135 research outputs found
Nonsteroidal therapy of sarcoidosis
No full textNone of the medications used in clinical practice to treat sarcoidosis have been approved by the regulatory authorities. Understanding how to use disease-modifying antisarcoid drugs, however, is essential for physicians treating patients with sarcoidosis. This review summarizes the recent studies of medications used for sarcoidosis with a focus on nonsteroidal therapies. Studies from 2006 to 2013 were considered for review to update clinicians on the most relevant literature published over the last few years.
Several recently published pieces of evidence have helped expand our ability to more appropriately sequence second-line and third-line therapies for sarcoidosis. For instance, methotrexate and azathioprine may be useful and well tolerated medications as second-line treatment. Mycophenolate mofetil might have a role in neurosarcoidosis. TNF-α blockers and other biologics seem to be well tolerated medications for the most severely affected patients.
Corticosteroids remain the first-line therapy for sarcoidosis as many patients never require treatment or only necessitate a short treatment duration. Second-line and third-line therapies described in this article should be used in patients with progressive or refractory disease or when life-threatening complications are evident at the time of presentation
Noise or silence in the operating room?
No full textMusic or no music is a question that has been addressed in many studies, which is why we read with great interest the article, “Effect of noise on auditory processing in the operating room,” by Way and colleagues in the May issue of this journal.1 The study suggested that surgeons demonstrated poorer auditory performance with music than in quiet or with operating room noise. Another recent study also suggested that music might be a potential distractor in operating rooms during urologic procedures.2 There are many studies that try to further elucidate the effects of music on patient factors on one hand (anxiety, stress, need for analgesic drugs, and sedation) and surgeons and surgical staff on the other hand (communication, task performance, speed, and accuracy), as reviewed recently by Moris and Linos.3 In addition, the type of music seems to be important. In a study by Siu and colleagues,4 music with high rhythmicity had beneficial effects on surgical performance in a simulated robotic model, suggesting that music might be of value during skill acquisition and training. In mechanically ventilated patients, patient-directed music reduced anxiety and sedation frequency as compared with noise-cancelling headphones or usual care.5 A caveat of this study was patient selection and lack of standardization of outcomes measures. Also, the findings of this study might not apply to patients who undergo elective surgery. As health care providers, we should be dedicated to keeping the surgical patient safe in the perioperative period and ensuring that care is provided in an optimal environment. Patient safety comes first; it is mandatory that monitors and alarms are audible and necessary measures can be taken in a timely manner. We would like to suggest that volume levels in the operating room should be monitored and balanced to account for the possible beneficial effects on patient satisfaction and surgical performance (which might be positively influenced by music) while not rendering communication between nurses and anesthesiologists difficult. Indeed, all potential distractors and disruptive behaviors pose a threat to patient safety. In the absence of controlled and well-designed studies on the effect of music in the operating room on operating room personnel vigilance and task performance, we cannot definitely answer the question (“music or no music in the operating room?”). Until that time, no general recommendations can be made, and music during intervention still is merely a matter of subjective preference. We acknowledge the fact that on one hand, music might have beneficial effects on patient satisfaction, use of sedative drugs, and surgical performance, while on the other hand, music could be a potential distractor, possibly impending communication. Future work should examine the effects of other nonpatient care activities like reading,6 the role of music in various settings and patient populations, and clear measurements of outcomes. In fact, music is an important aspect of cultural and social life and we as scientists should respect individual preferences of both patients and physicians
Bone Health Issues in Sarcoidosis
No full textSarcoidosis affects the bone directly in only a minority of patients. Nonetheless, bone health should be considered in the management of all patients with sarcoidosis. Deficiency in vitamin D, an important contributor to bone health, has been linked to autoimmune disease incidence. Studies have shown that patients with sarcoidosis frequently have low levels of vitamin D-25 but may have normal or increased levels of vitamin D-1,25. In addition, granuloma formation has been linked to a failure of the innate immune system, which could be related to a deficiency in vitamin D, although this relationship has not been fully characterized. Furthermore, many patients with sarcoidosis are treated with corticosteroids, which are known to induce osteoporosis. Therefore, bone health may be impacted in several ways in sarcoidosis--by direct involvement with granulomas, vitamin D deficiency, or corticosteroid therapy
Drug-Induced Granulomatous Interstitial Nephritis in a Patient With Ankylosing Spondylitis During Therapy With Adalimumab
No full textTumor necrosis factor alpha (TNF-alpha) inhibitors are used in the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn disease, ankylosing spondylitis, and juvenile idiopathic arthritis. Use of TNF inhibitors is associated with the induction of autoimmunity (systemic lupus erythematosus, vasculitis, psoriasis, and sarcoidosis/sarcoid-like granulomas). We report a case of interstitial granulomatous nephritis in a patient with ankylosing spondylitis after 18 months of treatment with adalimumab. Previously reported cases of sarcoid-like reactions secondary to the use of TNF-alpha inhibitors involved the liver, lung, lymph nodes, central nervous system, and skin. Granulomatous nephritis after adalimumab treatment has not been described. Close observation of patients undergoing treatment with TNF inhibitors for evolving signs and symptoms of autoimmunity is required. Organ involvement is unpredictable, which makes correct diagnosis and management extremely challenging. Am J Kidney Dis 56:e17-e21. (C) 2010 by the National Kidney Foundation, Inc
Reproducibility and rigor in rheumatology research
No full textThe pillars of scientific progress in rheumatology are experimentation and observation, followed by the publication of reliable and credible results. These data must then be independently verified, validated, and replicated. Peer and journal-specific technical and statistical reviews are paramount to improving rigor and reproducibility. In addition, research integrity, ethics, and responsible conduct training can help to reduce research misconduct and improve scientific evidence. As the number of published articles in rheumatology grows, the field has become critical for determining reproducibility. Prospective, longitudinal, randomized controlled clinical trials are the gold standard for evaluating clinical intervention efficacy and safety in this space. However, their applicability to larger, more representative patient populations with rheumatological disorders worldwide could be limited due to time, technical, and cost constraints involved with large-scale clinical trials. Accordingly, analysis of real-world, patient-centered clinical data retrieved from established healthcare inventories, such as electronic health records, medical billing reports, and disease registries, are increasingly used to report patient outcomes. Unfortunately, it is unknown whether this clinical research paradigm in rheumatology could be deployed in medically underserved regions
Increased Whole Blood Viscosity Is Associated with the Presence of Digital Ulcers in Systemic Sclerosis: Results from a Cross-Sectional Pilot Study
No full textObjective. To investigate the role of whole blood viscosity in digital ulcer (DU) development in patients with diffuse and limited Systemic sclerosis.Methods. A convenience sample of patients with Systemic sclerosis (SSc) was selected from the adult Rheumatology clinic at the University of Chicago. The study group consisted of patients with SSc (with ulcers present, a history of ulcers, and no ulcers); the control group consisted of matched healthy Rheumatology clinic staff. WBV was measured using a scanning capillary viscometer at different shear rates (1–1000 1/s).Results. Whole blood viscosity as measured by a scanning capillary viscometer was increased in patients with SSc compared to healthy controls (p<0.0001). Additionally, patients with present DU had significantly higher whole blood viscosity when compared to patients with a history of DU and patients with no history of DU (p<0.0001). These findings were most pronounced at lower shear rates between 1 and 10 1/s.Conclusion. Whole blood viscosity might be a contributing factor in DU development in patients with SSc. Further studies with larger patient cohorts are required to fully evaluate how increased WBV contributes to the development of DU and whether the currently available treatment options improve the microcirculation by influencing WBV.</jats:p
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