1,721,043 research outputs found
Focus on adverse events of tumour necrosis factor α blockade in juvenile idiopathic arthritis in an open monocentric long-term prospective study of 163 patients
No full textObjective: To report adverse events (AEs) seen in a large cohort of patients with juvenile idiopathic arthritis (JIA) treated with tumour necrosis factor (TNF) blockers (infliximab and etanercept).
Methods: All patients with JIA treated with infliximab or etanercept at the Paediatric Rheumatologic Centre of the G Pini Institute (Milan, Italy) from November 1999 to February 2006, were enrolled in an open, single-centre, long-term prospective study
Results: In all, 163 patients (68 infliximab, 95 etanercept) were enrolled. Mean (SD) age of onset was 6.4 (4.8) years, mean age 17.1 (9.2) years, mean therapy duration 22.9 (17.6) months. A total of 45 patients (32 infliximab, 13 etanercept) failed to respond to or did not tolerate the first therapy and switched to a second one. In all, 208 treatments (81 infliximab, 127 etanercept) were performed. A total of 71 AEs occurred in 51 (62.9%) patients on infliximab and led to discontinuation in 26 (32.1%); 133 AEs occurred in 69 (54.3%) patients on etanercept and led to discontinuation in 18 (14.2%). Some AEs, such as thrombocytopoenia, neuropsychiatric disorders, new onset of Crohn disease and new onset or flare-up of chronic iridocyclitis (CIC), are unusual and have rarely been described before, yet proved to be significant in frequency and/or clinically noteworthy in the large population we followed.
Conclusions: In our 6-year study, anti-TNF agents infliximab and etanercept were well tolerated and safe, and were associated with only few serious, but all reversible, AEs. However, such inhibitors are associated with various and numerous AEs. Children and young adults affected by JIA should be carefully monitored so as to limit the risk of AEs during anti-TNF therapy as much as possible
Efficacy of TNF blockers in patients with juvenile idiopathic arthritis (JIA) associated uveitis
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Biological therapy with TNF-inhibitors in pediatric rheumatology. Review of the literature and personal experience
No full textThe therapeutic approach to JIA is sometimes very troublesome and progression to erosive polyarthritis may occur in
all JIA categories. Only Methotrexate has shown efficacy and safety in a large controlled trial. Nevertheless, in many
cases, drug resistance or intolerance has led to try other therapeutic options, with still debatable results. Therefore,
there has been space, in the last few years, for new therapies as the TNF-inhibitors. This therapeutic approach has
shown a dramatic clinical benefit in active polyarticular refractory JIA: the rate and rapidity of response have exceeded
those of all other studied DMARDs. Preliminary data show that they are efficacious also for other pediatric
rheumatic disease (spondyloarthropathies, autoimmune uveitis, dermatomyositis, Kawasaki syndrome and some auto-
inflammatory diseases). TNF-inhibitors in JIA have demonstrated a favourable benefit-to-risk profile. However, as
their use has increased worldwide, some unusual, usually not serious, adverse events have emerged. Severe infections,
including TB, and deaths have been reported. Long-lasting active disease, systemic disease, concurrent and previous
immunosuppressive therapies, all contribute to risk of infection and other serious AEs. Given the evidence that TNF
has a primary role in the pathogenesis of JIA, particularly in joint destruction, neutralizing this cytokine early, within
the window of opportunity, could halt or delay progression of joint damage and debilitating consequences of the
disease. Thus, for JIA patients whose disease is not quickly controlled with MTX, TNF blockers may be considered as
first-line treatment, although long-term safety data still need to be establishe
Capillaroscopic observations in childhood rheumatic diseases and healthy controls
No full textObjective: To describe, by using video nailfold capillaroscopy (NFC), microvascular abnormalities in children with rheumatic diseases and to evaluate the capillary changes over a follow up period. Methods: 118 children suffering from rheumatic diseases: 55 juvenile idiopathic arthritis (JIA), 7 mixed connective tissue disease (MCTD), 6 primary Raynaud's phenomenon (PRP), 34 systemic lupus erythematosus (SLE), 8 juvenile systemic sclerosis (JSSc) and 8 juvenile dermatomyositis (JDM) were included in the study. Patients with major capillaries abnormalities or scleroderma pattern were followed up for at least 12 months. 70 age- and sex-matched healthy controls (HC) were also examined. Results: In HC there was a significant correlation between age and capillary length (p = 0.001). JIA patients showed capillary number size, shape and arrangement similar to HC. Minor abnormalities were frequently observed. The percentage of major abnormalities were significantly increased compared to HC in MCTD (p = 0.008), SLE (p = 0.0002) and JDM patients (p < 0.0001). 5/8 of JSSc had a scleroderma pattern from the onset of the disease. The serial observations in connective tissue diseases also showed that the evolution of capillaroscopic pattern was not unidirectional. In fact, in some nailfolds there was an increase in capillary loss and in avascular areas, whereas sometimes it remained stable on repeated examination. Conclusion: NFC can be used as a simple, inexpensive, non-invasive method to evaluate the microvascular abnormalities in childhood rheumatic conditions, and it may be useful in early recognition and monitoring scleroderma spectrum disorders
Chronic Recurrent Multifocal Osteomyelitis (CRMO): four cases treated with aminobisphosphonate (pamidronate)
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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
A Comparison of Response Criteria in Patients with Juvenile Idiopathic Arthritis Treated with Methotrexate And/or Anti-Tnfα Agents
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