1,721,082 research outputs found
Acute psycosis in systemic lupus erythematosus
No full textPsychiatric manifestations are common in systemic lupus erythematosus (SLE) and often represent a challenging diagnostic and therapeutic problem, mainly because the uncertainties of the pathogenic mechanisms. We report a case of acute psychosis occurring in a female with SLE due to the stress of having a severe disease, rather than to SLE per se
Successful treatment with etanercept of a patient with psoriatic arthritis after adalimumab-related hepatotoxicity
No full textInhibitors of Tumor Necrosis Factor (TNF) alpha (infliximab, etanercept, adalimumab) are nowadays widely used for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), not responding to conventional therapies. Anti-TNF alpha drugs have demonstrated great efficacy in slowing the disease, however, to date, concern still remains regarding acute and long-term toxicity related to TNF block. Increase in liver tests may be observed during treatment with anti-TNF agents, more often related to concomitant drugs (i.e. NSAIDS, methotrexate) or to reactivation of chronic HBV or HCV infections. However, liver damage directly induced by the drug has been described in patients treated with infliximab or adalimumab. To our knowledge, no cases of liver injury closely related to etanercept have been reported so far. We report the case of a patient with PsA who presented liver dysfunction during adalimumab, subsequently successfully treated with etanercept. Copyrigh
Le immunoglobuline nella terapia delle malattie reumatiche : descrizione di un caso di vasculite cutanea e revisione della letteratura
No full textIntravenous immunoglobulins (IVIG) have become an important therapeutic tool not only for patients with idiopathic and acquired immunodeficiencies, but also in a number of immunorheumatic conditions. The mechanisms by which IVIG exert their immunoregulatory effects are not completely defined and probably differ in the various diseases. Although generally well tolerated, since severe side-effects can occur, patients at risk (IgA deficient patients, older patients, patients with kidney or heart disease) must be identified to minimize adverse events. At present, ANCA-associated vasculitis, dermatomyositis and probably fibrosing conditions may represent the rheumatic diseases for which IVIG efficacy seems to be well documented. Controlled trials are however needed to provide guidelines for IVIG use in rheumatic diseases
Update on anti-TNF-alpha treatment in rheumatic diseases
No full textA review. The development of inhibitors of Tumor Necrosis Factor (TNF) a, a pro-inflammatory cytokine playing a pivotal role in chronic inflammatory diseases, represents a milestone in the therapy of several rheumatic diseases. Currently, three TNFa-blocking drugs are available for clin. use in rheumatic diseases: infliximab, etanercept and adalimumab. These drugs rapidly reduce disease activity and probably change the poor outcome of several chronic rheumatic diseases, by preventing the development of bone erosions, joint deformity and disability. Although these drugs have proved to be effective and well tolerated in the short period, some concerns exist about long-term safety and efficacy. In fact, the long-term use of inhibitors of TNFa, a pivotal cytokine in host defense, might result in the development of infections and neoplasms, therefore the long-term safety has to be defined. The most frightening infection to date is tuberculosis, and guidelines for the screening of patient candidates to biol. treatment has significantly reduced the risk. Parasitic and viral infections do not contraindicate biol. therapy. Lymphoma has been reported in assocn. with TNFa antagonists, but whether or not there is a causal relationship is still debated. The use of biol. agents in other rheumatic inflammatory conditions is rapidly increasing, but their cost poses a considerable financial burden on healthcare systems and a careful economic evaluation is needed
Risk factors of atherosclerosis in patients with spondyloarthropathies : comment on the article by Gonzalez-Juanatey et al.
No full textScleroderma heart disease
No full textHeart disease is a frequent and often severe feature of systemic sclerosis (scleroderma). Cardiomyopathy, with ventricular diastolic dysfunction and arrhythmias, is the most important form, since it is associated with a very poor prognosis. The current challenge is to define its pattern and identify individuals at risk, but evaluation in vivo may be hard to perform. The aim of this review is to provide an update on the clinical aspects of scleroderma heart disease and the early pivotal role that coronary microcirculation dysfunction plays in its development. A discussion of the diagnostic tools now available for this frequently asymptomatic condition will be provided. Treatment options will be reviewed, even though no cure for systemic sclerosis exists, and the current therapy of diastolic dysfunction remains unsatisfactory
- …
