Journal of rheumatic diseases and treatment最新文献

{"title":"Severe MTX Toxicity in Rheumatic Diseases - Analysis of 22 Cases","authors":"R. Bergner, D. Wadsack, C. Löffler","doi":"10.23937/2469-5726/1510070","DOIUrl":"https://doi.org/10.23937/2469-5726/1510070","url":null,"abstract":"Background: Severe MTX (methotrexate) toxicity due to low dose MTX used in rheumatic diseases is rare but linked with a high mortality ranging from 13 to 44%. We analyzed 22 cases with a minimum toxicity of CTC (common toxicity criteria) grade 2, that were admitted to our hospital. Methods: We retrospectively analyzed epidemiological data, the weekly MTX dosage, renal function before and at the beginning of the adverse event, co-medication with influence on MTX toxicity or on renal function and potential other co-factors like infections, as well as the outcome, respectively. Results: 22 patients were involved in the study. Three patients died due to pneumonia, all other patients recovered. The main reason for toxicity was an impaired renal function (82%), either from acute renal failure or from acute on chronic renal failure or chronic renal disease stage 4. In 5 cases a dosing error, mainly with daily instead of weekly MTX intake, was the reason. Only in one case the reason remains unclear. Discussion: An impaired renal function with an estimated glomerular filtration rate (eGFR) of 11-54 ml/min was the main cause for MTX toxicity with dosage errors being the second numerous reasons. Our data are in accordance with previous case series, but the influence of reduced renal function is still higher than in the most reports. One reason might be that most case series took only into account the serum creatinine but not a calculated GFR. Serum creatinine alone underestimates the stage of renal failure in patients with lower muscle mass.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80566370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle Ultrasound in Inflammatory Myopathies: A Critical Review","authors":"Leeuwenberg Kristofoor E, Albayda Jemima","doi":"10.23937/2469-5726/1510069","DOIUrl":"https://doi.org/10.23937/2469-5726/1510069","url":null,"abstract":"Muscle ultrasonography is an upcoming tool in the evaluation of neuromuscular disorders. It is easily applicable in multiple clinical settings, has no contraindications, and provides a cost-effective alternative to other imaging modalities such as MRI. However, a known disadvantage of ultrasound is its dependence on examiner expertise. Furthermore, the assessment of muscle quality is done mainly through an assessment of muscle echo intensity, which is affected by machine/system settings, hampering comparison across centers. Over the years new methods have been developed to make results more objective and comparable for the assessment of myopathies. In this review, we will examine the role of ultrasound in the evaluation of idiopathic inflammatory myopathies (IIM), a heterogeneous group of autoimmune disorders which may be treatment-responsive. Studies have shown that ultrasound can be useful both for diagnosis and follow-up of IIM, particularly for dermatomyositis and inclusion body myositis. The addition of other ultrasound modalities such as Doppler and elastography, as well as the application of machine learning, appear promising for IIM. Further developments of these techniques are expected and will lead to more widespread use of ultrasound in the clinical assessment of IIM.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74976626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Histone Deacetylases (HDACs) Expression in Patients with and without Systemic Lupus Erythematosus: Possible Drug Targets for Treatment","authors":"Wiley Kenneth L, Treadwell Edward, M. Kayihura, Word Beverly, Oates Jarren, Lyn-Cook Beverly D","doi":"10.23937/2469-5726/1510060","DOIUrl":"https://doi.org/10.23937/2469-5726/1510060","url":null,"abstract":"There is increasing evidence that epigenetic factors may play a role in the pathogenesis of Systemic Lupus Erythematosus (SLE). Both global and gene specific methylation is known to occur in lupus patients, as well as, changes in histone acetylation status. Histone acetylation is associated with active chromatin or activation of genes, whereas histone deacetylase (HDAC) activity is associated with silencing of genes. Therefore, HDACs have been targeted as potential therapeutic targets for a number of diseases, including lupus. The purpose of this study was to determine histone deacetylase (HDAC) expression in patients who are diagnosed with SLE compared to age-matched healthy controls. Quantitative real-time PCR expression levels of HDAC 1, HDAC 2 and HDAC 7 were investigated in peripheral blood mononuclear cells of African American and European American women. Our results showed that HDAC 1 expression is significantly (p < 0.0039) elevated in lupus patients compared to controls. HDAC 2 expression is also increased in lupus patients (p < 0.0427). However, HDAC 7 showed no significant difference (p < 0.4644) in expression in our SLE patients compared to their controls. Those lupus patients with a SLE disease activity index (SLEDAI) of 4 or greater showed lower expression of HDAC 1 (p < 0.0026) compared to those with modest disease and a SLEDAI of less than 4. However, in those lupus patients with a SLEDAI of 4 or greater showed increased expression of HDAC2 (p < 0.053) when compared to those with a SLEDAI of less than 4. This observation was also noted in HDAC7. Increased expression in HDAC 1 and 2 has been associated with induced kidney injury and induction of proinflammatory cytokines.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84705570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Pharmacological Management Status of Systemic Lupus Erythematous Population: Situational Analysis","authors":"Balushi Farida Al, Salmi Issa Al, Metry Abdel Masiah, Yousef Mohammed Abdalla, H. Suad","doi":"10.23937/2469-5726/1510068","DOIUrl":"https://doi.org/10.23937/2469-5726/1510068","url":null,"abstract":"Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that has various manifestations among different populations. This study aims to provide an overview of medical pharmacological management that SLE population received immediately at time of diagnosis. Method: This is a retrospective analysis using patients’ registry medical information system. All patients diagnosed with SLE were reviewed by accessing their medical records including pharmacy prescription and dispersions at the Royal hospital from 2006 to 2014. The following comorbidities were analyzed: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, lung disease, cardiovascular disease (CVD), cerebrovascular accident (CVA), chronic kidney disease (CKD), end-stage kidney disease (ESKD), infections, thyroid disease, malignancy, and miscarriages. Results: There were 966 patients diagnosed with SLE during the period from 2006 to 2014. The Mean (SD) of age at presentation was 35.5 (11.5) years. Most patients were female (88.7%) with mean age of 27.6 (1.4) years. Unsurprisingly anti-malarial drug, hydroxychloroquine was used in 95% of SLE patients and steroid therapy was used in 93% in which 60.95% received Methylprednisolone pulse. The immunosuppressive agent of choice was Cyclophosphamide in 25.04%. Mycophenolic acid (MPA) medication in 39.85% and azathioprine in 37.06% of patients. Anti CD20 monoclonal antibodies, rituximab, was used in 20.91%. Calcineurin inhibitors were used in total of 11% of patients (cyclosporin a in 6.72% and tacrolimus in 4.35%). Conclusion: The complexity of SLE presentation have led to diverse pharmacotherapeutic strategies based on the organ systems involved. Management is individualized and depends on presenting symptoms and reducing the likelihood of permanent damage to organs and tissues. Strengthen health system at primary level and education of public and health work force is the main challenge to further improve the management. The overall aim of management was to determine the extent of disease and prevent extensive organ involvement and deal with various traditional and non-traditional CVD risk factors. The involvement of clinical pharmacist is very important to further strengthen the pharmacological management of lupus patients.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78132469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatologic Diseases as Paraneoplastic Syndromes - A Paradigmatic Case","authors":"Figueiredo Inês Rego de, Alves Rita Vieira, Castro Sara Guerreiro, Lourenço Filipa, Antunes Ana Margarida, Gruner Heidi, Panarra António","doi":"10.23937/2469-5726/1510067","DOIUrl":"https://doi.org/10.23937/2469-5726/1510067","url":null,"abstract":"Rheumatic diseases can be a paraneoplastic syndrome for an occult neoplasia. Some syndromes are more characteristic than others. In this case report, we present a patient with musculoskeletal symptoms suggestive of both carcinomatous arthritis and polymyalgia rheumatica that was shown to have adenocarcinoma of the lung. The musculoskeletal symptoms accompanied the course of the disease, disappearing with the treatment and re-occurring when it relapsed. *Corresponding author: Inês Rego de Figueiredo, Serviço de Medicina 7.2 Hospital Curry Cabral, Centro Hospitalar Lisboa Central (CHLC), Rua da Beneficiência 8, 1050-099 Lisboa, Portugal CASe RePoRt","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80894327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring the Time Course of Disability through a Self-Assessment Instrument \"Activity Index\" (IA) in RA Patients","authors":"Ren L, Zhang X, L. Zg, Tang H, Theiler R","doi":"10.23937/2469-5726/1510065","DOIUrl":"https://doi.org/10.23937/2469-5726/1510065","url":null,"abstract":"","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85556602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Hydroxychloroquine Induced Hypoglycaemia in a Non-Diabetic Patient","authors":"D. Richard, D. Teresa","doi":"10.23937/2469-5726/1510066","DOIUrl":"https://doi.org/10.23937/2469-5726/1510066","url":null,"abstract":"Citation: De-Heer R, Doherty T (2018) A Case of Hydroxychloroquine Induced Hypoglycaemia in a Non-Diabetic Patient. J Rheum Dis Treat 4:066. doi.org/10.23937/2469-5726/1510066 Accepted: September 27, 2018: Published: September 29, 2018 Copyright: © 2018 De-Heer R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91530277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten Year Risk of Cardiovascular Events during anti-TNF Alpha in Rheumatoid Arthritis Patients","authors":"C. Ilaria, Scire Carlo Alberto, Dallara Francesca, Muiesan Maria Lorenza, Tincani Angela, F. Franco","doi":"10.23937/2469-5726/1510061","DOIUrl":"https://doi.org/10.23937/2469-5726/1510061","url":null,"abstract":"Objective: To analyze the rate of major CV events in 433 patients with longstanding RA, treated for more than 10 years with anti-TNFα or DMARDs. Methods: All RA patients treated with anti-TNF-α from 2000 and 2002 (n. 86; TNF+ group) and a random sample of 258 patients treated with DMARDs out of 829 followed-up in the same period in the same Unit (TNFgroup) were analyzed. Myocardial infarction, heart failure, stroke, transient cerebral ischemic attack were considered. Exposure (anti-TNF-α vs. DMARDs) and outcome (CV events) were analyzed by the proportional hazard Cox regression, adjusting for RA duration, DAS 28, seropositivity (RF, anti CCP), treatment and Framingham CV risk factors (adjusted according to EULAR recommendations). Results: CV events were detected in 18.9% of cases with an incidence rate of 2.4% patients/year (95%CI: 1.5-3.7) in TNF+ and 1.3% patients/year (95%CI: 0.9-1.7) in TNFgroup. Events occurred after a mean of 8.3 ± 3.6 years of anti-TNF exposure and 13.3 ± 8 years of DMARDs exposure (p: 0.006). Cox analysis, adjusted for sex, age, CV risk factors, DAS28, FR positivity, corticosteroids, anti-inflammatory drugs and methotrexate treatment, showed that only Framingham risk score is slightly associated with CV events (HR: 1.03, 95%CI: 1.01-1.06). In addition, diabetes (p: 0.017) and coronary artery disease (p: 0.015) were associated with myocardial infarction, while higher age at RA onset (p: 0.02) and Framingham risk score (p: 0.0008) were associated with heart failure. Conclusions: CV events occurred in 2.4% patient/year during anti-TNF alpha treatment. A strict cardiovascular monitoring was mandatory in order to prevent major CV events.","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83886203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmunity and Lymphoma: A Brief Review","authors":"Miller Edward B","doi":"10.23937/2469-5726/1510062","DOIUrl":"https://doi.org/10.23937/2469-5726/1510062","url":null,"abstract":"The relationship between the immune system and both Hodgkin’s (HL) and Non-Hodgkin’s (NHL) lymphomas is a complex bidirectional process which has fascinated researchers and clinicians for many years. Lymphomas of all types are known to be associated with autoimmune paraneoplastic manifestations, and conversely are recognized in increased frequency in patients with pre-existing autoimmune diseases. This review briefly surveys this two-way process whereby lymphomas induce autoimmune dysfunction, and autoimmune system dysfunction induces lymphomagenesis. An emphasis on the clinical manifestations of these disorders is presented along with a brief overview of the pathophysiologic mechanisms involved. *Corresponding author: Edward B. Miller, MD., Head, Division of Rheumatology, Assistant Head, Department of Internal Medicine, Kaplan Medical Center, POB 1, Rehovot, 76100, Israel, Tel: 972-8-9441-991, Fax: 972-8-9440-053, E-mail: edward_m@clalit.org.il REviEw ARticlE","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87903894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trend of Frequency and Outcome of Reactive Arthritis in Japanese Patients with Bladder Cancer following Intravesical BCG Therapy over the Last 20 Years","authors":"Taniguchi Yoshinori, Nishikawa Hirofumi, Yoshinaga Yasuhiko, Amano Eri, K. Shigeto, T. Yoshio","doi":"10.23937/2469-5726/1510064","DOIUrl":"https://doi.org/10.23937/2469-5726/1510064","url":null,"abstract":"","PeriodicalId":73938,"journal":{"name":"Journal of rheumatic diseases and treatment","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75978851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}