1,721,010 research outputs found
Recommendations for the use of biologic therapy in rheumatoid arthritis: update from the Italian Society for Rheumatology II. Safety
No full textSONOGRAPHIC PERSISTENCE OF SUBCLINICAL JOINT AND TENDON INFLAMMATION IN RHEUMATOID ARTHRITIS PATIENTS ACHIEVING SUSTAINED CLINICAL REMISSION ON SYNTHETIC OR BIOLOGIC DRUG THERAPY: PRELIMINARY DATA OF A CROSS-SECTIONAL STUDY
No full textRecommendations for the use of biologic therapy in rheumatoid arthritis: update from the Italian Society for Rheumatology II. Safety
No full textGiven the availability of novel biologic agents for the treatment of rheumatoid arthritis (RA), various national scientific societies have developed specific recommendations in order to assist rheumatologists in prescribing these drugs. The Italian Society for Rheumatology (Società Italiana di Reumatologia, SIR) decided to update its recommendations, and, to this end, a systematic literature review was performed and the evidence derived from it was discussed and summarized as expert opinions. Levels of evidence and strength of recommendations were reported. The recommendations reported refer to the safety of biologic agents and are intended to help prescribing rheumatologists to optimise the use of biologic agents in patients with RA seen in everyday practice; they are not to be considered as a regulatory rule
The 12-item Psoriatic Arthritis Impact of Disease Questionnaire: Construct Validity, Reliability, and Interpretability in a Clinical Setting
No full textIn 144 consecutive patients with PsA (81 men and 63 women, mean age of 51.4 ± 12.8 yrs, and 77 receiving biologic treatment), the PsAID-12 and other patient-reported outcomes (PRO) were collected, such as the Dermatology Life Quality Index. Each patient underwent articular and skin assessment.
Construct validity: Factor analysis revealed a 2-factor result defined as the PsAID Symptom Score and the PsAID Skin Score. In determining convergent validity, significant correlations were found between the PsAID-12 and the clinical Disease Activity index for Psoriatic Arthritis (cDAPSA; ρ = 0.867, p < 0.0001). Multivariable analysis showed that the PsAID-12 is determined by the articular disease activity (cDAPSA, p < 0.0001), severity of psoriasis (PsO; physician's global assessment, p < 0.0001), and the presence of a coexisting fibromyalgia (FM; p < 0.0001). Reliability: Cronbach's alpha coefficient was 0.93 for the total PsAID-12. Interpretability: Applying the cDAPSA categorization of disease activity states, the PsAID-12 cutoff values resulted in 1.4 between remission and low disease activity (LDA), 4.1 between LDA and moderate disease activity (MDA), and 6.7 between MDA and high disease activity. The PsAID-12 is an excellent PRO to evaluate the effect of PsA. It should be carefully handled in patients with coexisting FM
Serious infections during anti-TNFalpha treatment in rheumatoid arthritis patients
No full textThe objective was to estimate the incidence of serious infections in the patients treated with anti-TNFalpha agents for rheumatoid arthritis (RA) recorded in the Lombardy Rheumatology Network (LORHEN) registry. The study inclusion criteria were met by 1064 of the 1114 patients with long-standing RA, 519 treated with infliximab, 303 with adalimumab, and 242 with etanercept; their mean age was 55.8 years and the mean duration of RA 9.4 years. Seventy-three patients (6.9%) experienced a total of 74 serious infections, an incidence rate for all treatment courses of 35.9 per 1000 patient-years (95% confidence interval [95% CI] 27.66-44.13). Most were lower respiratory tract (34.2%) or skin and soft tissue infections (20.5%). Of the 1064 patients, the 790 treated with anti-TNFalpha after March 2002 underwent screening tests for LTBI; five patients developed active tuberculosis. Three patients died of septic shock. The type of anti-TNFalpha agent did not seem to affect the incidence or site of the infections. Both univariate and multivariate analyses identified age at the start of anti-TNFalpha treatment (p=0.008), baseline erythrocyte sedimentation rate ([ESR] p=0.014), and the concomitant use of corticosteroids (p=0.029) as significant predictors of infections. There was no statistically significant difference in risk between the anti-TNFalpha agent
Tumour necrosis factor antagonist therapy and cancer development: analysis of the LORHEN registry
No full textTreatment of rheumatoid arthritis with anti-TNF-alpha agents: A reappraisal
Full text linkIt has been found that tumour necrosis factor(TNF)-alpha plays a pivotal role in the pathogenesis of rheumatoid arthritis (RA), and the development of drugs targeting this molecule has extended the therapeutical approaches to RA patients. A number of observational studies of large patient series have also been published over the last few years, many of which have been based on national registries designed to monitor the efficacy and safety of anti-TNF agents, and allow healthcare institutions to control expenditure. Registry data can also help in identifying clinical and laboratory findings capable of predicting response. It has been suggested that the percentage of responding patients is lower in everyday clinical practice than that observed in RCTs, possibly because of patient selection, the use of a washout period before inclusion (which may artificially increase disease activity), and differences in doses, co-morbidities and adherence to therapy. A number of safety concerns have been raised since the introduction of anti-TNF agents, and they are now contraindicated in patients with advanced heart failure; however, the most widely debated current issues regard infections and neoplastic diseases. Moreover, the marketing of new and expensive biological agents has made strictly necessary to create systems capable of monitoring their safety and effectiveness in everyday practice, including the use of longitudinal observational studies. As the first published registry of anti-TNFalpha-treated patients in Italy, Lombardy Rheumatology Network (LORHEN) is already making its contribution in this directio
Patient preferences in the choice of anti-TNF therapies in rheumatoid arthritis. Results from a questionnaire survey (RIVIERA study).
No full textObjective. To identify the determinants of anti-TNF-naive patients’ preferences for the route of
administration of anti-TNF agents.
Methods. The study was carried out in 50 Italian rheumatology centres (802 patients). All patients
completed a 31-item questionnaire addressing their perceptions of current treatment and the preferences
for treatment with anti-TNF agents. Statistical methods included analysis of variance (ANOVA), t-test and
chi-square test.
Results. The response rate to the questionnaire was 97.6%. At the time of the survey, 310 (39.9%)
patients were dissatisfied with current treatments, owing to inefficacy, side effects and inconvenience
of administration. The i.v. and s.c. routes of administration were preferred by 50.2 and 49.8%, respectively.
No significant difference was found in patients by gender, age, RA duration or number of drugs
used. Reasons for the choice of i.v. administration were the safety of treatment at the hospital and the
reassuring effect of physician presence. The s.c. administration was chosen for the convenience of
treatment and in particular for home treatment. Patients dissatisfied with current therapy due to side
effects preferred s.c. administration (P1⁄40.029), whereas patients choosing the i.v. route had slightly
higher scores on ‘today pain’ (P1⁄40.047) and ‘articular pain’ (P1⁄40.023) of the Rheumatoid Arthritis
Disease Activity Index (RADAI).
Conclusions. Both i.v. and s.c. treatments were well accepted by patients. However, treatment choice
has to be discussed with patients, as individual preference seems to be determined by personal attitudes
towards safety and convenience, by past experience and by the perception of current disease status
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