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Antoine M, Perceval M, Nove-Josserand R, Durieu I, Reynaud Q. Extra respiratory comorbidities in adult patients with cystic fibrosis. Eur J Intern Med 2024; 119:151-153. [PMID: 37923586 DOI: 10.1016/j.ejim.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Affiliation(s)
- M Antoine
- Department of Internal Medicine, Adult Cystic Fibrosis Center, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.
| | - M Perceval
- Department of Internal Medicine, Adult Cystic Fibrosis Center, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - R Nove-Josserand
- Department of Internal Medicine, Adult Cystic Fibrosis Center, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - I Durieu
- Department of Internal Medicine, Adult Cystic Fibrosis Center, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Q Reynaud
- Department of Internal Medicine, Adult Cystic Fibrosis Center, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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2
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Holz F, Can E, Grehn C, Klotsche J, Materne B, Kruppa J, Kallinich T, Schwarz C. Manifestation and staging of arthropathy in cystic fibrosis. Defining different stages of cystic fibrosis arthropathy using ultrasound imaging and clinical scoring. J Cyst Fibros 2023; 22:980-988. [PMID: 37150649 DOI: 10.1016/j.jcf.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The true prevalence of cystic fibrosis arthropathy (CFA) remains unclear and may be significantly higher than previously reported. In recent studies, joint symptoms have been reported in up to 30% of adults with CF. This underlines the importance of CFA as a rising and clinically relevant co-morbidity. A clear definition of CFA is yet missing and its pathogenesis remains unclear. We investigated the clinical manifestation of CFA particularly via ultrasound (US) examination to define and implement a staging for clinical assessment. METHODS In a prospective cohort study between March 2018 and February 2020 a total of 98 consecutively recruited, adult cystic fibrosis (CF) patients underwent joint-US examination according to a newly developed ultrasound score (US-CFA). A clinical assessment including rheumatological scores (DAS28, HAQ) has been conducted as well as a specially designed questionnaire. Investigation on clinical and microbiological data, as well as a comprehensive laboratory analysis, were carried out. Cluster analysis has been performed to detect patterns defining different CFA stages based on disease activity. RESULTS US imaging has shown a considerable incidence of mild to moderate effusion as sign of joint inflammation/(teno-)synovitis. K-means clustering was used to distinguish 3 different stages of CFA based on the intensity of the detected effusion. These stages showed a significant association with disease activity (DAS28, p = 0.0004) as well as with patient-reported symptoms such as total weeks of CFA per year (p = 0.004), acute CFA (p = 0.015), chronic CFA (p = 0.016), disease burden (p = 0.04). Based on the US-CFA, 16% of patients suffered from severe CFA (II), 51% from intermediate CFA (I) and 33% did not present detectable arthritis. Positive serology for Chlamydophilia pneumoniae (IgA, IgG) and Chlamydia trachomatis (IgA, IgG) significantly correlated with the US-CFA. CONCLUSIONS The results of this study show that a definition and categorization for the clinical manifestation of CFA can be described through US examination, which is able to detect disease activity concordant with the DAS28 as a validated clinical score on arthritis. Defining these stages will lead to a better understanding of the clinical phenotype of the disease and will optimize diagnosis, therapy and research on CFA in the future.
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Affiliation(s)
- F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany.
| | - E Can
- Department of Radiology including Pediatric Radiology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany
| | - J Klotsche
- German Rheumatism Research Centre, Berlin, Germany
| | - B Materne
- Department of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - J Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Germany
| | - T Kallinich
- German Rheumatism Research Centre, Berlin, Germany; Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Rheumatology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Schwarz
- Division Cystic Fibrosis, CF Center Westbrandenburg, Clinic Westbrandenburg, Potsdam, Germany; HMU Health and Medical University, Potsdam, Germany
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Schmoll A, Launois C, Perotin JM, Ravoninjatovo B, Griffon M, Carré S, Mulette P, Ancel J, Hagenburg J, Lebargy F, Deslée G, Salmon JH, Dury S. Prevalence and Impact of Rheumatologic Pain in Cystic Fibrosis Adult Patients. Front Med (Lausanne) 2022; 8:804892. [PMID: 35211488 PMCID: PMC8861186 DOI: 10.3389/fmed.2021.804892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background With the improvement of cystic fibrosis (CF) patient survival, the prevalence of long-term complications increased, among them rheumatologic disorders. Methods The aim of this prospective study was to evaluate the prevalence of spinal and joint pain, and their impact on disability, anxiety, depression, and quality of life in CF adult patients. Results Forty-seven patients were analyzed, 72% of men, mean aged 28 years, with a mean body mass index of 22 kg/m2 and a mean FEV1% of 63%. Twenty-two patients (47%) described rheumatologic pain either spinal (n = 15, 32%) and/or joint pain (n = 14, 30%). Patients with spinal and/or joint pain were shorter (p = 0.023), more frequently colonized with Staphylococcus aureus (p < 0.008), had more frequent ΔF508 homozygous mutations (p = 0.014), and a trend for more impairment of the 6-min walking distance (p = 0.050). The presence of rheumatologic pain tended to be associated with disability according to the Health Assessment Questionnaire (HAQ) and anxiety. Compared with patients with no pain patients with both spinal and joint pain exhibited a more pronounced impact on the St George's Respiratory Questionnaire (SGRQ). Conclusion Rheumatologic pain is frequent in CF adult patients, and may affect daily living, anxiety and quality of life. Systematic assessment of rheumatologic pain should be included in the management of CF patients.
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Affiliation(s)
- Axelle Schmoll
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Bruno Ravoninjatovo
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Muriel Griffon
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Sophie Carré
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean Hagenburg
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Reims University Hospital, Reims, France.,EA3797, University of Reims Champagne-Ardenne, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
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4
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Prajapati BB, Filippi A, Sears EH. Chronic Joint Pain in a Young Adult With Cystic Fibrosis. Cureus 2021; 13:e17229. [PMID: 34540456 PMCID: PMC8442824 DOI: 10.7759/cureus.17229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
A 25-year-old male with end-stage cystic fibrosis (CF) with genotype F508del/F508del presented to the clinic complaining of bilateral knee and ankle pain. He had severe lung disease (forced expiratory volume 1 {FEV1} 19% of predicted), chronic colonization with achromobacter, malnutrition, and CF-related diabetes. On physical examination, he was found to have bilateral knee swelling as well as pain on flexion and extension of the wrists and ankles without erythema or warmth. He was empirically started on prednisone and tramadol; however, at a three-month follow-up visit, he remained symptomatic. He was sent for a whole-body bone scan, which was consistent with hypertrophic pulmonary osteoarthropathy (HPOA). He was started on highly effective modulator therapy with elexacaftor/tezacaftor/ivacaftor and symptoms spontaneously resolved without further intervention.
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Affiliation(s)
| | - Alexandra Filippi
- Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, USA
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5
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Delaney-Nelson KL, Henry SM, Siva C. Rheumatoid arthritis in a patient with cystic fibrosis: challenging treatment options. BMJ Case Rep 2020; 13:13/9/e234305. [PMID: 32895251 DOI: 10.1136/bcr-2020-234305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old Caucasian male patient with a history of cystic fibrosis presented with a 6-month history of diffuse joint pain and swelling. He was found to have active synovitis in bilateral wrists and proximal interphalangeal joints of the hands on physical examination. He was diagnosed with seropositive rheumatoid arthritis since he had positive anti-cyclic citrullinated peptide antibodies and erosions on hand and foot X-rays. The patient has responded well to abatacept which may have less infection risk compared with other biological therapies.
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Affiliation(s)
- Kelly Lynn Delaney-Nelson
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
| | - Sheena Marie Henry
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
| | - Chokkalingam Siva
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
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6
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Friedlander HM, Ford JA, Zaccardelli A, Terrio AV, Cho MH, Sparks JA. Obstructive lung diseases and risk of rheumatoid arthritis. Expert Rev Clin Immunol 2020; 16:37-50. [PMID: 31774329 DOI: 10.1080/1744666x.2019.1698293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Smoking is an established risk factor for both lung diseases and rheumatoid arthritis (RA). Chronic mucosal airway inflammation may result in immune tolerance loss, neoantigen formation, and production of RA-related autoantibodies that increase the subsequent risk of RA. In this review, we aimed to summarize the current evidence supporting the role of obstructive lung diseases and subsequent risk of RA.Areas covered: We identified scientific articles discussing the biologic mechanisms linking mucosal airway inflammation and RA risk. We also identified studies investigating asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, chronic tuberculous and nontuberculous mycobacterial infections, and interstitial lung disease with subsequent risk for RA.Expert opinion: The current evidence supports the hypothesis that mucosal airway inflammation may increase the risk of developing RA. However, most studies investigating this relationship have been retrospective and may not have adequately addressed the role of smoking. Larger prospective studies may provide stronger evidence for obstructive lung disease and RA risk. Determining the role of obstructive lung disease in RA pathogenesis may provide opportunity for RA prevention and screening strategies, while identifying novel biologic mechanisms that could offer targets to improve treatment and outcomes.
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Affiliation(s)
- H Maura Friedlander
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Julia A Ford
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessandra Zaccardelli
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Alexsandra V Terrio
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Michael H Cho
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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7
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Rheumatologic Manifestations of CF. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Chin M, Aaron SD, Bell SC. The treatment of the pulmonary and extrapulmonary manifestations of cystic fibrosis. Presse Med 2017; 46:e139-e164. [PMID: 28576636 DOI: 10.1016/j.lpm.2016.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/12/2016] [Accepted: 11/06/2016] [Indexed: 12/26/2022] Open
Abstract
Cystic fibrosis (CF) is a complex multisystem disease with considerable between patient variability in its manifestations and severity. In the past several decades, the range of treatments and the evidence to support their use for the pulmonary and extrapulmonary manifestations of CF have increased dramatically, contributing to the improved median survival of patients. As therapy for CF has evolved, new challenges including treatment adherence, medication intolerance and allergy, medical complications and coping with the burden of disease in the context of having a family and managing employment have arisen. While the majority of current therapy focuses primarily on improving symptoms, new therapies (CFTR modulators) target the underlying genetic defect.
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Affiliation(s)
- Melanie Chin
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, 501, Smyth Road, K1H 8L6 Ottawa, Canada
| | - Scott C Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia; QIMR Berghofer Medical Research Institute, 300, Herston Road, Herston, QLD 4006, Australia; School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia.
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9
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Ronan NJ, Elborn JS, Plant BJ. Current and emerging comorbidities in cystic fibrosis. Presse Med 2017; 46:e125-e138. [PMID: 28554721 DOI: 10.1016/j.lpm.2017.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023] Open
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) is expressed ubiquitously throughout the body. Thus, while respiratory manifestations dominate much of cystic fibrosis (CF) care, there are prominent multi-organ manifestations and comorbidities. In the general population, the number of comorbidities increases with aging. Few illnesses have experienced such a dramatic improvement in survival as CF, which has been transformed from an illness of childhood death to one of adult survival. Hence, as longevity increases in CF, it is paralleled by an increasing number of patients with multicomplex comorbidities availing of care from adult CF multi-disciplinary teams. This review gives an overview of the traditional CF associated comorbidities and those emerging in an aging adult cohort. While historically the treatment of CF focused on the consequences of CFTR dysfunction, the recent advent of CFTR modulators with the potential to enhance CFTR function represents an opportunity to potentially reverse or delay the development of some of the comorbidities associated with CF. Where evidence is available for the impact of CFTR modulatory therapy, namely ivacaftor on comorbidities in CF, this is highlighted.
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Affiliation(s)
- Nicola J Ronan
- Cork university hospital, university college Cork, Cork adult cystic fibrosis centre, HRB clinical research facility, Wilton,T12 DFK4 Cork, Ireland
| | - Joseph Stuart Elborn
- London and Queen's university Belfast, National heart and lung institute, Imperial College, Royal Brompton hospital, London, United Kingdom
| | - Barry J Plant
- Cork university hospital, university college Cork, Cork adult cystic fibrosis centre, HRB clinical research facility, Wilton,T12 DFK4 Cork, Ireland.
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10
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Thornton J, Rangaraj S. Anti-inflammatory drugs and analgesics for managing symptoms in people with cystic fibrosis-related arthritis. Cochrane Database Syst Rev 2016; 2016:CD006838. [PMID: 26798057 PMCID: PMC7390346 DOI: 10.1002/14651858.cd006838.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its intense treatment. This is an update of a previously published review. OBJECTIVES To review the effectiveness and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis in adults and children with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.Date of most recent search: 19 January 2016. SELECTION CRITERIA Randomised controlled studies which compared the efficacy and safety of anti-inflammatory and analgesic agents (e.g. non-steroidal anti-inflammatory agents, systemic corticosteroids, intra-articular corticosteroids) with each other, with no treatment or with placebo for CFA and HPO. DATA COLLECTION AND ANALYSIS No relevant studies were identified. MAIN RESULTS No studies were included in this review. AUTHORS' CONCLUSIONS Although it is generally recognised that CFA may be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. While this approach may be sufficient to manage symptoms, it is disappointing that no randomised controlled trials to rigorously evaluate these agents were found, nor could the authors identify any quasi-randomised. This systematic review has identified the need for a well-designed adequately-powered randomised controlled trial to assess the efficacy and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis (CFA and HPO) in adults and children with cystic fibrosis. Studies should also better define the two conditions. A study has recently been conducted in CFA and may help fill this gap when analysed and published.There are no trials included in the review up to January 2016. We will continue to run searches to identify any potentially relevant studies; however, we do not plan to update other sections of the review until new studies are published.
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Affiliation(s)
- Judith Thornton
- Centre for Clinical Practice, National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, UK, M1 4BD
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11
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T. JM, V. PF. FIBROSIS QUÍSTICA EN EL ADULTO. REVISTA MÉDICA CLÍNICA LAS CONDES 2015. [DOI: 10.1016/j.rmclc.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Abstract
As a testimony to advances in patient care, more individuals with cystic fibrosis are surviving into their adult years than ever before. The clinical epidemiology of this complex multi-organ disease is evolving and has changed dramatically over the past two to three decades. This article discusses the emergence of chronic disease-related co-morbidities such as CF-related diabetes, chronic kidney disease, bone disease, arthropathy, and depression. It also provides an overview of the many challenges confronted by adult CF care providers.
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Affiliation(s)
- Bradley S Quon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medical Center, 1959 NE Pacific St., Campus Box 356522, Seattle, Washington, USA, 98195
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13
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Thornton J, Rangaraj S. Disease modifying anti-rheumatic drugs in people with cystic fibrosis-related arthritis. Cochrane Database Syst Rev 2012; 2012:CD007336. [PMID: 22972107 PMCID: PMC6481469 DOI: 10.1002/14651858.cd007336.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy. Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its treatment. OBJECTIVES To review the effectiveness and safety of disease-modifying anti-rheumatic drugs for the management of arthritis related to cystic fibrosis in adults and children. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Cystic Fibrosis Trials Register which comprises references identified from comprehensive electronic database handsearches of relevant journal and abstract books of conference proceedings.Date of most recent search: 10 July 2012. SELECTION CRITERIA Randomised controlled trials which compared the efficacy and safety of disease-modifying anti-rheumatic drugs (e.g. methotrexate, gold, sulfasalazine, penicillamine, leflunomide, hydroxychloroquine and newer agents such as biologic disease modifying agents and monoclonal antibodies) with each other, with no treatment or with placebo for cystic fibrosis-related arthropathy or hypertrophic osteoarthropathy. DATA COLLECTION AND ANALYSIS No relevant studies were identified. MAIN RESULTS No studies were included in this review. AUTHORS' CONCLUSIONS Although it is generally recognised that cystic fibrosis-related arthritis can be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. But when episodic symptoms progress to persistent disease, disease-modifying anti-rheumatic drugs may be needed to limit the course of the disease. It is disappointing that no randomised controlled trials to rigorously evaluate these drugs could be found. This systematic review has identified the need for a well-designed adequately powered randomised controlled trial to assess the efficacy and safety of disease-modifying anti-rheumatic drugs for the management of cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy in adults and children with cystic fibrosis. However, given the infrequency of cystic fibrosis-related arthritis and the range of symptoms and severity, randomised controlled trials may not be feasible and well-designed non-randomised observational studies may be more appropriate. Studies should also better define the two conditions.
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Affiliation(s)
- Judith Thornton
- School of Community-based Medicine, University of Manchester, Manchester, UK.
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14
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Thornton J, Rangaraj S. Anti-inflammatory drugs and analgesics for managing symptoms in people with cystic fibrosis-related arthritis. Cochrane Database Syst Rev 2012:CD006838. [PMID: 22419317 DOI: 10.1002/14651858.cd006838.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its intense treatment. OBJECTIVES To review the effectiveness and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis in adults and children with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.Date of most recent search: 16 December 2011. SELECTION CRITERIA Randomised controlled trials which compared the efficacy and safety of anti-inflammatory and analgesic agents (e.g. non-steroidal anti-inflammatory agents, systemic corticosteroids, intra-articular corticosteroids) with each other, with no treatment or with placebo for CFA and HPO. DATA COLLECTION AND ANALYSIS No relevant studies were identified. MAIN RESULTS No studies were included in this review. AUTHORS' CONCLUSIONS Although it is generally recognised that CFA may be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. While this approach may be sufficient to manage symptoms, it is disappointing that no randomised controlled trials to rigorously evaluate these agents were found, nor could the authors identify any quasi-randomised. This systematic review has identified the need for a well-designed adequately-powered randomised controlled trial to assess the efficacy and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis (CFA and HPO) in adults and children with cystic fibrosis. Studies should also better define the two conditions. A study has recently been conducted in CFA and may help fill this gap when analysed and published.There are no trials included in the review up to January 2012. We do not plan to update this review until new trials are published, although we will search the Group's Cystic Fibrosis Trials Register on a two-yearly cycle.
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Affiliation(s)
- Judith Thornton
- School of Community-based Medicine, University of Manchester, Manchester, UK.
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15
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Thornton J, Rangaraj S. Disease modifying anti-rheumatic drugs in people with cystic fibrosis-related arthritis. Cochrane Database Syst Rev 2009:CD007336. [PMID: 19160333 DOI: 10.1002/14651858.cd007336.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy. Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its treatment. OBJECTIVES To review the effectiveness and safety of disease-modifying anti-rheumatic drugs (DMARDs) for the management of arthritis related to cystic fibrosis in adults and children. SEARCH STRATEGY We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database handsearches of relevant journal and abstract books of conference proceedings.Date of most recent search: May 2008 SELECTION CRITERIA Randomised controlled trials which compared the efficacy and safety of DMARDs (e.g. methotrexate, gold, sulfasalazine, penicillamine, leflunomide, hydroxychloroquine and newer agents such as biologic disease modifying agents and monoclonal antibodies) with each other, with no treatment or with placebo for cystic fibrosis-related arthropathy or hypertrophic osteoarthropathy. DATA COLLECTION AND ANALYSIS No relevant studies were identified. MAIN RESULTS No studies were included in this review. AUTHORS' CONCLUSIONS Although it is generally recognised that cystic fibrosis-related arthritis can be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. But when episodic symptoms progress to persistent disease, DMARDs may be needed to limit the course of the disease. It is disappointing that no randomised controlled trials to rigorously evaluate DMARDs could be found. This systematic review has identified the need for a well-designed adequately powered randomised controlled trial to assess the efficacy and safety of DMARDs for the management of cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy in adults and children with cystic fibrosis. However, given the infrequency of cystic fibrosis-related arthritis and the range of symptoms and severity, randomised controlled trials may not be feasible and well-designed non-randomised observational studies may be more appropriate. Studies should also better define the two conditions.
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Affiliation(s)
- Judith Thornton
- Greater Manchester, Lancashire & South Cumbria Medicines for Children Research Network, 2nd Floor, Colwyn House, Royal Manchester Children's Hospital, Manchester, UK, M27 4HA.
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Durieu I, Nove Josserand R. La mucoviscidose en 2008. Rev Med Interne 2008; 29:901-7. [DOI: 10.1016/j.revmed.2007.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 11/16/2022]
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Gordon CM, Anderson EJ, Herlyn K, Hubbard JL, Pizzo A, Gelbard R, Lapey A, Merkel PA. Nutrient status of adults with cystic fibrosis. ACTA ACUST UNITED AC 2008; 107:2114-9. [PMID: 18060897 DOI: 10.1016/j.jada.2007.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Indexed: 10/22/2022]
Abstract
Nutrition is thought to influence disease status in patients with cystic fibrosis (CF). This cross-sectional study sought to evaluate nutrient intake and anthropometric data from 64 adult outpatients with cystic fibrosis. Nutrient intake from food and supplements was compared with the Dietary Reference Intakes for 16 nutrients and outcomes influenced by nutritional status. Attention was given to vitamin D and calcium given potential skeletal implications due to cystic fibrosis. Measurements included weight, height, body composition, pulmonary function, and serum metabolic parameters. Participants were interviewed about dietary intake, supplement use, pulmonary function, sunlight exposure, and pain. The participants' mean body mass index (+/-standard deviation) was 21.8+/-4.9 and pulmonary function tests were normal. Seventy-eight percent used pancreatic enzyme replacement for malabsorption. Vitamin D deficiency [25-hydroxyvitamin D (25OHD)<37.5 nmol/L] was common: 25 (39%) were deficient despite adequate vitamin D intake. Lipid profiles were normal in the majority, even though total and saturated fat consumption represented 33.0% and 16.8% of energy intake, respectively. Reported protein intake represented 16.9% of total energy intake (range 10%-25%). For several nutrients, including vitamin D and calcium, intake from food and supplements in many participants exceeded recommended Tolerable Upper Intake Levels. Among adults with cystic fibrosis, vitamin D deficiency was common despite reported adequate intake, and lipid profiles were normal despite a relatively high fat intake. Mean protein consumption was adequate, but the range of intake was concerning, as both inadequate or excessive intake may have deleterious skeletal effects. These findings call into question the applicability of established nutrient thresholds for patients with cystic fibrosis.
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Affiliation(s)
- Catherine M Gordon
- Division of Endocrinology, Children's Hospital Boston, Boston, MA 22015, USA.
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Thornton J, Rangaraj S. Pharmacological agents (anti-inflammatory and analgesic) for managing symptoms in people with cystic fibrosis-related arthritis. Cochrane Database Syst Rev 2008:CD006838. [PMID: 18254117 DOI: 10.1002/14651858.cd006838.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its intense treatment. OBJECTIVES To review the effectiveness and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis in adults and children with cystic fibrosis. SEARCH STRATEGY We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: September 2007. SELECTION CRITERIA Randomised controlled trials which compared the efficacy and safety of anti-inflammatory and analgesic agents (e.g. non-steroidal anti-inflammatory agents, systemic corticosteroids, intra-articular corticosteroids) with each other, with no treatment or with placebo for CFA and HPO. DATA COLLECTION AND ANALYSIS No relevant studies were identified. MAIN RESULTS No studies were included in this review. AUTHORS' CONCLUSIONS Although it is generally recognised that CFA may be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. While this approach may be sufficient to manage symptoms, it is disappointing that no randomised controlled trials to rigorously evaluate these agents were found, nor could the authors identify any quasi-randomised. This systematic review has identified the need for a well-designed adequately-powered randomised controlled trial to assess the efficacy and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis (CFA and HPO) in adults and children with cystic fibrosis. Studies should also better define the two conditions. A study has recently been conducted in CFA and may help fill this gap when analysed and published.
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Affiliation(s)
- J Thornton
- Greater Manchester, Lancashire & South Cumbria Medicines for Children Research Network, 2nd Floor, Colwyn House, Royal Manchester Children's Hospital, Manchester, UK, M27 4HA.
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Botton E, Saraux A, Laselve H, Jousse S, Le Goff P. Musculoskeletal manifestations in cystic fibrosis. Joint Bone Spine 2004; 70:327-35. [PMID: 14563459 DOI: 10.1016/s1297-319x(03)00063-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although bone and joint manifestations are common in children with cystic fibrosis (CF), they have received little attention in adults. As compared to healthy individuals, bone mineral density is low, even with calcium intakes greater than 1500 mg/d. Nevertheless, calcium and phosphate levels in blood and urine are often normal, and vitamin D levels vary. Short stature with a low body mass index and central hypogonadism are the rule in these patients. Fractures and kyphosis are often reported. CF arthropathy occurs in 2-8.5% of patients. Arthritis develops, and there may be skin eruptions. Non-steroidal antiinflammatory drug therapy is effective. Hypertrophic osteoarthropathy associated with respiratory failure is present in 2-7% of patients. Rheumatoid arthritis, spondyloarthropathies, sarcoidosis, and amyloidosis have been reported in association with CF. Knee pain due to patellofemoral syndrome, quinolone-induced arthropathy, and mechanical back pain have been described. Rheumatoid factor titers are higher than in healthy controls, particularly in patients with episodic arthritis. No data are available on antiperinuclear factor or antikeratin antibody titers. Tests for antinuclear antibody are usually negative. Circulating immune complex levels and antibodies to heat shock proteins may be elevated. Antineutrophil cytoplasmic antibody of the bactericidal/permeability-increasing protein (BPI) or azurocidin (AZ) type has been reported, often in high titers (up to 40%).
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Affiliation(s)
- Estelle Botton
- Service de rhumatologie, Hôpital de la cavale blanche, CHU Brest, 29609 Brest cedex, France
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