1,721,456 research outputs found
Management of patients with inflammatory rheumatic diseases after treatment failure with a first tumour necrosis factor inhibitor. a narrative review
No full textThe emergence of biologics with different modes of action (MoAs) and therapeutic targets has changed treatment patterns in patients with inflammatory rheumatic diseases. While tumour necrosis factor inhibitors (TNFis) are often utilized as the first biologic disease-modifying antirheumatic drug, some patients may not respond adequately (primary failure), fail to sustain response over time (secondary failure), or experience intolerable adverse events. Whether these patients would benefit more from cycling to a different TNFi or switching to a biologic with a different MoA is still unclear. We discuss here treatment outcomes of TNFi cycling versus MoA switching after treatment failure with a first TNFi in patients with inflammatory rheumatic diseases, focusing specifically on rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis. Treatment guidelines for these patients are ambiguous and, at times, contradictory in their recommendations. However, this is due to a lack of high-quality head-to-head data to definitively support cycling between TNFis after failure to a first-line TNFi over switching to a different MoA
Vaccination and Rheumatic Diseases: Is There Still a Dilemma?
No full textThe development of rheumatic diseases after immunization has been reported in the medical literature but a causal relationship has not been established. Infections remain an important cause of morbidity and mortality in patients with rheumatic diseases who may be immunodepressed for immunological dysfunctions or immunosuppressed due to the pharmacologic therapy. Although vaccines against infectious diseases are considered the standard way in preventive medicine, it is still a controversial issue among rheumatologists whether or not patients with rheumatic disorders should undergo vaccination. In recent decades increased numbers of studies on influenza and pneumococcal vaccines administered to patients with systemic lupus erythematosus have proven their safety. These vaccinations, generally immunogenic (i.e. able to induce a protective level of specific antibodies), may not induce an adequate response in patients receiving immunosuppressive therapy. The safety and the immunogenity of Tetanus toxoid, and HBV vaccinations in SLE patients are not completely defined so far. Considering the few available studies, influenza, pneumococcal, and HBV vaccines seem to be safe and immunogenic in patients with rheumatoid arthritis. The effect of TNF blocking therapies on human immune responses to vaccination is discussed. We also review existing knowledge on vaccination in patients with Sjogren’s syndrome and in children with rheumatic disorders, discussing risks and benefits
Efficacia e sicurezza delle vaccinazioni nei pazienti reumatici in terapia immunosoppressiva.
No full text
- …
