- and long-term benefit and safety of the interventions and the comparative safety of different agents.