934 research outputs found
Treatment of non-systemic juvenile idiopathic arthritis
No full text: In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. In addition, a more rational therapeutic approach has been fostered by the promulgation of therapeutic recommendations and guidelines. A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA. There is currently increasing interest in establishing the optimal time and modality for discontinuation of treatment in children with JIA who achieve sustained clinical remission. The aim of this Review is to summarize the current evidence and discuss the therapeutic approaches to the management of non-systemic phenotypes of JIA, including oligoarthritis, polyarthritis, enthesitis-related arthritis and psoriatic arthritis
NMR‐based clinical metabolomics revealed distinctive serum metabolic profiles in patients with spondyloarthritis
No full textSpondyloarthritis (SpA) is an umbrella term for autoimmune rheumatic diseases that can affect the back, pelvis, neck and some larger joints, as well as internal organs, like the intestines and eyes. The most common of these diseases is ankylosing spondylitis (ASp) which predominantly affects the spine and sacroiliac joints causing characteristic inflammatory back pain (IBP) and severe spine stiffness. In addition, AsP may involve peripheral joints causing asymmetrical peripheral oligo-arthritis often associated with extra-articular symptoms such as acute anterior uveitis (iritis), psoriasis, enthesitis, dactylitis and chronic inflammatory bowel disease (IBD). These clinical features adversely affect the quality of life in ASp patients owing to restricted spinal/hip mobility, pain, fatigue, disease flares and depression. The clinical management of SpA is marred by delay in diagnosis, and paucity of biomarkers of disease activity. The present study aimed to explore the potential of serum metabolic profiling of patients with SpA to identify biomarker for the diagnosis and assessment of disease activity. The serum metabolic profiles of 81 patients with SpA were compared with that of 86 healthy controls (HC) using nuclear magnetic resonance (NMR) based metabolomics approach. Seventeen patients were followed-up after 3 months of standard treatment and paired sera were analyzed for effects of therapy. Comparisons were done using the multivariate partial least-squares discriminant analysis (PLS-DA) and the discriminatory metabolic entities were identified based on variable importance in projection (VIP) statistics and further evaluated for statistical significance (p-value<0.05). We found that the serum metabolic profiles differed significantly in SpA as compared with healthy controls. Compared to HC, the SpA patients were characterized by increased serum levels of amino-acids, acetate, choline, N-acetyl glycoproteins, N-alpha-acetyllysine, creatine/creatinine etc. and decreased levels of low/very-low density lipoproteins, and poly-unsaturated lipids. PLS-DA analysis also revealed metabolic differences between axial and peripheral SpA patients. Further metabolite profiles were found to differ with disease activity and treatment in responding patients. The results presented in this study demonstrate the potential of serum metabolic profiling of SpA as a useful tool for diagnosis, prediction of peripheral disease, assessment of disease activity, and treatment response.The decreased circulatory levels of glutamine were found to be associated with SpA disease activity
sj-pdf-1-lup-10.1177_0961203320918011 - Supplemental material for Nuclear magnetic resonance–based targeted profiling of urinary acetate and citrate following cyclophosphamide therapy in patients with lupus nephritis
No full textSupplemental material, sj-pdf-1-lup-10.1177_0961203320918011 for Nuclear magnetic resonance–based targeted profiling of urinary acetate and citrate following cyclophosphamide therapy in patients with lupus nephritis by Sujata Ganguly, Umesh Kumar, Nikhil Gupta, Anupam Guleria, Sanjukta Majumdar, Sanat Phatak, Smriti Chaurasia, Sandeep Kumar, Amita Aggarwal, Dinesh Kumar and Ramnath Misra in Lupus</p
sj-pdf-1-lup-10.1177_09612033221112066 – Supplemental Material for Differentiating flare and infection in febrile lupus patients: Derivation and validation of a calculator for resource constrained settings
No full textSupplemental Material, sj-pdf-1-lup-10.1177_09612033221112066 for Differentiating flare and infection in febrile lupus patients: Derivation and validation of a calculator for resource constrained settings by Pankti Mehta, Komal Singh, Swathi Anand, Akshay Parikh, Abinash Patnaik, Rudrarpan Chatterjee, Able Lawrence, Saumya R.anjan Tripathy, Chengappa Kavadichanda, Liza Rajasekhar, Negi VS, Bidyut Das and Aggarwal Amita in Lupus</p
sj-xlsx-2-lup-10.1177_09612033221112066 – Supplemental Material for Differentiating flare and infection in febrile lupus patients: Derivation and validation of a calculator for resource constrained settings
No full textSupplemental Material, sj-xlsx-2-lup-10.1177_09612033221112066 for Differentiating flare and infection in febrile lupus patients: Derivation and validation of a calculator for resource constrained settings by Pankti Mehta, Komal Singh, Swathi Anand, Akshay Parikh, Abinash Patnaik, Rudrarpan Chatterjee, Able Lawrence, Saumya R.anjan Tripathy, Chengappa Kavadichanda, Liza Rajasekhar, Negi VS, Bidyut Das and Aggarwal Amita in Lupus</p
How do variations in Urban Heat Islands in space and time influence household water use? The case of Phoenix, Arizona
No full textabstract: This paper explores how urbanization, through its role in the evolution of Urban Heat Island (UHI), affects residential water consumption. Using longitudinal data and drawing on a mesoscale atmospheric model, we examine how variations in surface temperature at the census tract level have affected water use in single family residences in Phoenix, Arizona. Results show that each Fahrenheit rise in nighttime temperature increases water consumption by 1.4%. This temperature effect is found to vary significantly with lot size and pool size. The study provides insights into the links between urban form and water use, through the dynamics of UHI.Corresponding Author:
Rimjhim M. Aggarwal
Arizona State University
[email protected]
The Hindi version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)
No full textThe Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Hindi language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach’s alpha, interscale correlations, test–retest reliability, and construct validity (convergent and discriminant validity). A total of 275 JIA patients (28.4% systemic, 10.9% oligoarticular, 13.8% RF negative polyarthritis, 46.9% other categories) and 98 healthy children were enrolled in three centres. The JAMAR components discriminated well healthy subjects from JIA patients. Notably, there is no significant difference between the healthy subjects and their affected peers in the school-related problems variable. All JAMAR components revealed good psychometric performances. In conclusion, the Hindi version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research
Work productivity loss among rheumatoid arthritis patients in India: a qualitative study
No full textObjectiveTo explore to what extent rheumatoid arthritis (RA) impacts on work productivity loss in patients living with RA in India.MethodsFace to face semi structured interviews took place in 13 male and 7 female patients attending outpatient clinics at Sanjay Gandhi Postgraduate Institute of Medical Sciences, India living with RA. Patients currently working were recruited. Data were audio recorded, transcribed by an independent translation company and were analysed using the framework method of thematic analysis.ResultsFour themes that explained patients’ experiences of coping with work whilst having RA were identified. These included [1] “Balancing act of work and RA” where participants expressed their day to day struggle living with RA and coping at work. [2] “Work place adaptation after RA”: here participants shared insights into communicating with employers and their efforts to adapt at work place. [3] “Support from others and information to manage RA and work”: here participants had considered seeking support from different sources that would help them cope at work and understand RA. [4] “Wanting a better support mechanism”: here participants made recommendations that could help them cope at work.ConclusionThis is the first study to have explored the impact of RA on patients’ work productivity in India. Patients may have different support needs compared to previous studies in other countries. Patients seem to be employing additional coping strategies not addressed by current interventions or country systems, which may not be sufficient to support patients in staying employed. Patients made future recommendations
Delay in seeking medical help in patients with rheumatoid arthritis in India: a qualitative study
No full textBackgroundRheumatoid arthritis (RA) is an autoimmune disease with varied articular and extra‐articular manifestations. In developing countries such as India patients with RA often delay seeking medical advice which may impact prognosis and disease burden.AimTo explore perceptions and experiences of patients living in India in seeking medical help for their RA symptoms.MethodsClinician‐diagnosed RA participants from different socioeconomic backgrounds were interviewed using a semi‐structured topic guide. Participants were purposively selected and interviewed following an iterative approach. All interviews were recorded and transcribed by an independent company and analyzed using a thematic framework. Findings were reported in accordance with consolidated criteria for reporting qualitative research guidelines.ResultsTwenty participants (13 male, 7 female) with median age 40 years (35.7‐46.5) were recruited. Three overarching themes demonstrating participants’ experiences and reasons for delay in seeking medical help were identified. (1) “Symptoms perspectives and delay in participants’ journey” narrated participants’ experiences of having RA symptoms, how these were perceived, rationalized and led to delay. (2) “Participants’ experience of the healthcare system” illustrated delay in referral, reaching diagnosis and treatment initiation highlighting their experiences with the health system. (3) “Recommendations for improving care” where participants made recommendations for reducing the delay at local and national levels.ConclusionThis is the first qualitative study which explored perceptions and experiences of RA patients in India resulting in delay. Improved provision of rheumatology care, effective referral system and greater involvement of government at local and national levels are needed to improve the delay in seeking medical help for Indian patients
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