1,721,489 research outputs found
Mixed connective tissue diseases: new aspects of clinical picture, prognosis and pathogenesis.
No full textIn this review the most recent observations on meixed connective tissue diseases are summarize
Assessing remission in systemic lupus erythematosus
No full textThe past few decades have witnessed development and validation of indices to assess activity, damage, and quality of life (QoL) in patients with systemic lupus erythematosus (SLE). These indices are widely used in clinical research and randomised controlled clinical trials, but not in usual clinical care. Definitions of flares and response to therapy have been proposed on the basis of indices. However, criteria for disease remission have not been clearly established for these indices, except for the SLE Disease Activity Index (SLEDAI). Defining remission in SLE in an objective manner depends on reaching agreement on the relative importance of systemic activity, damage, QoL, and laboratory tests, as well as activity and damage of specific organs
Health information technologies in systemic lupus erythematosus: focus on patient assessment
No full textDisease-specific quality indicators, guidelines and outcomes measures in systemic lupus erythematosus (SLE)
No full textThe assessment of quality of care is becoming increasingly important, but as yet no standard set of measures to assess quality has been developed. The ACR Quality Measures Committee has selected the following areas of study to develop quality indicators: diagnostic/classification criteria, outcome measures/response criteria, treatment guidelines/management recommendations, definition of quality indicators, and definition of data collection systems. The aim of the present review is to evaluate existing guidelines and outcome measures concerning disease/activity monitoring, autoantibody and laboratory assessment, outcomes, and therapy in systemic lupus erythematosus (SLE) that could be used to define disease-specific quality indicators. Much data is available in the literature that could serve to define a starter set of quality indicators for SLE. Monitoring issues are discussed in the ACR and EULAR recommendations. As far as therapy is concerned, the ACR has provided indicators for rheumatoid arthritis that could also be applied to SLE, as well as indications for anti-malarial monitoring. The outcomes measures most frequently used in SLE are damage and death, but organ-specific definitions of outcome and response are being evaluated. The development of quality measures for SLE is just beginning; existing information could serve to construct a starter set of indicators such as the one proposed here. Certainly much progress will be made in the near future. A practical, user-friendly tool for physicians that will help them deliver high quality care to populations is also needed
New drugs in systemic lupus erythematosus: when to start and when to stop
No full textSurvival of patients with systemic lupus erythematosus (SLE) has greatly improved compared to earlier decades. However, this improvement appears to have reached a plateau. In addition, damage accrual appears to have an important impact on patient prognosis. In this scenario a number of new drugs targeting different pathways of the immune response are being developed, and some are already available in clinical practice. In clinical practice and in clinical trials, the indications for treating SLE patients with new drugs are active or refractory disease despite standard-of-care treatment. While RCTs are able to document the capacity of new drugs to control the disease in selected patients, many important questions arise from clinical practice and at present are largely unanswered. When should we start a new drug? Should this drug be introduced early, as are anti-TNF drugs in rheumatoid arthritis? Perhaps some drugs should be initiated only after a patient's incomplete response? How many traditional drugs should be used and for how long, before considering a new therapy? Should we stop an effective drug and if yes, when and how? Additional studies and data derived from registries and observational studies will give valuable evidence to answer these questions. In this article, we review indications for the use of new drugs in SLE, and examine existing data on patient outcome after withdrawal, focusing our attention on rituximab and belimumab
Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria.
No full textPregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Practical messages from the EULAR guidelines.
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LJP-394 (abetimus sodium) in the treatment of systemic lupus erythematosus
No full textRenal disease is one of the most severe aspects of systemic lupus erythematosus (SLE), potentially leading to irreversible kidney failure. The standard of care for severe lupus nephritis involves the use of high-dose corticosteroids, cyclophosphamide and other immunosuppressive drugs. Although these drugs are effective in controlling disease activity in the majority of patients, up to 25% of patients treated with cyclophosphamide-based protocols develop renal insufficiency and end-stage renal disease, and treatment discontinuation is associated with the occurrence of flares. Furthermore, these therapies are associated with a high incidence of short- and long-term side effects. LJP-394 (abetimus sodium) is an investigational agent specifically designed to decrease anti-dsDNA antibody levels, and it is under development for the prevention of nephritic flares in patients with SLE since the early 1990s. The drug has been evaluated in 13 clinical trials that evaluated > 800 patients with SLE, over a 10-year time span. It is likely that LJP-394 might have a role in the prevention of renal flares in SLE patients, and if the initial data is confirmed in an ongoing trial, this drug could represent either a substitute for immunosuppressive drugs or could allow a reduction of their dose, thereby reducing the risks of short- and long-term side effects. This paper reviews the principal aspects of chemistry, pharmacokinetics, efficacy and safety of LJP-394, and analyses studies on animal models and clinical studies conducted in the last few years
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