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Repeated infusions of low-dose infliximab plus methotrexate in psoriathic arthrtritis: immediate benefitis are not maintained after discontinuation of inlfiximab
No full textKnowledge-based decision support in healthcare via Near Field Communication
Full text linkThe benefits of automatic identification technologies in healthcare have been largely recognized. Nevertheless, unlocking their potential to support the most knowledge-intensive medical tasks requires to go beyond mere item identification. This paper presents an innovative Decision Support System (DSS), based on a semantic enhancement of Near Field Communication (NFC) standard. Annotated descriptions of medications and patient’s case history are stored in NFC transponders and used to help caregivers providing the right therapy. The proposed framework includes a lightweight reasoning engine to infer possible incompatibilities in treatment, suggesting substitute therapies. A working prototype is presented in a rheumatology case study and preliminary performance tests are reported. The approach is independent from back-end infrastructures. The proposed DSS framework is validated in a limited but realistic case study, and performance evaluation of the prototype supports its practical feasibility. Automated reasoning on knowledge fragments extracted via NFC enables effective decision support not only in hospital centers, but also in pervasive IoT-based healthcare contexts such as first aid, ambulance transport, rehabilitation facilities and home care
The treatment of recurrent uveitis with TNF-alpha inhibitors
No full textObjective. Uveitis is a severe manifestation of rheumatic diseases since it can lead to visual impairment and even blindness. Ocular involvement is frequently a clinical challenge because its occurrence often requires changes of the therapeutic strategy. There are growing evidence that tumor necrosis factor α (TNFα) inhibitors may be an effective treatment of refractory uveitis. Purpose of this study was to evaluate the efficacy and safety of TNFα blocking agents in patients with seronegative spondylo-arthropathies (SNSA) and Behcet disease (BD) associated relapsing uveitis. Methods. Five consecutive patients with chronic or relapsing uveitis were prospectively studied. Two patients with SNSA had recurrent anterior uveitis and three patients had BD associated uveitis (one anterior, two posterior uveitis). All of the patients were taking systemic and topical corticosteroids and three of them were also treated with DMARDS (methotrexate, cyclosporine, sulphasalazine) without clinical benefit. Four patients received infliximab, an anti- TNFα monoclonal antibody, at a dosage of 5 mg/kg body weight and one patient was treated with etanercept, a TNFα receptor p75-Fc fusion protein, at a dosage of 25 mg twice weekly. Results. Both infliximab and etanercept induced a marked improvement in uveitis and none relapse was observed throughout all the study. Systemic corticosteroids were progressively tapered and stopped in all patients. Also methotrexate and sulphasalazine were discontinued, while cyclosporine dose has been reduced by 30% until now. No side effects were observed. Conclusions. Therapy with TNFα blockers, infliximab and etanercept, was effective and safe in the treatment of rheumatic disease associated uveitis. A complete remission was achieved even in patients with severe steroid resistant uveitis. Further controlled studies on larger number of patients are needed to better define the different forms of ocular involvement that can benefit from the therapy with TNFα inhibitors
Use of etanercept in the treatment of dermatomyositis: a case series
No full textObjective. To evaluate the efficacy of etanercept, a recombinant human soluble fusion protein of tumor
necrosis factor-a (TNF-a) type II receptor and IgG1, in patients with adult dermatomyositis (DM).
Methods. Five patients with active DM were studied. All patients reported muscle weakness and had
elevated muscle enzymes creatine kinase and lactate dehydrogenase. Because of lack of response to
steroid and cytotoxic therapy, etanercept was given at a dose of 25 mg subcutaneously twice a week for
at least 3 months.
Results. All patients experienced an exacerbation of disease, with increase of muscle weakness, elevation
of muscle enzyme levels, and unchanged rash. Treatment with etanercept was stopped. After
receiving a combination of methotrexate (MTX) and azathioprine, disease manifestations improved in
all patients.
Conclusions. In our case series, TNF-a inhibition by etanercept was not effective, suggesting that a
broad immunosuppressive therapy is needed to treat DM
Obesity reduces the drug survival of second line biological drugs following a first TNF-α inhibitor in rheumatoid arthritis patients
No full textObjectives: The aim of this study was to assess whether body mass index (BMI) affects clinical outcomesin rheumatoid arthritis (RA) patients starting a second line biological drug after failure of a first TNF-blocker.Methods: From a longitudinal cohort, we analyzed 292 RA patients (66 obese, 109 overweight, and117 normal-weight) treated with a first ever anti-TNF- drug. Patients discontinuing the therapy werefollowed-up if began a second biological drug. Drug survival, by Kaplan-Meier life analysis, and 12 monthsdisease remission based on the 28-joint Disease Activity Score (DAS28) were assessed for either courseof biologics. The baseline predictors of clinical outcomes were assessed by Cox regression analysis.Results: Survival of the first anti-TNF- drug was lower in obese (39.4%) than in normal-weight (49.1%)patients, but the difference was not statistically significant. Obese patients had the highest hazard todiscontinue the first anti-TNF- drug (HR 1.64, 1.02–2.62 95% IC, P = 0.04), and the lowest percent-age of DAS28-based disease remission at 12 months (P = 0.04). In 97 (37 normal-weight, 36 overweight,24 obese) patients who started a second non-anti-TNF- biological drug, persistence on therapy wassignificantly lower in obese (43.5%) than in normal-weight (80%, P = 0.04) group, and again obesity sig-nificantly predicted drug discontinuation (HR 2.9, 1.08–8.45 95% IC, P = 0.04). Significantly, less obesepatients attained a disease remission (12%, P = 0.004) at 12 months.Conclusion: Our study provides evidence that obese RA patients poorly respond to second line non-anti-TNF- drugs after failure of a first TNF- inhibitor
Body mass does not affect the remission of psoriatic arthritis patients on anti-TNF-α therapy
No full textObjectives: There is evidence that fat tissue may influence the response to therapy in patients with arthritis. The aim of this study was to assess whether the body mass index (BMI) affects rates of clinical remission in patients with psoriatic arthritis (PsA) treated with anti-tumour necrosis factor (TNF)-α biological drugs. Method: We retrospectively studied 135 patients with active peripheral PsA (45 obese, 47 overweight, and 43 normal-weight). Baseline BMI was correlated with the clinical response to adalimumab, etanercept, or infliximab. After 36 months (median, range 6-79) of treatment, disease remission rates were assessed using the Disease Activity Score in 28 joints (DAS28) or the Simplified Disease Activity Index (SDAI). Possible predictors of clinical outcomes were assessed by multivariate analysis. Results: At baseline, BMI was significantly correlated only with the Health Assessment Questionnaire (HAQ) score (r = 0.21, p = 0.02) and not with disease activity. BMI did not predict disease remission or changes in HAQ score following anti-TNF-α therapy. Obese patients showed a significantly higher HAQ score and took significantly lower doses of prednisone than normal-weight or overweight patients, but their disease remission rates on the DAS28 (37%) or the SDAI (21%) were not significantly different from those of the other two groups (44% and 21%, respectively), regardless of the TNF-α inhibitor prescribed. Conclusions: In our retrospective analysis, disease activity and clinical response to anti-TNF-α therapy in PsA do not seem to be affected by BMI. Further prospective studies are needed to confirm these preliminary results. © 2013 Informa Healthcare on license from Scandinavian Rheumatology Research Foundation
Two-year survival rates of anti-TNF-α therapy in psoriatic arthritis (PsA) patients with either polyarticular or oligoarticular PsA
No full textObjectives: To evaluate the 2-year drug survival rates of the tumour necrosis factor (TNF)-alpha blockers adalimumab, etanercept, and infliximab in psoriatic arthritis (PsA) patients with either oligoarticular (oligo-PsA) or polyarticular PsA (poly-PsA).
Method: We studied a prospective cohort of 328 PsA patients with peripheral arthritis (213 with poly-PsA and 115 with oligo-PsA), beginning their first ever anti-TNF-alpha treatment with adalimumab, etanercept, or infliximab. The aim of the study was to evaluate the drug survival rates and possible baseline predictors at 2 years.
Results: After 24 months, persistence in therapy with the first anti-TNF-alpha blocker was not statistically different in the oligo-PsA (70.4%) and poly-PsA (65.7%) subsets. Predictors of drug discontinuation were female sex [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.00-2.68, p = 0.04] and starting the therapy in years 2003-8 (HR 0.51, 95% CI 0.330.80, p = 0.003). In poly-PsA, the persistence of etanercept (68.3%) was significantly higher than that of adalimumab (51.9%, p = 0.01), whereas in oligo-PsA no significant difference was detected. In poly-PsA, the period 2003-8 was a negative predictor (HR 0.36, 95% CI 0.21-0.62, p = 0.0001) whereas in oligo-PsA female gender was a positive predictor of drug discontinuation (HR 2.08, 95% CI 1.02-4.24, p = 0.04). With regard to clinical outcomes, the best responses in terms of European League Against Rheumatism (EULAR) 'good' response or Disease Activity Score (DAS28) remission, crude or adjusted according to the LUND Efficacy indeX (LUNDEX), were seen in patients on etanercept or infliximab.
Conclusions: Our study provides some evidence that anti-TNF-alpha drugs may perform differently in PsA, and that the analysis of clinical disease subsets may improve our knowledge and promote better management of PsA
Intentional etanercept use during pregnancy for maintenance of remission in rheumatoid arthritis
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