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Proft F, Duran TI, Ghoreschi K, Pleyer U, Siegmund B, Poddubnyy D. Treatment strategies for Spondyloarthritis: Implementation of precision medicine - Or "one size fits all" concept? Autoimmun Rev 2024; 23:103638. [PMID: 39276959 DOI: 10.1016/j.autrev.2024.103638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/05/2024] [Accepted: 09/07/2024] [Indexed: 09/17/2024]
Abstract
Spondyloarthritis (SpA) is a term to describe a group of chronic inflammatory rheumatic diseases, which have common pathophysiological, genetic, and clinical features. Under the umbrella term SpA, two main groups are subsumed: axial SpA (radiographic axSpA and non-radiographic axSpA) and peripheral SpA (with the leading representative being psoriatic arthritis (PsA) but also arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated pSpA). The key clinical symptom in axSpA is chronic back pain, typically with inflammatory characteristics, which starts in early adulthood, while the leading clinical manifestations of peripheral SpA (pSpA) are arthritis, enthesitis, and/or dactylitis. Furthermore, extra-musculoskeletal manifestations (EMMs) (acute anterior uveitis, psoriasis, and IBD) can accompany axial or peripheral symptoms. All these factors need to be taken into account when making treatment decisions in SpA patients. Despite the major advances in the treatment landscape over the past two decades with the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and most recently targeted synthetic DMARDs (tsDMARDs), a relevant proportion of patients still does not achieve the desired state of remission (=absence of disease activity). With this implementation of new treatment modalities, clinicians now have more choices to make in the treatment algorithms. However, despite generalized treatment recommendations, all factors need to be carefully considered when deciding on the optimal treatment strategy for an individual patient in clinical practice, aiming at an important first step towards personalized treatment strategies in SpA. In this narrative review, we focus on the efficacy of approved and emerging treatment options in axSpA and PsA as the main representative of pSpA and discuss their selective effect on the different manifestations associated with SpA to provide guidance on drivers of treatment decisions in specific situations.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Clinic of Rheumatology, Denizli State Hospital, Denizli, Turkey
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Berlin, Germany and (5)Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Epidemiology unit, German Rheumatism Research Centre, Berlin, Germany; Division of Rheumatology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
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Aboelwafa HO, Abou Khodair Mohamed H, Ibrahim DM, Bedair NI. Efficacy of Leflunomide Compared to Methotrexate in the Treatment of Moderate to Severe Plaques Psoriasis: A Randomized Controlled Clinical Trial. Dermatol Pract Concept 2024; 14:dpc.1403a165. [PMID: 39122533 PMCID: PMC11314144 DOI: 10.5826/dpc.1403a165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory autoimmune skin disease. Several treatment options are available including topical and systemic options. Methotrexate was the main systemic medication in treating severe psoriasis, yet adverse events can limit its use. Leflunomide is an isoxazole derivative that inhibits the synthesis of pyrimidines, and subsequently inhibits RNA and DNA synthesis. OBJECTIVES As available data directly comparing MTX to leflunomide in psoriasis are lacking, this double blinded study was designed to compare the efficacy of methotrexate versus leflunomide in the treatment of moderate to severe psoriasis. METHODS The study included 40 patients (25 males and 15 females) with chronic plaque psoriasis. s. Patients were randomly assigned to one of two equal groups, group A for subcutaneous methotrexate injections and group B for leflunomide (loading dose 100mg daily for the first 3 days, then 20 mg daily for 3 months. Disease severity was determined by psoriasis area and severity index (PASI) score before and at the end of treatment The treatment response was evaluated at the baseline and weeks 4, 8 and 12 PASI score. RESULTS Both groups were matching at the baseline in aspects of gender, age, disease duration and PASI scores Both medications yielded comparable results with no significant difference between both groups in PASI score neither in side effects. CONCLUSIONS Leflunomide can be as effective as methotrexate in treatment of moderate to severe psoriasis.
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Affiliation(s)
- Hany Othman Aboelwafa
- Department of Dermatology, Venereology and Andrology, AlAzhar University- Damietta Faculty of Medicine, Damietta, Egypt
| | - Hassan Abou Khodair Mohamed
- Department of Dermatology, Venereology and Andrology, AlAzhar University- Damietta Faculty of Medicine, Damietta, Egypt
| | | | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Torosian K, Lal E, Kavanaugh A, Loomba R, Ajmera V, Guma M. Psoriatic disease and non-alcoholic fatty liver disease shared pathogenesis review. Semin Arthritis Rheum 2023; 59:152165. [PMID: 36716599 PMCID: PMC9992353 DOI: 10.1016/j.semarthrit.2023.152165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/03/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
Psoriatic disease (PD) and non-alcoholic fatty liver disease (NAFLD) potentially share disease pathways given the numerous inflammatory pathways involved in both diseases and a higher prevalence of NAFLD in PD patients. Metabolic syndrome and obesity are a key link between the two diseases, but even when controlling for this, associations between both diseases are still seen. Therapeutics that impact metabolic or inflammatory pathways may be impactful in both PD and NAFLD. In this review, we describe common inflammatory pathways contributing to both PD and NAFLD and critically review the potential impact of treatments for and on both diseases.
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Affiliation(s)
- Kelly Torosian
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Esha Lal
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Arthur Kavanaugh
- Department of Rheumatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, USA; Division of Epidemiology, Department of Family and Preventative Medicine, University of California at San Diego, La Jolla, USA
| | - Veeral Ajmera
- Division of Gastroenterology and Hepatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, USA.
| | - Monica Guma
- Department of Rheumatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain; San Diego VA Healthcare Service, San Diego, CA, 92161, USA.
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4
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Zheng K, Chen Y, Liu S, He C, Yang Y, Wu D, Wang L, Li M, Zeng X, Zhang F. Leflunomide: Traditional immunosuppressant with concurrent antiviral effects. Int J Rheum Dis 2023; 26:195-209. [PMID: 36371788 DOI: 10.1111/1756-185x.14491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/06/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
Leflunomide is a classic disease-modifying anti-rheumatic drug that is widely used to treat autoimmune diseases. Studies also show its antiviral effects in in vitro and/or in vivo experiments. Considering glucocorticoids, immunosuppressants and newly emerged antibodies commonly used in autoimmune diseases and autoinflammatory disorders bring risk of infection such as viral infection, leflunomide with combination of anti-viral and immunosuppressive features to maintain the balance between infection and anti-inflammation are attractive. Here we summarize the actions and mechanisms of leflunomide in immunoregulatory and antiviral effects.
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Affiliation(s)
- Kunyu Zheng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Yiran Chen
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Suying Liu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Chengmei He
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Di Wu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Li Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, China
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5
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Alnaqbi KA, Hannawi S, Namas R, Alshehhi W, Badsha H, Al‐Saleh J. Consensus statements for pharmacological management, monitoring of therapies, and comorbidity management of psoriatic arthritis in the United Arab Emirates. Int J Rheum Dis 2022; 25:1107-1122. [PMID: 35916205 PMCID: PMC9804226 DOI: 10.1111/1756-185x.14406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/28/2022] [Accepted: 07/17/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Psoriatic arthritis (PsA), a chronic inflammatory disease characterized by heterogeneous clinical manifestations, substantially impacts the quality of life of affected individuals. This article aims at developing consensus recommendations for the management of PsA and associated comorbidities and screening and monitoring requirements of PsA therapies in the United Arab Emirates (UAE) population. METHODS An extensive review of present international and regional guidelines and publications on the pharmacological management, monitoring of therapies in the context of PsA was performed. Key findings from guidelines and literature were reviewed by a panel of experts from the UAE at several meetings to align with current clinical practices. Consensus statements were formulated based on collective agreement of the experts and members of Emirates Society for Rheumatology. RESULTS The consensus recommendations were developed to aid practitioners in clinical decision-making with respect to dosage recommendations for pharmacological therapies for PsA, including conventional drugs, non-biologic, and biologic therapies. Consensus recommendations for therapeutic options for the treatment of PsA domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, psoriasis, and nail disease, were developed. The panel emphasized the importance of monitoring PsA therapies and arrived at a consensus on monitoring requirements for PsA therapies. The expert panel proposed recommendations for the management of common comorbidities associated with PsA. CONCLUSION These consensus recommendations can guide physicians and healthcare professionals in the UAE in making proper treatment decisions, as well as efficiently managing comorbidities and monitoring therapies in patients with PsA.
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Affiliation(s)
- Khalid A. Alnaqbi
- Department of RheumatologyTawam HospitalAl AinUAE
- College of Medicine and Health SciencesUAE UniversityAl AinUAE
| | - Suad Hannawi
- Emirates Health Services (EHS)DubaiUAE
- Ministry of Health and PreventionDubaiUAE
| | - Rajaie Namas
- Division of Rheumatology, Department of Internal MedicineCleveland Clinic Abu DhabiUAE
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6
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Faria RJ, Cordeiro FJR, dos Santos JBR, Alvares-Teodoro J, Guerra Júnior AA, Acurcio FDA, da Silva MRR. Conventional Synthetic Disease-Modifying Anti-rheumatic Drugs for Psoriatic Arthritis: Findings and Implications From a Patient Centered Longitudinal Study in Brazil. Front Pharmacol 2022; 13:878972. [PMID: 35559237 PMCID: PMC9086188 DOI: 10.3389/fphar.2022.878972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Conventional synthetic disease-modifying antirheumatic drugs are the first-line treatment to inhibit the progression of psoriatic arthritis. Despite their widespread clinical use, few studies have been conducted to compare these drugs for psoriatic arthritis. Methods: a longitudinal study was carried out based on a centered patient national database in Brazil. Market share of drugs, medication persistence, drug costs, and cost per response were evaluated. Results: a total of 1,999 individuals with psoriatic arthritis were included. Methotrexate was the most used drug (44.4%), followed by leflunomide (40.6%), ciclosporin (8.2%), and sulfasalazine (6.8%). Methotrexate and leflunomide had a greater market share than ciclosporin and sulfasalazine over years. Medication persistence was higher for leflunomide (58.9 and 28.2%), followed by methotrexate (51.6 and 25.4%) at six and 12 months, respectively. Leflunomide was deemed the most expensive drug, with an average annual cost of $317.25, followed by sulfasalazine ($106.47), ciclosporin ($97.64), and methotrexate ($40.23). Methotrexate was the drug being the lowest cost per response. Conclusion: Methotrexate had the best cost per response ratio, owing to its lower cost and a slightly lower proportion of persistent patients when compared to leflunomide. Leflunomide had a slightly higher medication persistence than methotrexate, but it was the most expensive drug.
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Affiliation(s)
- Ronaldo José Faria
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
| | | | - Jéssica Barreto Ribeiro dos Santos
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
| | | | | | | | - Michael Ruberson Ribeiro da Silva
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
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7
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Casasola-Vargas J, Flores-Alvarado D, Silveira LH, Sicsik-Ayala S, Reyes-Cordero G, Villanueva Quintero G, Amaya Guerra M, Reyes Orozco SG, Zazueta Montiel BE, Hernández-Paz R, Mendoza-Fuentes A, Bernard-Medina AG, López Rodriguez A, Barbosa Cobos RE, Burgos-Vargas R, Pacheco-Tena C. Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. REUMATOLOGIA CLINICA 2021; 17:611-621. [PMID: 34305032 DOI: 10.1016/j.reumae.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022]
Abstract
Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.
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Affiliation(s)
- Julio Casasola-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Diana Flores-Alvarado
- Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Monterrey, Nuevo León, Nuevo León, Mexico
| | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Sandra Sicsik-Ayala
- Hospital De Especialidades 71, Unidad Médica De Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | | | - Mario Amaya Guerra
- Centro de Salud y Desarrollo, Universidad de Monterrey, Monterrey, Nuevo León, Mexico
| | - Sara G Reyes Orozco
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Beatriz E Zazueta Montiel
- Centro Médico del Ángel S.C. Centro de Investigación de Enfermedades Reumáticas, Mexicali, Baja California, Mexico
| | | | | | | | | | | | - Rubén Burgos-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico.
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8
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Kedia AK, Mohansundaram K, Goyal M, Ravindran V. Safety of long-term use of four common conventional disease modifying anti-rheumatic drugs in rheumatoid arthritis. J R Coll Physicians Edinb 2021; 51:237-245. [PMID: 34528610 DOI: 10.4997/jrcpe.2021.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Conventional disease-modifying antirheumatic drugs (DMARDs) have been used in the management of rheumatoid arthritis for a long time. Whereas methotrexate (MTX) is the anchor drug, leflunomide, hydroxychloroquine and sulfasalazine are used along with MTX either in combination or sequentially. Together these four drugs are the most commonly used DMARDs. They are also used in combination with biological DMARDs (bDMARDs) to enhance their efficacy and MTX in particular to reduce antibodies against anti-tumour necrosis factor. Despite their widespread use, concerns regarding their safety especially when used long-term hinder their optimum use in clinical medicine. In this narrative review we have critically appraised the available literature regarding the safety of these four DMARDs when used long-term.
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Affiliation(s)
| | - Kavitha Mohansundaram
- Department of Rheumatology, Saveetha Medical College Hospital, Chennai, Tamilnadu, India
| | - Mohit Goyal
- CARE Pain & Arthritis Centre, Goyal Hospital, Udaipur, Rajasthan, India
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9
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Casasola-Vargas J, Flores-Alvarado D, Silveira LH, Sicsik-Ayala S, Reyes-Cordero G, Villanueva Quintero G, Amaya Guerra M, Reyes Orozco SG, Zazueta Montiel BE, Hernández-Paz R, Mendoza-Fuentes A, Bernard-Medina AG, López Rodriguez A, Barbosa Cobos RE, Burgos-Vargas R, Pacheco-Tena C. Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. REUMATOLOGIA CLINICA 2021; 17:S1699-258X(21)00029-2. [PMID: 33931333 DOI: 10.1016/j.reuma.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/20/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022]
Abstract
Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.
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Affiliation(s)
- Julio Casasola-Vargas
- Servicio de Reumatología. Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Diana Flores-Alvarado
- Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Monterrey, Nuevo León, Nuevo León, México
| | - Luis H Silveira
- Departamento de Reumatología. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sandra Sicsik-Ayala
- Hospital de Especialidades 71. Unidad Médica De Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | - Mario Amaya Guerra
- Centro de Salud y Desarrollo. Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Sara G Reyes Orozco
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Beatriz E Zazueta Montiel
- Centro Médico del Ángel S.C. Centro de Investigación de Enfermedades Reumáticas, Mexicali, Baja California, México
| | | | | | | | | | - Rosa E Barbosa Cobos
- Departamento de Reumatología, Hospital Juárez de México, Ciudad de México, México
| | - Rubén Burgos-Vargas
- Servicio de Reumatología. Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México.
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Tsai TF, Hsieh TY, Chi CC, Chou CT, Hsieh LF, Chen HH, Hui RCY, Lee CH, Liu CH, Liu HC, Yeo KJ, Chen CH, Chen HA, Chen YC, Chen YJ, Chiu HY, Ho JC, Huang YH, Lai PJ, Lee WR, Liao HT, Lin SH, Tseng JC, Wang TS, Wu NL, Yang DH, Tsai WC, Wei JCC. Recommendations for psoriatic arthritis management: A joint position paper of the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology. J Formos Med Assoc 2021; 120:926-938. [PMID: 33012636 DOI: 10.1016/j.jfma.2020.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/25/2020] [Accepted: 08/18/2020] [Indexed: 01/14/2023] Open
Abstract
In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan; Program of Business, College of Business, Feng Chia University, Taichung, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital-Keelung, Keelung, Taiwan
| | - Chih-Hung Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hwa-Chang Liu
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Kai-Jieh Yeo
- Division of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hung-An Chen
- Department of Allergy, Immunology, and Rheumatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ji-Chen Ho
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Ju Lai
- Division of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Woan-Ruoh Lee
- Department of Dermatology, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan; Department of Dermatology, School of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Medical Science, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Hung Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; Division of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
| | - Nan-Lin Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan; Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Chan Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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11
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Lai TL, Au CK, Chung HY, Leung MC, Ng WL, Lau CS. Fatigue in psoriatic arthritis: Is it related to disease activity? Int J Rheum Dis 2021; 24:418-425. [PMID: 33506651 DOI: 10.1111/1756-185x.14069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022]
Abstract
AIM Fatigue is commonly associated with psoriatic arthritis (PsA). However, information about its prevalence and associated factors is sparse. The primary objective here was to find the prevalence and magnitude of PsA fatigue. The secondary objective was to explore its associated risk factors, particularly emphasis on the effect of disease activity control. METHODS PsA patients who fulfilled Classification Criteria For Psoriatic Arthritis were consecutively recruited from local rheumatology clinics. Fatigue was assessed by a 13-item self-administered questionnaire (Functional Assessment of Chronic Illness Therapy - Fatigue [FACIT-F]) (0-52). Data collected and analyzed included: demographic data, disease activity data, comorbidities and medications use. RESULTS There were 231 eligible PsA patients recruited. The mean FACIT-F score was 37.5 ± 9.1. Severe fatigue, defined as FACIT-F score < 30, was found in 49 (22.1%) of them. The univariate model identified these associated factors of fatigue: tender and swollen joint count, dactylitis count, Psoriasis Area and Severity Index (PASI) score, pain and general health perception, Disease Activity in Psoriatic Arthritis (DAPSA) score, Health Assessment Questionnaire, the use of cyclosporine, sulphasalazine and biologic agents. The final regression model identified DAPSA and PASI were closely associated with severe fatigue (P = .003 and P = .04 respectively). No associations with fatigue were found between age, gender, disease duration, comorbidities and medication use. However, there were weak correlations between the magnitude of FACIT-F score, DAPSA and PASI with r = -.3 and r = -.26 respectively. CONCLUSION Severe fatigue was common in PsA patients, and its magnitude was closely correlated with DAPSA and PASI score, indicating its multifactorial nature. Achieving DAPSA and PASI remission could significantly alleviate the fatigue intensity to a certain extent. However, treatment for PsA-related fatigue should adopt a multidisciplinary approach in addition to disease activity control.
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Affiliation(s)
- Tin Lok Lai
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Chi Kit Au
- Rheumatology Team, Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Ho Yin Chung
- Rheumatology & Clinical Immunology team, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Man Chi Leung
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
| | - Woon Leung Ng
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
| | - Chak Sing Lau
- Rheumatology Team, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong
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12
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Schmalzing M, Behrens F, Schwaneck EC, Koehm M, Greger G, Gnann H, Burkhardt H, Tony HP. Does concomitant methotrexate confer clinical benefits in patients treated with prior biologic therapy? Analysis of data from a noninterventional study of rheumatoid arthritis patients initiating treatment with adalimumab. Medicine (Baltimore) 2020; 99:e20201. [PMID: 32384515 PMCID: PMC7220320 DOI: 10.1097/md.0000000000020201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Most studies of methotrexate (MTX) in combination with tumor necrosis factor (TNF) inhibitors have focused on treatment-naive patients with early disease. The goal of this study was to evaluate whether previous biologic therapy influenced the impact of concomitant MTX in patients initiating treatment with adalimumab.We retrospectively analyzed data from 2 large noninterventional studies of German patients with active rheumatoid arthritis (RA) who initiated adalimumab therapy during routine clinical practice. Patients were seen between April 2004 and February 2013 for study 1 and between April 2003 and March 2013 for study 2. Key outcomes were Disease Activity Score-28 joints (DAS28), patient global assessment of health (PGA), and pain. Subgroup analyses by prior biologic treatment were performed on patients treated with continuous adalimumab monotherapy or adalimumab plus MTX for 12 months and 2-sample t tests were used to evaluate differences. We also assessed outcomes in subgroups in which MTX had been added or removed at 6 months and compared outcomes with 1-sample t tests.Of 2654 patients, 1911 (72%) were biologic naive and 743 (28%) had received prior biologic therapy, usually with a TNF inhibitor. All subgroups showed improvements following initiation of adalimumab therapy. In patients with no previous biologic treatment, continuous adalimumab plus MTX was associated with greater improvements in DAS28, PGA, and pain at month 12 compared with continuous adalimumab monotherapy (P = .0006, .0031, and .0032, respectively). In patients with previous biologic treatment, concomitant MTX was associated with statistically significant benefits in pain only. Adding MTX at month 6 resulted in additional benefits in patients with no prior biologic therapy, but not those with previous biologics.We conclude that concomitant MTX resulted in additional improvements in DAS28 and PGA vs adalimumab monotherapy in patients with no previous biologic therapy, but changes were not statistically significant in patients treated with prior biologics. These findings may help inform the patient/provider treatment decision during routine clinical care.
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Affiliation(s)
- Marc Schmalzing
- Rheumatology/Clinical Immunology, University Hospital Würzburg
| | - Frank Behrens
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main
| | | | - Michaela Koehm
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main
| | | | - Holger Gnann
- Abteilung Biostatistik, GKM Gesellschaft für Therapieforschung mbH, München, Germany
| | - Harald Burkhardt
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main
| | - Hans-Peter Tony
- Rheumatology/Clinical Immunology, University Hospital Würzburg
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13
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Li H, Wang Y, Zhou Z, Tian F, Yang H, Yan J. Combination of leflunomide and benazepril reduces renal injury of diabetic nephropathy rats and inhibits high-glucose induced cell apoptosis through regulation of NF-κB, TGF-β and TRPC6. Ren Fail 2020; 41:899-906. [PMID: 31552773 PMCID: PMC6764370 DOI: 10.1080/0886022x.2019.1665547] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To investigate effects of combination use of leflunomide and benazepril on diabetic nephropathy (DN) both in vivo and in vitro. Methods: The streptozotocin (STZ) induced Sprague-Dawley rats were treated with leflunomide (15 mg/kg/d), benazepril (15 mg/kg/d) or both the two drugs. Fasting blood glucose (FBG) and renal function indexes including blood urea nitrogen (BUN), serum creatinine (Scr), and proteinuria and kidney/body weight ratio (KW/BW) were measured. HE staining was used for histological analysis. The rat glomerular mesangial cells (RMCs) were treated with high-glucose (150 mg/ml) and the leflunomide and benazepril with both concentrations of 50 μmol/l were used to treat the high-glucose induced cells. TUNEL assay was used for measurement of cell apoptosis. Western blotting was conducted to determine expression of nuclear factor Kappa B (NF-κB), transforming growth factor-β (TGF-β) and transient receptor potential canonical 6 (TRPC6). Results: The body weight was significantly lower and all indexes of FBG, BUN, Scr, proteinuria and KW/BW ratio, GFR, as well as inflammatory factors TNF-α and IL-6 were significantly increased in the DN group after STZ treatment for 4 weeks. The treatment with leflunomide, benazepril or the both dramatically reduced the above effects induced by STZ, and the alteration was the most significant in the combination group. Treatment of leflunomide and benazepril significantly reduced expression levels of NF-κB, TGF-β and TRPC6 in renal tissues of DN rats as well as in high-glucose induced RMCs. It was also observed leflunomide and benazepril reduced high-glucose induced cell apoptosis of RMCs. Conclusion: The combination use of leflunomide and benazepril could improve the renal function and reduce the renal injury of DN rats and could reduce the levels of NF-κb, TGF-β and TRPC6 in both DN rats and high-glucose induced RMCs.
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Affiliation(s)
- Huili Li
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
| | - Yuanyuan Wang
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
| | - Zhangqing Zhou
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
| | - Fang Tian
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
| | - Huanhuan Yang
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
| | - Juzhen Yan
- Department of Nephrology, Xixi Hospital of Hangzhou (Hangzhou XIXI Affiliated Hospital of Zhejiang Chinese Medical University) , Hangzhou , Zhejiang Province , People's Republic of China
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14
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Dai Q, Xu L, Yu X. Efficacy and safety of leflunomide in psoriatic arthritis treatment: A single-arm meta-analysis. Int J Rheum Dis 2019; 22:1498-1505. [PMID: 31134727 DOI: 10.1111/1756-185x.13599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/24/2019] [Accepted: 04/16/2019] [Indexed: 01/17/2023]
Abstract
AIM To systematically assess the clinical efficacy and safety of leflunomide for treating psoriatic arthritis (PsA). METHODS PubMed, Embase, and Cochrane Library databases were searched until 1 January, 2018, to include relevant studies in this single-arm meta-analysis. Psoriasis improvement was evaluated using Psoriasis Area and Severity Index (PASI) scores. The primary outcome in patients was assessed using the Psoriatic Arthritis Response Criteria (PsARC). Other effectiveness evaluations included those of adverse events, quality of life including functional status (Health Assessment Questionnaire [HAQ] total score), and a quality-of-life instrument for dermatologic diseases (Dermatology Life Quality Index [DLQI] total score). RESULTS A total of 6 studies were included. After leflunomide treatment, 48% of the patients experienced a reduction of ≥50% based on PASI scores (95% confidence interval [CI]: 0.22-0.73). PASI 75 improvement was observed among 25% of the patients (95% CI: 0.11-0.38). The primary effectiveness analysis revealed that 15% of the patients (95% CI: 0.07-0.26) discontinued leflunomide treatment. Further, 77% of the patients (95% CI: 0.59-0.92) achieved a PsARC response. Adverse events occurred in 38% of the patients (95% CI: 0.04-0.71). The mean ± SD percentage PASI improvement was -4.88 (95% CI: -8.92, -0.85). Moreover, DLQI and HAQ were -2.02 (95% CI: -3.01, -1.03) and -0.19 (95% CI: -0.29, -0.09), respectively. CONCLUSIONS Leflunomide is an effective and well-tolerated treatment for PsA, and would be a safe and convenient option.
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Affiliation(s)
- Qiaoding Dai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China.,The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Liping Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Xiali Yu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China
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15
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Medication persistence for psoriatic arthritis in a Brazilian real-world setting. Future Sci OA 2019; 5:FSO369. [PMID: 30820348 PMCID: PMC6391629 DOI: 10.4155/fsoa-2018-0101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022] Open
Abstract
Aim: To evaluate the persistence of biological (TNF inhibitor [anti-TNF]) and synthetic (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs]) antirheumatic agents for psoriatic arthritis and their associated factors. Methods: A historical cohort was developed. Persistence and associated factors were evaluated at 6 and 12 months. Results: A total of 161 patients were included. The anti-TNF treatment presented higher persistence as compared with csDMARDs at 6 (83.4 vs 50.8%; p < 0.05) and 12 months (66.4 vs 35.6%; p < 0.05). From anti-TNFs, adalimumab and etanercept presented similar persistence, along with leflunomide and methotrexate among the csDMARDs. The factors associated with non-persistence with regard to anti-TNF agents were female sex and use of infliximab. Conclusion: Anti-TNF agents are important therapeutic alternatives and present lower rates of discontinuation as compared with csDMARDs. Conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and anti-TNF agents were included in the Brazilian National Health System in 2009, yet were not previously the target of evaluations in a Brazilian context. Persistence, that is the time between starting and discontinuing the drug, is a proxy of effectiveness and safety for antirheumatic agents. This study evaluated medication persistence and relevant factors associated with it. Patients using infliximab showed a lower medication persistence when compared with adalimumab and etanercept. The medication persistence with anti-TNF agents was higher when compared with csDMARDs. Female sex and infliximab were predictors of medication non-persistence.
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16
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Elmamoun M, Leung YY, O'Sullivan D, Steinkoenig I, Chandran V, Gladman DD, FitzGerald OM, Orbai AM, Eder L. Using Acute-phase Reactants to Inform the Development of Instruments for the Updated Psoriatic Arthritis Core Outcome Measurement Set. J Rheumatol 2018; 46:266-273. [PMID: 30385708 DOI: 10.3899/jrheum.180195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Systemic inflammationˆ is assessed through measurement of acute-phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). With few exceptions, most randomized controlled trials (RCT) have assessed acute-phase reactants (CRP and ESR) as part of the American College of Rheumatology (ACR) 20 response criteria. As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) working group, we performed a systematic review of the literature to assess the performance of inflammatory biomarkers in psoriatic arthritis (PsA). METHODS A systematic search of PubMed and Embase was performed. The search included peer-reviewed articles and scientific meeting abstracts about RCT and longitudinal observational studies that assessed systemic inflammation using acute-phase reactants in PsA. Studies were assessed following the components of the OMERACT filter including construct validity, responsiveness, and predictive validity. RESULTS There were 2764 articles retrieved, and 71 articles were included for this systematic review. Twenty-eight articles reported CRP and/or ESR separately, and the remaining articles reported CRP and/or ESR as part of the ACR response criteria. Studies assessing OMERACT responsiveness provided conflicting reports. Inflammatory biomarkers had construct validity for more active disease. Evidence suggests that an elevation of ESR predicts cardiovascular outcomes. CONCLUSION Data regarding assessment of systemic inflammation using acute-phase reactants (CRP and ESR) are limited. There is only weak evidence to support normalization of these biomarkers in predicting good clinical outcomes/remission criteria. The predictive value for cardiovascular outcomes was generally good. Further studies to assess systemic inflammation in PsA using acute-phase reactants and other laboratory biomarkers are needed.
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Affiliation(s)
- Musaab Elmamoun
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ying Ying Leung
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Denis O'Sullivan
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ingrid Steinkoenig
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Vinod Chandran
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Dafna D Gladman
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Oliver M FitzGerald
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ana-Maria Orbai
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Lihi Eder
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto.
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Treatment of Enthesitis, Dactylitis and Nail Lesions in Psoriatic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D'Angelo S, Carriero A, Gilio M, Ursini F, Leccese P, Palazzi C. Safety of treatment options for spondyloarthritis: a narrative review. Expert Opin Drug Saf 2018; 17:475-486. [PMID: 29505325 DOI: 10.1080/14740338.2018.1448785] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Spondyloarthritis (SpA) are chronic inflammatory diseases with overlapping pathogenic mechanisms and clinical features. Treatment armamentarium against SpA includes non-steroidal anti-inflammatory drugs, glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs, including sulfasalazine, methotrexate, leflunomide, cyclosporine), targeted synthetic DMARDs (apremilast) and biological DMARDs (TNF inhibitors, anti-IL 12/23 and anti-IL-17 agents). AREAS COVERED A narrative review of published literature on safety profile of available SpA treatment options was performed. Readers will be provided with a comprehensive overview on frequent and rare adverse events associated with each drug listed in current SpA treatment recommendations. EXPERT OPINION The overall safety profile of such molecules is good and serious adverse events are rare but need to be promptly recognized and treated. However, the monitoring of adverse events is a major challenge for clinicians because it is not adequately addressed by current treatment recommendations. A tailored treatment is crucial and rheumatologists must accurately select patients in order to identify those more susceptible to develop adverse events.
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Affiliation(s)
- Salvatore D'Angelo
- a Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy.,b Basilicata Ricerca Biomedica (BRB) Foundation , Potenza , Italy
| | - Antonio Carriero
- a Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy.,c Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Michele Gilio
- a Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy
| | - Francesco Ursini
- d Department of Health Sciences , University of Catanzaro "Magna Graecia" , Catanzaro , Italy
| | - Pietro Leccese
- a Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy
| | - Carlo Palazzi
- a Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy
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Maese J, Díaz del Campo P, Seoane-Mato D, Guerra M, Cañete JD. Eficacia de los fármacos antirreumáticos modificadores de la enfermedad sintéticos en artritis psoriásica: una revisión sistemática. ACTA ACUST UNITED AC 2018; 14:81-89. [DOI: 10.1016/j.reuma.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
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Schemoul J, Poulain C, Claudepierre P. Treatment strategies for psoriatic arthritis. Joint Bone Spine 2017; 85:537-544. [PMID: 29155104 DOI: 10.1016/j.jbspin.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
The therapeutic management of psoriatic arthritis has seen major changes over the last few years, as illustrated by the recent updates of the GRAPPA and EULAR recommendations. These changes were driven by new studies establishing important benefits from early management and tight control of disease activity. The concepts underlying the treatment of psoriatic arthritis must be reappraised in the light of these new data. The objectives of this review are to discuss new concepts, to describe and assess the new drug classes introduced for psoriatic arthritis and, whenever possible, to define the specific indications of each class based on the rheumatic disease phenotype and presence of extraarticular manifestations.
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Affiliation(s)
- Julien Schemoul
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Cécile Poulain
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Pascal Claudepierre
- Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; EA 7379, Epiderm E, université Paris Est-Créteil, 94010 Créteil, France.
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21
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Haneke E. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management. PSORIASIS (AUCKLAND, N.Z.) 2017; 7:51-63. [PMID: 29387608 PMCID: PMC5774607 DOI: 10.2147/ptt.s126281] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy, nail bed involvement may cause salmon spots, subungual hyperkeratosis, and splinter hemorrhages, and psoriasis of the distal nail bed and hyponychium causes onycholysis whereas that of the proximal nail fold causes psoriatic paronychia. The more extensive the involvement, the more severe is the nail destruction. Pustular psoriasis may be seen as yellow spots under the nail or, in case of acrodermatitis continua suppurativa, as an insidious progressive loss of the nail organ. Nail psoriasis has a severe impact on quality of life and may interfere with professional and other activities. Management includes patient counseling, avoidance of stress and strain to the nail apparatus, and different types of treatment. Topical therapy may be tried but is rarely sufficiently efficient. Perilesional injections with corticosteroids and methotrexate are often beneficial but may be painful and cannot be applied to many nails. All systemic treatments clearing widespread skin lesions usually also clear the nail lesions. Recently, biologicals were introduced into nail psoriasis treatment and found to be very effective. However, their use is restricted to severe cases due to high cost and potential systemic adverse effects.
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Affiliation(s)
- Eckart Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland
- Dermatology Practice Dermaticum, Freiburg, Germany
- Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal
- Department of Dermatology, University Hospital, Gent, Belgium
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22
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Dereure O, Camu W. Teriflunomide-induced psoriasiform changes of fingernails: a new example of paradoxical side effect? Int J Dermatol 2017; 56:1479-1481. [DOI: 10.1111/ijd.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Olivier Dereure
- Department of Dermatology; INSERM U1058; University of Montpellier; Montpellier France
| | - William Camu
- Department of Neurology; University of Montpellier; Montpellier France
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23
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Behrens F, Thaçi D, Wollenhaupt J, Krüger K. [Psoriatic arthritis : Overview of drug therapy options and administration characteristics]. Hautarzt 2017; 68:153-169. [PMID: 28083597 DOI: 10.1007/s00105-016-3925-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Psoriatic arthritis is a chronic inflammatory disease of the musculoskeletal system with association to skin psoriasis and is characterized by variable clinical symptoms with very heterogeneous degrees of disease suffering for patients. Clinical manifestations essentially include alterations to the skin and nails, peripheral arthritis, enthesitis, dactylitis and/or spinal involvement. This variability necessitates an individualized therapy of patients with different therapy targets. Apart from international guidelines no therapy recommendations are available in Germany for treatment of psoriatic arthritis. For this reason this article summarizes the established points, characteristics and aspects to be considered in the therapy of psoriatic arthritis in Germany, taking the various main forms of the disease into consideration.
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Affiliation(s)
- F Behrens
- CIRI/Rheumatologie und Fraunhofer IME, Translationale Medizin und Pharmakologie, Universitätsklinikum Goethe Universität Frankfurt, Frankfurt am Main, Deutschland
| | - D Thaçi
- Exzellenzzentrum Entzündungsmedizin, UKSH - Campus Lübeck, Lübeck, Deutschland
| | - J Wollenhaupt
- Rheumatologikum Hamburg an der Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
| | - K Krüger
- Internistisch-rheumatologische Praxis, München, Deutschland
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24
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Maharaj AB, Chandran V. Treatment of psoriatic arthritis with traditional DMARD’s and novel therapies: approaches and recommendations. Expert Rev Clin Immunol 2016; 13:319-331. [DOI: 10.1080/1744666x.2017.1257939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ajesh B. Maharaj
- Department of Internal Medicine, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vinod Chandran
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto Western Hospital, Toronto, Canada
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Abstract
Nail involvement affects 80-90 % of patients with plaque psoriasis, and is even more prevalent in patients with psoriatic arthritis. This review is the result of a systemic approach to the literature and covers topical, intralesional, conventional systemic, and biologic systemic treatments, as well as non-pharmacological treatment options for nail psoriasis. The available evidence suggests that all anti-tumor necrosis factor-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies which are available for plaque psoriasis and psoriatic arthritis are highly effective treatments for nail psoriasis. Conventional systemic treatments, including methotrexate, cyclosporine, acitretin, and apremilast, as well as intralesional corticosteroids, can also be effective treatments for nail psoriasis. Topical treatments, including corticosteroids, calcipotriol, tacrolimus, and tazarotene, have also been shown to have a position in the treatment of nail psoriasis, particularly in mild cases. Finally, non-pharmacological treatment options, including phototherapy, photodynamic therapy, laser therapy, and several radiotherapeutic options, are also reviewed but cannot be advised as first-line treatment options. Another conclusion of this review is that the lack of a reliable core set of outcomes measures for trials in nail psoriasis hinders the interpretation of results, and is urgently needed.
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Affiliation(s)
- Marcel C Pasch
- Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen (370), The Netherlands.
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28
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Sritheran D, Leung YY. Making the next steps in psoriatic arthritis management: current status and future directions. Ther Adv Musculoskelet Dis 2015; 7:173-86. [PMID: 26425146 DOI: 10.1177/1759720x15595966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition with articular and extra-articular manifestations: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail disease. It is associated with cardiovascular comorbidities. It is now recognized as a new entity, different from rheumatoid arthritis and other spondyloarthritis in terms of clinical manifestations, pathogenesis, and response to therapies. Anti-tumor necrosis factors (anti-TNFs) have demonstrated clinical efficacies exceeding that of conventional disease modifying antirheumatic drugs (DMARDs). The current treatment paradigms recommend early diagnosis and treatment, and a strategic and target orientated approach, aiming at a low disease activity status. New understanding in the immunopathogenesis of PsA has led to new treatment targets. This review addresses the evidence of current treatment for each of the domains as an aid to the clinician managing these patients in the clinic. Some new therapeutic targets are presented. We highlight the importance of development and validation in outcome measures, including that of composite scores that capture various disease domains that will facilitate future clinical trials to inform the best treatment.
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Affiliation(s)
- Diviya Sritheran
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, he Academia, Level 4, 20 College Road, 169856, Singapore and Duke-NUS Graduate Medical School, Singapore
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29
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Abstract
Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory spondyloarthropathy that affects approximately one-third of patients with all types of psoriasis. Dermatologists are in a unique position to recognize early symptoms of PsA, initiate appropriate therapy, and prevent development of further disability. The course of PsA can be modulated by immunosuppressive therapy; patients with moderate-to-severe disease require aggressive management with medications proven to halt disease progression. It is essential for the dermatologist to understand the safety, tolerability, efficacy, cost, and potential to halt disease progression with available medications for this relatively common and potentially disabling disease.
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Affiliation(s)
- Suzanne J Tintle
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA.
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA
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30
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Kang EJ, Kavanaugh A. Psoriatic arthritis: latest treatments and their place in therapy. Ther Adv Chronic Dis 2015; 6:194-203. [PMID: 26137209 DOI: 10.1177/2040622315582354] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease that may affect peripheral and axial joints, entheses, skin and nails, and other organs. Treatment with nonsteroidal anti-inflammatory drugs, steroid and disease-modifying antirheumatic drugs had been the backbone of traditional management of PsA for many years. However, improvement in our understanding of immunopathogenesis of PsA has led to new immunomodulatory therapies. Introduction of novel agents has raised the bar for treatment and helped drive research into additional therapeutic options.
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Affiliation(s)
- Eun Jin Kang
- Division of Rheumatology, Department of Medicine, Busan Medical Center, Busan, Republic of Korea
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, Center for Innovative Therapy, University of California, San Diego, 9500 Gilman Drive, Mail Code 0943, La Jolla, CA 92037, USA
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31
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Palazzi C, D’Angelo S, Gilio M, Leccese P, Padula A, Olivieri I. Pharmacological therapy of spondyloarthritis. Expert Opin Pharmacother 2015; 16:1495-504. [DOI: 10.1517/14656566.2015.1052744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kujawski J, Bernard MK, Jodłowska E, Czaja K, Drabińska B. On the interactions of leflunomide and teriflunomide within receptor cavity--NMR studies and energy calculations. J Mol Model 2015; 21:105. [PMID: 25851105 PMCID: PMC4391734 DOI: 10.1007/s00894-015-2643-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Abstract
Leflunomide is a disease-modifying antirheumatic drug with antiinflammatory and immunosuppressive activity used for the treatment of psoriatic and rheumatoid arthritis. It undergoes rapid metabolization to teriflunomide, a metabolite that is responsible for the biological activity of leflunomide. Continuing our investigations on the interactions of biologically important azahetarenes with the environment, we focused on leflunomide and its active metabolite, teriflunomide, considering the interactions teriflunomide–amino acid within the target protein (dihydroorotate dehydrogenase) using density functional theory, as well as ONIOM techniques. The results of theoretical studies have shown that the interactions of teriflunomide with tyrosine and arginine involve principally the amide fragment of teriflunomide. The presence of the internal hydrogen bond between (Z)-teriflunomide carbonyl oxygen and enolic hydroxyl decreases the interaction strength between teriflunomide and tyrosine or arginine. Even the E isomer of teriflunomide would usually provide a stronger interaction teriflunomide—amino acid than the Z isomer with the internal hydrogen bond. The interactions of leflunomide and teriflunomide within receptor cavityᅟ ![]()
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Affiliation(s)
- Jacek Kujawski
- Department of Organic Chemistry, Faculty of Pharmacy, Poznan University of Medical Sciences, Grunwaldzka 6 street, 60-780, Poznań, Poland,
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Rohekar S, Chan J, Tse SM, Haroon N, Chandran V, Bessette L, Mosher D, Flanagan C, Keen KJ, Adams K, Mallinson M, Thorne C, Rahman P, Gladman DD, Inman RD. 2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations. J Rheumatol 2015; 42:665-81. [DOI: 10.3899/jrheum.141001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/01/2023]
Abstract
Objective.The Canadian Rheumatology Association (CRA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) have collaborated to update the recommendations for the management of spondyloarthritis (SpA).Methods.A working group was assembled and consisted of the SPARCC executive committee, rheumatologist leaders from SPARCC collaborating sites, Canadian rheumatologists from across the country with an interest in SpA (both academic and community), a rheumatology trainee with an interest in SpA, an epidemiologist/health services researcher, a member of the CRA executive, a member of the CRA therapeutics committee, and a patient representative from the Canadian Spondylitis Association. An extensive review was conducted of literature published from 2007 to 2014 involving the management of SpA. The working group created draft recommendations using multiple rounds of Web-based surveys and an in-person conference.Results.Recommendations for the management of SpA were created. Part II: Specific Management Recommendations addresses management with nonpharmacologic methods, nonsteroidal anti-inflammatories and analgesics, disease-modifying antirheumatic drugs, antibiotics, tumor necrosis factor inhibitors, other biologic agents, and surgery. Also included are 10 modifications for application to juvenile SpA.Conclusion.These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that implementation of these recommendations will promote best practices in the treatment of SpA.
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35
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Management of psoriatic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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36
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A Case of Multicentric Carcinoid in a Patient with Psoriatic Spondyloarthropathy. Case Rep Rheumatol 2015; 2015:179696. [PMID: 25802789 PMCID: PMC4353421 DOI: 10.1155/2015/179696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/17/2015] [Indexed: 11/19/2022] Open
Abstract
We describe the first case of a patient presenting with multicentric carcinoid occurring in the lung and subsequently in the rectum, with chronic psoriatic arthritis. Although reports have been published regarding carcinoid syndrome occurring alongside rheumatoid arthritis, no reports have been made on such a case. Initial presentation of carcinoid syndrome in this patient was insidious and atypical with few symptoms, including shortness of breath and long standing abdominal bloating. Several years later a sudden change in bowel habit prompted a colonoscopy with biopsy that revealed a carcinoid rectal polyp. The case we report describes a rare presentation of carcinoid syndrome in chronic psoriatic arthropathy.
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Acosta Felquer ML, Coates LC, Soriano ER, Ranza R, Espinoza LR, Helliwell PS, FitzGerald O, McHugh N, Roussou E, Mease PJ. Drug Therapies for Peripheral Joint Disease in Psoriatic Arthritis: A Systematic Review. J Rheumatol 2014; 41:2277-85. [DOI: 10.3899/jrheum.140876] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for peripheral joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.
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38
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Armstrong AW, Tuong W, Love TJ, Carneiro S, Grynszpan R, Lee SS, Kavanaugh A. Treatments for Nail Psoriasis: A Systematic Review by the GRAPPA Nail Psoriasis Work Group. J Rheumatol 2014; 41:2306-14. [DOI: 10.3899/jrheum.140881] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).
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39
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Caruntu C, Boda D, Dumitrascu G, Constantin C, Neagu M. Proteomics focusing on immune markers in psoriatic arthritis. Biomark Med 2014; 9:513-28. [PMID: 25034152 DOI: 10.2217/bmm.14.76] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The immune-pathogenesis of psoriatic arthritis represents a subject of intense research, as a still unknown factor can trigger the chronic inflammation that, upon a defective immune terrain, generates this auto-immune/auto-inflammatory condition. The pathogenesis complexity of psoriatic arthritis resides in the psoriatic synovitis milieu, where intricate immune relations are emerging during disease development. Innate immune response generates inflammatory cytokines driving effectors functions for immune and non-immune cells that sustain the chronical character of the synovitis. Herein, we review the updated information regarding biomarkers/immune markers that sustain the heterogeneity and complexity of psoriatic arthritis pathogenesis, this complexity leading to multifaceted methodological approaches for disease investigation. New immune proteomic or genomic biomarkers can enlarge and identify new therapeutic targets.
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Affiliation(s)
- Constantin Caruntu
- Dermatology Research Laboratory, "Carol Davila" University of Medicine & Pharmacy, 22-24 Gr. Manolescu, 0111234, Sector 1, Bucharest, Romania.,"Victor Babes" National Institute of Pathology,99-101 Splaiul Independentei, 050096, Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, "Carol Davila" University of Medicine & Pharmacy, 22-24 Gr. Manolescu, 0111234, Sector 1, Bucharest, Romania
| | - Georgiana Dumitrascu
- "Victor Babes" National Institute of Pathology,99-101 Splaiul Independentei, 050096, Bucharest, Romania
| | - Carolina Constantin
- "Victor Babes" National Institute of Pathology,99-101 Splaiul Independentei, 050096, Bucharest, Romania
| | - Monica Neagu
- "Victor Babes" National Institute of Pathology,99-101 Splaiul Independentei, 050096, Bucharest, Romania
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40
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Olivieri I, D'Angelo S, Palazzi C, Padula A. Advances in the management of psoriatic arthritis. Nat Rev Rheumatol 2014; 10:531-42. [DOI: 10.1038/nrrheum.2014.106] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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41
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Baronaite Hansen R, Kavanaugh A. Treatment options for psoriatic arthritis. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.917952] [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: 11/05/2022]
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42
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Sevrain M, Villani A, Rouzaud M, Barnetche T, Paul C, Richard MA, Beylot-Barry M, Jullien D, Aractingi S, Aubin F, Joly P, Le Maitre M, Cantagrel A, Ortonne JP, Misery L. Treatment (biotherapy excluded) of psoriatic arthritis: an appraisal of methodological quality of international guidelines. J Eur Acad Dermatol Venereol 2014; 28 Suppl 5:33-9. [DOI: 10.1111/jdv.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Sevrain
- Dermatology Department; Morvan University Hospital; Brest France
| | - A.P. Villani
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - M. Rouzaud
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - T. Barnetche
- Rheumatology Department; Bordeaux University Hospital; Bordeaux France
| | - C. Paul
- Dermatology Department; Paul Sabatier University; UMR CNRS 5165; INSERM 1056; Toulouse France
| | - M.-A. Richard
- Aix-Marseille University; UMR 911; INSERM CRO2; Assistance Publique and Dermatology Department; Timone Hospital; Marseille France
| | - M. Beylot-Barry
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - D. Jullien
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - S. Aractingi
- Dermatology Department; Cochin Tarnier Hospital; APHP; Paris 5 Descartes University; INSERM UMR S 938; UPMC; CDR Saint-Antoine Hospital; Paris France
| | - F. Aubin
- Dermatology Department; Besançon University Hospital and University of Franche-Comté; Besançon France
| | - P. Joly
- Clinique Dermatologique; Rouen University Hospital; Inserm U905; Institute for Research and Innovation in Biomedicine (IRIB); Rouen University; Normandy France
| | | | - A. Cantagrel
- Rheumatology Center; Purpan Teaching Hospital; Toulouse France
| | - J.-P. Ortonne
- Dermatology Department; Nice University; L'Archet II Hospital; Nice France
| | - L. Misery
- Dermatology Department; Morvan University Hospital; Brest France
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43
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Hopkins AM, O'Doherty CE, Foster DJ, Upton RN, Proudman SM, Wiese MD. Individualization of leflunomide dosing in rheumatoid arthritis patients. Per Med 2014; 11:449-461. [PMID: 29783485 DOI: 10.2217/pme.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Leflunomide is largely considered to be a second-line treatment option for rheumatoid arthritis (RA). Those who fail to respond, tend to progress to treatment with expensive biological agents, which can also be associated with serious toxicities. Optimizing leflunomide treatment to meet the needs of individuals would hence be beneficial in terms of patient outcomes and health care expenditure. In this respect, therapeutic drug monitoring (TDM) may be useful, as plasma concentrations of leflunomide's active metabolite, teriflunomide, correlate with response to treatment, but are highly variable between patients. A number of pharmacogenetic markers have also been identified that influence response and toxicity. Incorporation of these findings into clinical practice could facilitate more efficient use of leflunomide.
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Affiliation(s)
- Ashley M Hopkins
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia.,University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Catherine E O'Doherty
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - David Jr Foster
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Richard N Upton
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Susanna M Proudman
- Royal Adelaide Hospital, Department of Rheumatology, North Terrace, Adelaide, South Australia, 5000, Australia.,Adelaide University, Discipline of Medicine, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Michael D Wiese
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
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44
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Enthesitis in psoriatic arthritis. Semin Arthritis Rheum 2013; 43:325-34. [DOI: 10.1016/j.semarthrit.2013.04.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 04/01/2013] [Accepted: 04/11/2013] [Indexed: 12/18/2022]
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45
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Märker-Hermann E. [Therapy of psoriatic arthritis]. Z Rheumatol 2013; 72:784-90. [PMID: 24043297 DOI: 10.1007/s00393-013-1190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In psoriatic arthritis (PsA) the heterogeneous spectrum of the disease with arthritis/synovitis, axial manifestation, enthesitis, dactylitis, psoriatic skin disease and nail psoriasis has to be considered. Moreover, PsA activity and severity as well as comorbidities are of importance for making therapeutic decisions. Measurement instruments developed for therapeutic studies of rheumatoid arthritis or ankylosing spondylitis are often not appropriate for application in PsA investigations. In this paper established therapies with nonsteroidal antirheumatic drugs, disease modifying antirheumatic drugs (DMARDs) and TNF-alpha inhibitors and the current EULAR guidelines from 2012 are reviewed. However, there is a need for new therapeutic agents for those patients who do not respond to or do not tolerate the current therapies. Other biologic agents have also been tested for PsA with moderate effects only. New therapeutic options could result from the anti-IL12 and anti-IL23 receptor monoclonal antibody ustekinumab and from small molecules such as the oral PDE-4 inhibitor apremilast.
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Affiliation(s)
- E Märker-Hermann
- Klinik Innere Medizin IV (Rheumatologie, klinische Immunologie, Nephrologie), HSK Dr. Horst Schmidt Kliniken GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland,
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46
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Huynh D, Kavanaugh A. Psoriatic arthritis: current therapy and future directions. Expert Opin Pharmacother 2013; 14:1755-64. [DOI: 10.1517/14656566.2013.810208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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47
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I Keen H, Conaghan PG, Tett SE. Safety evaluation of leflunomide in rheumatoid arthritis. Expert Opin Drug Saf 2013; 12:581-8. [DOI: 10.1517/14740338.2013.798299] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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48
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Kerschbaumer A, Fenzl KH, Erlacher L, Aletaha D. [Serum phospholipid of patients with sequela of cerebrovascular disorders]. Wien Klin Wochenschr 1971; 128:791-795. [PMID: 27822746 PMCID: PMC5104808 DOI: 10.1007/s00508-016-1111-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
Psoriatic arthritis is a chronic inflammatory joint disease occurring in a subgroup of patients suffering from psoriasis. This article gives an overview of the complexity of psoriatic arthritis, looking at several aspects of this heterogeneous disease, such as epidemiology, important clinical features and comorbidities as well as current concepts of the pathophysiology and subsequent insights in novel treatment targets.
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Affiliation(s)
- Andreas Kerschbaumer
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Karl Landsteiner Institute for Autoimmune Diseases and Rheumatology, Kundratstraße 3, 1100, Vienna, Austria.
| | - Karl H Fenzl
- Karl Landsteiner Institute for Autoimmune Diseases and Rheumatology, Kundratstraße 3, 1100, Vienna, Austria
| | - Ludwig Erlacher
- Karl Landsteiner Institute for Autoimmune Diseases and Rheumatology, Kundratstraße 3, 1100, Vienna, Austria
- 2nd Medical Department with Rheumatology, Osteology and Geriatrics, Kundratstraße 3, 1100, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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