1,721,446 research outputs found
Biological therapy of rheumatoid arthritis: Use of new drugs in the treatment of arthritic patients. Hope and possible risks
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The management of neuropsychiatric lupus in the 21st century: Still so many unmet needs?
No full textNeuropsychiatric (NP) events occur in the majority of patients with SLE and predominantly affect the CNS in addition to the peripheral and autonomic systems. Approximately 30% of all NP events are attributable to SLE (NPSLE) and present most frequently around the time of SLE onset. NPSLE is associated with increased morbidity and mortality and the proposed pathogenesis includes both ischaemic and neuroinflammatory mechanisms. Following diagnosis and causal attribution, the treatment of NPSLE is tailored to the type of NP event, the predominant putative pathogenic pathway and the activity and severity of the clinical event. There is a dearth of controlled clinical trials to guide management, but therapeutic options include symptomatic, antithrombotic and immunosuppressive agents that are supported by observational cohort studies. Our objective was to review what is currently known about NPSLE and to identify deficiencies in diagnostic biomarkers, novel therapies and clinical trials for this manifestation of SLE
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Adult-onset still’s disease: Novel biomarkers of specific subsets, disease activity, and relapsing forms
No full textAdult-onset Still’s disease (AOSD) is a systemic inflammatory disease of unknown etiology. Recent studies have demonstrated that the hallmark of AOSD is a cytokine storm, which is characterized by the excessive production of interleukin (IL)-1, IL-6, IL-18, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ), suggesting how pro-inflammatory cytokines play an important role in the pathogenesis of this disease. Actually, a certain proportion of patients (around 17–32%) with severe clinical symptoms achieves only partial remission or is resistant to both first-line corticosteroids and second-line DMARDs. These patients are defined as refractory AOSD patients, requiring higher dosage glucocorticoids, longer treatment duration, or the simultaneous introduction of immunosuppressive drugs, further leading to AOSD relapses. In this narrative review, we will analyze the latest literature data to unravel potential pathogenetic factors associated with specific patterns of AOSD disease or relapses in order to identify biomarkers that may guide clinical decisions, eventually leading to new therapeutic options
HIGH INCIDENCE OF SERIOUS ADVERSE EVENTS AMONG ELDERLY RHEUMATOID PATIENTS RECEIVING MONOCLONAL ANTIBODIES ANTI-TNFALPHA
No full textObjectives: Approximately 10-33% of patients with rheumatoid arthritis (RA) are diagnosed after the age of 60. Treatment with anti-TNFalpha drugs in elderly might enhance the incidence of serious adverse events, particularly infections and cardiovascular disease. We retrospectively evaluated the safety of anti-TNFalpha therapy in elderly (age ≥ 65 yrs) and younger adult subjects (age < 65 yrs) with rheumatoid arthritis followed by a tertiary Rheumatology institution.
Methods: Data regarding the safety of anti-TNFalpha therapy (infliximab, etanercept, adalimumab) in 73 elderly rheumatoid arthritis patients were retrospectively evaluated and compared with those of 236 younger patients. All patients received anti-TNFalpha at the recommended dose. Safety and survival of anti-TNFalpha drugs were assessed at regularly scheduled visit. Differences between groups were analyzed by means of a chi-square test. P < 0.05 was taken as statistically significant.
Results: 1) Infliximab group. 19 pts (12 F/7 M, mean age 69,1±3,4, mean duration of disease 125,1±63,4 months) were ≥ 65 and 82 (64 F/18 M, mean age 50,1±9, mean duration of disease 139,4±81,3 months) were < 65 years of age. All patients received infliximab infusion at starting dose of 3 mg/kg along with a concomitant DMARD (methotrexate or leflunomide) and low-dose prednisone (5 mg/day). The infliximab dosage could be increased to 5 mg/kg or treatment interval shortened in case of inefficay. During the follow-up (median = 27,5 months), serious adverse events occurred in 68.4% (13/19) of pts ≥ 65 as opposed to 39% (32/82) of younger pts (p = 0,03). The rate of infliximab withdrawal due to serious adverse event was higher among elderly pts (57.8% vs 29.2%, p = 0,03). Among pts ≥ 65 yrs, cardiovascular disease (35.7%) resulted the main adverse events followed by infusion reaction (28.5%) and infections (21.4%).
2) Etanercept group. 29 pts (23 F/6 M, mean age 69,6±4,1, mean duration of disease 148,1±84,6 months) were ≥ 65 and 94 (78 F/16 M, mean age 48,1±11,8, mean duration of disease 105±81,8 months) were < 65 years of age. Concomitant DMARD therapy was similar between elderly and younger subjects (68.9% and 73.4%, p = ns). During the follow-up (median = 20,5 months), the rate of withdrawal due to serious adverse events did not differ between elderly and younger pts (10.3% vs 9.5%, p = ns). Furthermore, the rate of serious infection tended to be higher in younger than elderly pts (61.9% vs 20%, p = ns).
3) Adalimumab group. 25 pts (21 F/4 M, mean age 69,1±3,3, mean duration of disease 122,8±133 months) were ≥ 65 and 60 (51 F/9 M, mean age 48,1±11,1, mean duration of disease 105±84,9 months) were < 65 years of age. 88% in elderly group took a concomitant DMARD as opposed to 71.6% in younger subject (p = ns). During the follow-up (median = 12,1 months), more pts ≥ 65 yrs developed serious adverse than younger (48% vs 25%, p = 0,01). The rate of withdrawal due to serious adverse events was higher among elderly pts (36% vs 15%, p = 0,06). Infections (40%) and solid tumors (20%) were the main types of adverse events in elderly pts.
Conclusion: Among TNFalpha antagonists, only etanercept has a similar safety profile both in younger and elderly people with rheumatoid arthritis. On the basis of our observations monoclonal antibodies should be given with more caution in this population
Do Pomegranate Hydrolyzable Tannins and Their Derived Metabolites Provide Relief in Osteoarthritis? Findings from a Scoping Review
Full text linkOsteoarthritis (OA) is the most common form of arthritis affecting both the elderly and the middle-aged population. Although various therapeutics have been developed to arrest the structural deterioration of cartilage, the current treatments are limited to delay the progress of OA clinically. Therefore, it is pivotal to study new therapeutic agents for chondroprotection and the prevention of cartilage degeneration. Hydrolyzable tannin (HT)-containing foods aroused considerable interest in recent years for their relevant anti-inflammatory effects. The focus of this scoping review is to provide an overview of the evidence of the therapeutic potential of HTs and their metabolites in preventing or alleviating the course of OA. A broad search of PubMed and Scopus databases on this topic resulted in 156 articles. After the exclusion of reviews and not relevant records, 31 articles were retrieved. Although only some papers did not consider the biotransformation of HTs, most recent studies also have investigated the effect of HT metabolites. Further larger clinical trials, with an in-deep analysis of HT metabolization, are still needed to unravel the potential benefits of these compounds in OA, paving the way towards the development of a dietary strategy for the improvement of pro-inflammatory cytokine-induced chondrocyte dysfunctions and injuries
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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