1,720,969 research outputs found
Mavrilimumab: an evidence based review of its potential in the treatment of rheumatoid arthritis.
No full textRheumatoid arthritis (RA) management has greatly improved with the development of biologic disease modifying antirheumatic drugs, but a proportion of patients do not improve despite the biologic drugs currently available. We need new biologic agents with novel mechanisms of action for the treatment of refractory patients. Recent evidence has shown that granulocyte-macrophage colony-stimulating factor (GM-CSF) is involved in the pathogenesis of RA. GM-CSF can exacerbate RA and elevated levels of this cytokine have been observed in synovial fluid from RA patients. Antagonism of GM-CSF can strikingly reduce established disease in mouse models of arthritis. Mavrilimumab, a human monoclonal antibody to GM-CSF receptor α, is a competitive antagonist of GM-CSF signaling. Phase I and II studies have shown good clinical response with a good safety profile in patients with mild to moderate RA, suggesting encouraging effects of mavrilimumab for the treatment of RA. This paper reviews the preclinical and clinical data evaluating the safety, tolerability, and efficacy of mavrilimumab in the treatment of RA. © 2014 Di Franco et al
Reactive arthritis: current treatment challenges and future perspectives
Full text linkReactive arthritis is a group of inflammatory joint diseases triggered by a previous infection, often associated with extra-articular features. The clinical course and consequently the treatment are complicated by the variability of the disease evolution in the single patient. In some patients, the disease assumes a chronic and destructing course, requiring the introduction of therapy. However, the role of antibiotic treatment of the triggering infection as well as the role of the currently available disease-modifying anti-rheumatic drugs is still unclear. The better understanding of the infectious agents-host interaction in reactive arthritis pathogenesis opens the possibility of new therapeutic strategies for the disease management. The purpose of this review is to illustrate the recent discoveries about the induction of joint inflammation by the infectious agents, the prognostic factors to better identify patients at risk of chronicity, the current available therapeutic strategies and lastly, the future possibilities of therapeutic approaches to reactive arthritis
Reactive arthritis: current treatment challenges and future perspectives
No full textReactive arthritis is a group of inflammatory joint diseases triggered by a previous infection, often associated with extra-articular features. The clinical course and consequently the treatment are complicated by the variability of the disease evolution in the single patient. In some patients, the disease assumes a chronic and destructing course, requiring the introduction of therapy. However, the role of antibiotic treatment of the triggering infection as well as the role of the currently available disease-modifying anti-rheumatic drugs is still unclear. The better understanding of the infectious agents-host interaction in reactive arthritis pathogenesis opens the possibility of new therapeutic strategies for the disease management. The purpose of this review is to illustrate the recent discoveries about the induction of joint inflammation by the infectious agents, the prognostic factors to better identify patients at risk of chronicity, the current available therapeutic strategies and lastly, the future possibilities of therapeutic approaches to reactive arthritis
Mental health and well-being during the COVID-19 pandemic. stress vulnerability, resilience and mood disturbances in fibromyalgia and rheumatoid arthritis
No full textObjectives: The COVID-19 pandemic severely increased the stress levels in the population. The aim of present study was to investigate the impact of the lockdown measures on emotional well-being and disease activity in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) through a telemedicine approach. Methods: An on-line survey, including demographic characteristics, disease-activity and psychometric scales (Stress-related Vulnerability Scale, Resiliency scale), Zung Anxiety and Depression Self-assessment Scale), was anonymously administered to FM, RA and healthy controls (HC). Disease activities were compared to the pre-lockdown cohort referring to our centre. Results: Levels of anxiety and depression worthy of psychiatric attention were documented in 36.7% of FM, 14.6% of RA, 12.5% of HC and in 50% of FM, 17.1% of RA, 15% of HC, respectively. HC featured the highest stress scores, followed FM and then RA. RA showed higher resiliency than FM. Both anxiety and depression scores were significantly higher in FM than RA and HC. Disease severity was higher in RA patients and lower in FM patients when compared to the respective historical cohorts. Conclusions: Lockdown significantly affected emotional well-being and disease activity of patients suffering from rheumatic diseases. While HC showed a higher vulnerability to stress, RA patients showed a greater resilience compared to both HC and to FM patients, especially. Emotional disturbances are greater in patients with RDs and in particular with FM. The use of a telemedicine approach to screen for severe symptoms represents a useful addition to the overall management of rheumatic patients.Objectives: The COVID-19 pandemic severely increased the stress levels in the population. The aim of present study was to investigate the impact of the lockdown measures on emotional well-being and disease activity in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) through a telemedicine approach.
Methods: An on-line survey, including demographic characteristics, disease-activity and psychometric scales (Stress-related Vulnerability Scale, Resiliency scale), Zung Anxiety and Depression Self-assessment Scale), was anonymously administered to FM, RA and healthy controls (HC). Disease activities were compared to the pre-lockdown cohort referring to our centre.
Results: Levels of anxiety and depression worthy of psychiatric attention were documented in 36.7% of FM, 14.6% of RA, 12.5% of HC and in 50% of FM, 17.1% of RA, 15% of HC, respectively. HC featured the highest stress scores, followed FM and then RA. RA showed higher resiliency than FM. Both anxiety and depression scores were significantly higher in FM than RA and HC. Disease severity was higher in RA patients and lower in FM patients when compared to the respective historical cohorts.
Conclusions: Lockdown significantly affected emotional well-being and disease activity of patients suffering from rheumatic diseases. While HC showed a higher vulnerability to stress, RA patients showed a greater resilience compared to both HC and to FM patients, especially. Emotional disturbances are greater in patients with RDs and in particular with FM. The use of a telemedicine approach to screen for severe symptoms represents a useful addition to the overall management of rheumatic patients
Asymmetric Dimethyl Arginine as a Biomarker of Atherosclerosis in Rheumatoid Arthritis
Full text linkCardiovascular disease is the main cause of morbidity and mortality in rheumatoid arthritis (RA). Despite the advent on new drugs targeting the articular manifestations, the burden of cardiovascular disease is still an unmet need in the management of RA. The pathophysiology of accelerated atherosclerosis associated to RA is not yet fully understood, and reliable and specific markers of early cardiovascular involvement are still lacking. Asymmetric dimethylarginine is gaining attention for its implication in the pathogenesis of endothelial dysfunction and as biomarkers of subclinical atherosclerosis. Moreover, the metabolic pathway of methylarginines offers possible targets for therapeutic interventions to decrease the cardiovascular risk. The purpose of this review is to describe the main causes of increased methylarginine levels in RA, their implication in accelerated atherosclerosis, the possible role as biomarkers of cardiovascular risk, and finally the available data on current pharmacological treatment
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
Perceived disease activity in rheumatoid arthritis. when the physician's gender mattersis
No full textBackground: In rheumatoid arthritis (RA), females usually have a worse prognosis. To date, the influence of physician gender in the evaluation of RA activity is still largely unknown. Objectives: To investigate the discrepancy in RA disease activity assessment between male and female physicians and to compare patient and evaluator perception of disease activity and global health (GH) status. Methods: One female and one male rheumatologist evaluated 154 RA patients recording tender and swollen joint count, GH, evaluator global assessment (EGA), and patient global assessment (PGA) disease activity. A third rheumatologist calculated DAS28, CDAI, and SDAI. Difference was evaluated by Wilcoxon test. Physician-patient agreement was assessed by intraclass correlation coefficient. Results: GH, PGA, and DAS28 were higher when recorded by the female examiner. Male EGA was higher than female. Among male patients, PGA was higher when collected by the female examiner. The probability of being judged as having an active disease did not rely on physician gender. The agreement with the physician's evaluation of disease activity was high. PGA values were higher than EGA in both examiners. The physician-patient agreement was moderate for the male examiner and good for the female. The female physician had a higher agreement with both genders. Conclusions: Subjective measure of disease activity differs between female and male rheumatologists, contributing to a different evaluation of disease activity. Patients have a higher perception of disease activity compared to physicians. The stronger agreement between female physicians and patients may be related to a more emphatic setting established by the female physician
Lung Infections in Systemic Rheumatic Disease:Focus on Opportunistic Infections
No full textSystemic rheumatic diseases have significant morbidity and mortality, due in large part
to concurrent infections. The lung has been reported among the most frequent sites of infection in
patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by
common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a
peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related
immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic
agents have been associated to a wide spectrum of infections, complicating the management of
rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in
rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and
appropriate therapeutic strategies
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