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Skaarup L, Ingrid E, Sepriano A, Nikiphorou E, Østgård R, Lauper K, Grosse-Michaelis I, Kloppenburg M, Glintborg B, Liew DFL, Kragstrup TW. A Systematic Overview of Contraindications and Special Warnings for Biologic and Targeted Synthetic Disease Modifying Antirheumatic Drugs: Establishing a Framework to Create a "Safety Checklist". Drug Saf 2024:10.1007/s40264-024-01461-1. [PMID: 39012469 DOI: 10.1007/s40264-024-01461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND/AIM The purpose of this review is to provide an overview of the contraindications, special warnings, and boxed warnings with the aim to establish a framework to create a prescription safety checklist for a class of drugs or disease indication. This study covers biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs). METHODS We identified contraindications, boxed warnings, and special warnings provided by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). The study included b/tsDMARDs approved for treating rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (SpA), and juvenile idiopathic arthritis (JIA) within the drug-classes anti-CD20, tumor necrosis factor inhibitors (TNFi), interleukin-1 inhibitors (IL-1i), cytotoxic T-lymphocyte-associated protein (CTLA) 4, interleukin-12/23 inhibitors (IL-12/23i), interleukin 6 receptor inhibitors (IL-6Ri), Janus kinase inhibitors (JAKi), phosphodiesterase 4 inhibitors (PDE4i), interleukin-17 inhibitors (IL-17i), and interleukin-23 inhibitors (IL-23i). RESULTS All drug classes, except PDE4i, had contraindications and/or warnings related to infections, including tuberculosis. A warning about herpes zoster was listed for anti-CD20, IL-1i, IL-6Ri, and JAKi, while a warning about hepatitis reactivation was listed for anti-CD20, TNFi, IL-1i, CTLA4-Ig, IL-6Ri, and JAKi. Malignancy risk was mentioned for all drug classes except PDE4i, IL-17i, and IL-23i. Other warnings included demyelinating disease (TNFi, CTLA4-Ig, and IL-6Ri), heart failure (anti-CD20 and TNFi), major adverse cardiac events (JAKi and IL-12/23) and venous thromboembolism (JAKi), hyperlipidemia (IL-6Ri and JAKi), liver impairment (TNFi, IL-1i, IL-6Ri, and JAKi), kidney impairment (IL-1i, JAKi, and PDE4i), inflammatory bowel disease (IL-17i), gastrointestinal perforation (IL-6Ri, JAKi), cytopenia (anti-CD20, TNFi, IL-1i, IL-6Ri, JAKi), and depression (PDE4i). Contraindications and warnings appeared to increase with the passage of time since the drug's approval. CONCLUSION This review provides an overview to establish the framework to create an easily accessible and actionable prescription safety checklist from individual medical product prescription information provided by regulatory medical authorities.
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Affiliation(s)
- Lykke Skaarup
- Department of Biomedicine, Aarhus University, Skou Building, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
- Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Elvina Ingrid
- Department of Rheumatology, Austin Health, Melbourne, Australia
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elena Nikiphorou
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - René Østgård
- Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Kim Lauper
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Tue W Kragstrup
- Department of Biomedicine, Aarhus University, Skou Building, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark.
- Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark.
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Puig L, Notario J, López-Ferrer A, Scheneller-Pavelescu L, Pérez B, Galache C, de la Cueva P, Carrascosa JM. Recommendations from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group on the Management of Patients with Cancer and Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:702-711. [PMID: 38382743 DOI: 10.1016/j.ad.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 02/23/2024] Open
Abstract
Several studies suggest that patients with psoriasis have a higher incidence of neoplasms, especially of the skin, which could be associated with the use of therapies to treat psoriasis. Furthermore, the evidence available on the safety profile of some treatments in this context, and the management of these patients is scarce, which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous. This study provides recommendations on the management and use of the therapies currently available for these patients. They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group, whose goal is to help specialists in the field in their decision-making processes.
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Affiliation(s)
- L Puig
- Servicio de Dermatología, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - B Pérez
- Servicio de Dermatología, Hospital Morales Meseguer, Murcia, España; Facultad de Medicina, Universidad Católica San Antonio, Murcia, España
| | - C Galache
- Departamento de Dermatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, España
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3
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Favalli EG, Maioli G, Caporali R. Biologics or Janus Kinase Inhibitors in Rheumatoid Arthritis Patients Who are Insufficient Responders to Conventional Anti-Rheumatic Drugs. Drugs 2024:10.1007/s40265-024-02059-8. [PMID: 38949688 DOI: 10.1007/s40265-024-02059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/02/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20 years, the improvement of knowledge on the pathogenesis of the disease has made available several drugs targeting key elements of the pathogenetic process, which now represent the preferred treatment option after the failure of first-line therapy with conventional drugs such as methotrexate (MTX). To this category of targeted drugs belong anti-cytokine or cell-targeted biological agents and more recently also Janus kinase inhibitors (JAKis). In the absence to date of specific biomarkers to guide the therapeutic choice in the context of true precision medicine, the choice of the first targeted drug after MTX failure is guided by treatment cost (especially after the marketing of biosimilar products) and by the clinical characteristics of the patient (age, sex, comorbidities and compliance) and the disease (presence or absence of autoantibodies and systemic or extra-articular manifestations), which may influence the efficacy and safety profile of the available products. This viewpoint focuses on the decision-making process underlying the personalized approach to RA therapy and will analyse the evidence in the literature supporting the choice of individual products and in particular the differential choice between biological drugs and JAKis.
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Affiliation(s)
- Ennio Giulio Favalli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Gabriella Maioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
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4
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Spini A, L’Abbate L, Ingrasciotta Y, Pellegrini G, Carollo M, Ientile V, Leoni O, Zanforlini M, Ancona D, Stella P, Cavazzana A, Scapin A, Lopes S, Belleudi V, Trifirò G. Development and Validation of a META-Algorithm to Identify the Indications of Use of Biological Drugs Approved for the Treatment of Immune-Mediated Inflammatory Diseases from Claims Databases: Insights from the VALORE Project. Clin Epidemiol 2024; 16:395-407. [PMID: 38854895 PMCID: PMC11162210 DOI: 10.2147/clep.s445120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose This research aimed to develop and validate a META-algorithm combining individual immune-mediated inflammatory disease (IMID)-specific algorithms to identify the exact IMID indications for incident biological drug users from claims data within the context of the Italian VALORE project. Methods and Patients All subjects with at least one dispensing of TNF-alpha inhibitors, anti-interleukin agents, and selective immunosuppressants approved for IMIDs were identified from claims databases of Latium region in Italy (observation period: 2010-2020). Validated coding algorithms for identifying individual IMIDs from claims databases were found from published literature and combined into a META-algorithm. Positive predictive value (PPV), sensitivity (Se), negative predictive value (NPV), specificity (Sp), and accuracy (Acc) were estimated for each indication against the electronic therapeutic plans (ETPs) of the Latium region as the reference standard. Lastly, the frequency of the indication of use across individual biologic drugs was compared with that reported in three other Italian regions (Lombardy, Apulia, and the Veneto region). Results In total, 9755 incident biological drug users with a single IMID indication were identified. Using the newly developed META-algorithm, an indication of use was detected in 95% (n=9255) of the total cohort. The estimated Acc, Se, Sp, PPV, and NPV, against the reference standard were as follows: 0.96, 0.86, 0.97, 0.82, and 0.98 for Crohn's disease, 0.96, 0.80, 0.98, 0.85, and 0.97 for ulcerative colitis, 0.93, 0.76, 0.99, 0.95, and 0.92 for rheumatoid arthritis, 0.97, 0.75, 0.99, 0.85, and 0.98 for spondylarthritis, and 0.91, 0.92, 0.91, 0.88, and 0.94 for psoriatic arthritis/psoriasis, respectively. Additionally, no substantial difference was observed in the frequency of indication of use by active ingredient among Latium and the other three Italian regions included in the study. Conclusion The newly developed META-algorithm demonstrated high validity estimates in the Italian claims data and was capable of discriminating with good performance among the most frequent IMID indications.
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Affiliation(s)
- Andrea Spini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luca L’Abbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giorgia Pellegrini
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Massimo Carollo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Olivia Leoni
- Lombardy Regional Centre of Pharmacovigilance and Regional Epidemiologic Observatory, Milan, Italy
| | | | | | | | | | | | - Sara Lopes
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Puig L, Notario J, López-Ferrer A, Scheneller-Pavelescu L, Pérez B, Galache C, de la Cueva P, Carrascosa JM. [Translated article] Recommendations from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group on the Management of Patients with Cancer and Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00432-0. [PMID: 38821353 DOI: 10.1016/j.ad.2024.05.011] [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: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 06/02/2024] Open
Abstract
Several studies suggest that patients with psoriasis have a higher incidence of neoplasms, especially of the skin, which could be associated with the use of therapies to treat psoriasis. Furthermore, the evidence available on the safety profile of some treatments in this context, and the management of these patients is scarce, which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous. This study provides recommendations on the management and use of the therapies currently available for these patients. They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group, and their goal is to help specialists in the field in their decision-making processes.
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Affiliation(s)
- L Puig
- Servicio de Dermatología, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - B Pérez
- Servicio de Dermatología, Hospital Morales Meseguer, Murcia, Spain; Facultad de Medicina, Universidad Católica San Antonio, Murcia, Spain
| | - C Galache
- Departamento de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
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Lorenzon M, Zabotti A, Cereser L. Cancer screening before treatments in rheumatoid arthritis: lights and shadows. Rheumatology (Oxford) 2024; 63:1475-1476. [PMID: 37707539 DOI: 10.1093/rheumatology/kead478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Michele Lorenzon
- Department of Medicine, Institute of Radiology, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
| | - Alen Zabotti
- Department of Medicine, Rheumatology Institute, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
| | - Lorenzo Cereser
- Department of Medicine, Institute of Radiology, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
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7
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Dickson KS, Regan A, Wemyss C, Paley M, Siddiqui A. A call for guidance on the treatment of patients taking disease-modifying anti-rheumatic drugs (DMARDs). Br J Oral Maxillofac Surg 2024; 62:389-390. [PMID: 38548509 DOI: 10.1016/j.bjoms.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 05/18/2024]
Affiliation(s)
| | | | - Callum Wemyss
- Glasgow Dental School and Hospital, NHS Greater Glasgow and Clyde, United Kingdom.
| | - Martin Paley
- St John's Hospital, NHS Lothian, United Kingdom.
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Rudi T, Zietemann V, Meissner Y, Zink A, Krause A, Lorenz HM, Kneitz C, Schaefer M, Strangfeld A. Impact of DMARD treatment and systemic inflammation on all-cause mortality in patients with rheumatoid arthritis and interstitial lung disease: a cohort study from the German RABBIT register. RMD Open 2024; 10:e003789. [PMID: 38580343 PMCID: PMC11002391 DOI: 10.1136/rmdopen-2023-003789] [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: 10/06/2023] [Accepted: 02/19/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES To investigate the impact of disease activity and treatment with disease-modifying antirheumatic drugs (DMARDs) on all-cause mortality in patients with rheumatoid arthritis and prevalent interstitial lung disease (RA-ILD). METHODS Patients with RA-ILD were selected from the biologics register Rheumatoid Arthritis: Observation of Biologic Therapy (RABBIT). Using time-varying Cox regression, the association between clinical measures and mortality was investigated. The impact of DMARDs was analysed by (1) Cox regression considering cumulative exposure (ie, treatment months divided by total months) and (2) time-varying Cox regression as main approach (treatment exposures at monthly level). RESULTS Out of 15 566 participants, 381 were identified as RA-ILD cases with 1258 person-years of observation and 2.6 years median length of follow-up. Ninety-seven patients (25.5%) died and 34 (35.1%) of these were not receiving DMARD therapy at the time of death. Higher inflammatory biomarkers but not swollen and tender joint count were significantly associated with mortality. Compared with tumour necrosis factor inhibitors (TNFi), non-TNFi biologic DMARDs (bDMARDs) exhibited adjusted HRs (aHRs) for mortality below 1, lacking statistical significance. This finding was stable in various sensitivity analyses. Joint aHR for non-TNFi biologics and JAKi versus TNFi was 0.56 (95% CI 0.33 to 0.97). Receiving no DMARD treatment was associated with a twofold higher mortality risk compared with receiving any DMARD treatment, aHR 2.03 (95% CI 1.23 to 3.35). CONCLUSIONS Inflammatory biomarkers and absence of DMARD treatment were associated with increased risk of mortality in patients with RA-ILD. Non-TNFi bDMARDs may confer enhanced therapeutic benefits in patients with RA-ILD.
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Affiliation(s)
- Tatjana Rudi
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Vera Zietemann
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V Hematology Oncology Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Martin Schaefer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
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Mohamed A. What is the impact of biologics on the management of the oral surgery patient? Br Dent J 2024; 236:637-640. [PMID: 38671123 DOI: 10.1038/s41415-024-7289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 04/28/2024]
Abstract
The use of biologics in medicine is on the rise. As dental professionals, it is becoming increasingly important that we are aware of this class of medications and the theoretical risks that they pose specific to the oral cavity to ensure safe delivery of dental treatment. This paper discusses some of these risks and recommendations to follow to manage patients undergoing oral surgery specifically.
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Affiliation(s)
- Ayesha Mohamed
- Department of Oral Surgery, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
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10
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Al-Homood IA, Al Ghanim N, Fatani MIA, Hussein AH, Alolaiwi AM, Abualiat A, Alqurtas E, Alomari BAA, Khardaly AM, Alenzi KAO, Albarakati RG, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. The Saudi consensus recommendations for the management of psoriatic arthritis (2023). Clin Rheumatol 2024; 43:879-894. [PMID: 38217738 PMCID: PMC10876726 DOI: 10.1007/s10067-024-06867-x] [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: 10/27/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
Psoriatic arthritis (PsA) is a complex inflammatory disease characterized by musculoskeletal and non-musculoskeletal manifestations. It is a distinct disease entity at the interface between rheumatology and dermatology, making it challenging to manage. The diverse clinical presentation and severity of PsA require a multidisciplinary approach for optimal care. Early diagnosis and management are necessary to improving quality of life for patients. In Saudi Arabia, there is currently no unified national consensus on the best practices for managing PsA. This lack of consensus leads to debate and uncertainty in the treatment of the disease, resulting in over or under prescribing of biological agents. To address this issue, a multidisciplinary work group was formed by the Saudi Ministry of Health. This group, consisting of dermatologists, rheumatologists, and pharmacists, aimed to develop evidence-based consensus recommendations for he use and monitoring of biological therapy in PsA management. The work group conducted five consensus workshops between December 2021 to March 2022. Using the nominal group technique, they discussed various aspects of PsA management, including eligibility criteria for biological treatment, monitoring of disease activity, treatment goals, screening, precautions, and management of PsA with biologic therapies. The group also considered special considerations for patients with comorbidities, pregnant and lactating women, as well as pediatric and adolescent populations. The resulting consensus document provides recommendations that are applicable to the Saudi setting, taking into account international guidelines and the specific needs of PsA patients in the country. The consensus document will be regularly updated to incorporate new data and therapeutic agents as they become available. Key Points • In Saudi Arabia, there is a lack of unified national consensus on the optimal management of PsA, therefore, this article aims to provide up-to-date evidence-based consensus recommendations for the optimal use and monitoring of biologic therapy in the management of PsA in Saudi Arabia. • The consensus development process was undertaken by a multidisciplinary work group of 13 experts, including two dermatologists, six rheumatologists, and five pharmacists. • There is more than one disease activity tool used in PsA disease, depending on the disease domain - peripheral arthritis Disease Activity Index in Psoriatic Arthritis (DAPSA) or Minimal Disease Activity (MDA), axial PsA Ankylosing Spondylitis Disease Activity Score (ASDAS), and dactylitis and enthesitis MDA. • The main goal of therapy in all patients with PsA is to achieve the target of remission, or alternatively, low disease activity in all disease domains and improve quality of life (QoL).
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Affiliation(s)
- Ibrahim Abdulrazag Al-Homood
- Medical Specialties Department, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Nayef Al Ghanim
- Department of Internal Medicine, Rheumatology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Albader Hamza Hussein
- Department of Rheumatology, King Fahad General Hospital, Ministry of Health, Madinah, Saudi Arabia
| | - Abdulaziz Mohammed Alolaiwi
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Abualiat
- Department of Dermatology and Venereology, Armed Forces Hospitals-Southern Region (AFHSR), Khamis Mushait, Saudi Arabia
| | - Eman Alqurtas
- Department of Medicine, College of Medicine, Rheumatology Unit, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Rayan G Albarakati
- Department of Obstetrics and Gynecology, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine and College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Maysa Tariq Yousef Eshmawi
- Department of Dermatology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Nishitani K, Ito H, Murata K, Kuriyama S, Nakamura S, Matsuda S. Postoperative function of patients with rheumatoid arthritis after total knee arthroplasty in the last decade was comparable in the unadjusted cohort but inferior in the propensity score matched cohort with that of patients with osteoarthritis. Knee 2024; 47:228-238. [PMID: 38447350 DOI: 10.1016/j.knee.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND The perioperative pain and function of total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) approach those in patients with osteoarthritis (OA). This study aimed to evaluate whether the clinical outcomes, especially functions, of patients with RA reached those of OA, utilizing a background-matched cohort. METHODS Patients who underwent TKA between 2013 and 2021 were enrolled. Preoperative and minimum 2-year postoperative scores, specifically the Original Knee Society Score (OKSS) and New Knee Society Score (2011KSS), between RA and OA were compared. Clinical assessments were performed on unadjusted and propensity-score matched cohorts, ensuring age, sex, body mass index, and valgus deformity rate parity. RESULTS In an unadjusted cohort involving 98 patients with RA and 560 patients with OA, patients with RA demonstrated inferior preoperative OKSS-Function Score (FS) but similar postoperative functional scores to OA patients. In the matched cohort of 83, patients with RA displayed lower preoperative OKSS- FS (median difference: 20, P < 0.001) and 2011KSS functional activities (difference: 9, P = 0.01) beyond minimum clinically important differences than patients with OA. Patients with RA improved more in OKSS-FS, yielding no postoperative difference compared with patients with OA. However, postoperative 2011KSS functional activities remained lower in patients with RA (difference: 9.5, P = 0.03), especially in advanced functions, than in those with OA. CONCLUSION Postoperative function showed no difference between patients with RA and OA in the unadjusted cohort; within the background-matched cohort, postoperative function, especially advanced function, was inferior in patients with RA to those with OA.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Advanced Medicine of Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Advanced Medicine of Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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Fukui S, Kawaai S, Sawada H, Kishimoto M. Upadacitinib for the treatment of adults with active non-radiographic axial spondyloarthritis (nr-axSpA). Expert Rev Clin Immunol 2024; 20:141-153. [PMID: 37955181 DOI: 10.1080/1744666x.2023.2282696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Non-radiographic axial spondyloarthritis (nr-axSpA) is a chronic inflammatory condition with axial and peripheral musculoskeletal involvement, fulfilling criteria of axSpA in the absence of advanced radiographic sacroiliitis. While appropriate treatment is required for chronic pain and disability resulting from disease progression, the limited availability of treatment options becomes evident. Upadacitinib, an oral selective Janus kinase 1 inhibitor, was approved in Europe, the United States, and other countries for management of nr-axSpA with inadequate response to existing therapies. AREA COVERED This review summarizes essential drug profiles, efficacy, and safety of upadacitinib for nr-axSpA in conjunction with data pertaining to radiographic axSpA. EXPERT OPINION In a phase 3 trial, upadacitinib exhibited efficacy for patients with nr-axSpA, irrespective of prior exposures to biological disease-modifying antirheumatic drugs (bDMARDs). The safety profiles of upadacitinib in nr-axSpA mirrored those in other indications, underscoring its potential as a promising treatment option for nr-axSpA. Concurrently, physicians should be aware of the absence of real-world data, longitudinal efficacy and safety, direct comparative studies between upadacitinib and bDMARDs in nr-axSpA, and evidence for precision medicine to identify patients who may optimally benefit from upadacitinib over bDMARDs. Future research is imperative to facilitate the effective utilization of upadacitinib in daily clinical practice.
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Affiliation(s)
- Sho Fukui
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo, Japan
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Satoshi Kawaai
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Haruki Sawada
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
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Atienza-Mateo B, Fernández-Díaz C, Vicente-Rabaneda EF, Melero-González RB, Ortiz-Sanjuán F, Casafont-Solé I, Rodríguez-García SC, Ferraz-Amaro I, Castañeda S, Blanco R. Abatacept in usual and in non-specific interstitial pneumonia associated with rheumatoid arthritis. Eur J Intern Med 2024; 119:118-124. [PMID: 37673775 DOI: 10.1016/j.ejim.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To compare the effectiveness of abatacept (ABA) in Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) according to the radiological patterns of usual (UIP) or non-specific interstitial pneumonia (NSIP). METHODS From an observational longitudinal multicentre study of 263 RA-ILD patients treated with ABA, those with UIP or NSIP were selected. Lung function, chest high resolution computerised tomography (HRCT) and dyspnoea were recorded and compared in both groups from baseline to the end of follow-up (progression definitions: improvement or worsening >10% of FVC or DLCO, changes in HRCT extension and 1-point change in the mMRC scale, respectively). Differences between final and baseline visits were calculated as the average difference (95% CI) through mixed effects models regression. RESULTS We studied 190 patients with UIP (n=106) and NSIP (n=84). General features were similar in both groups except for older age, positive rheumatoid factor, and previous sulfasalazine therapy, which were more frequent in patients with UIP. ILD duration up to ABA initiation was relatively short: median 16 [4-50] and 11 [2-36] months (p=0.36) in UIP and NSIP, respectively. Mean baseline FVC and DLCO were 82% and 63% in UIP and 89% and 65% in NSIP, respectively. Both parameters remained stable during 24 months with ABA. HRCT lesions and dyspnoea improved/stabilized in 73.1% and 90.5% and 72.9% and 94.6% of UIP and NSIP patterns, respectively. CONCLUSION ABA seems equally effective in stabilizing dyspnoea, lung function and radiological impairment in both UIP and NSIP patterns of RA-ILD. Early administration of ABA may prevent RA-ILD progression, regardless of the radiological pattern.
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Affiliation(s)
- Belén Atienza-Mateo
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain
| | | | | | | | | | | | | | - Iván Ferraz-Amaro
- Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Santos Castañeda
- Rheumatology, Hospital de La Princesa, IIS-Princesa, Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain.
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14
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Lee H, Jeong OY, Park HJ, Lee SL, Bok EY, Kim M, Suh YS, Cheon YH, Kim HO, Kim S, Chun SH, Park JM, Lee YJ, Lee SI. Promising Therapeutic Effects of Embryonic Stem Cells-Origin Mesenchymal Stem Cells in Experimental Pulmonary Fibrosis Models: Immunomodulatory and Anti-Apoptotic Mechanisms. Immune Netw 2023; 23:e45. [PMID: 38188598 PMCID: PMC10767550 DOI: 10.4110/in.2023.23.e45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Interstitial lung disease (ILD) involves persistent inflammation and fibrosis, leading to respiratory failure and even death. Adult tissue-derived mesenchymal stem cells (MSCs) show potential in ILD therapeutics but obtaining an adequate quantity of cells for drug application is difficult. Daewoong Pharmaceutical's MSCs (DW-MSCs) derived from embryonic stem cells sustain a high proliferative capacity following long-term culture and expansion. The aim of this study was to investigate the therapeutic potential of DW-MSCs in experimental mouse models of ILD. DW-MSCs were expanded up to 12 passages for in vivo application in bleomycin-induced pulmonary fibrosis and collagen-induced connective tissue disease-ILD mouse models. We assessed lung inflammation and fibrosis, lung tissue immune cells, fibrosis-related gene/protein expression, apoptosis and mitochondrial function of alveolar epithelial cells, and mitochondrial transfer ability. Intravenous administration of DW-MSCs consistently improved lung fibrosis and reduced inflammatory and fibrotic markers expression in both models across various disease stages. The therapeutic effect of DW-MSCs was comparable to that following daily oral administration of nintedanib or pirfenidone. Mechanistically, DW-MSCs exhibited immunomodulatory effects by reducing the number of B cells during the early phase and increasing the ratio of Tregs to Th17 cells during the late phase of bleomycin-induced pulmonary fibrosis. Furthermore, DW-MSCs exhibited anti-apoptotic effects, increased cell viability, and improved mitochondrial respiration in alveolar epithelial cells by transferring their mitochondria to alveolar epithelial cells. Our findings indicate the strong potential of DW-MSCs in the treatment of ILD owing to their high efficacy and immunomodulatory and anti-apoptotic effects.
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Affiliation(s)
- Hanna Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon 51427, Korea
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Ok-Yi Jeong
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Hee Jin Park
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Sung-Lim Lee
- College of Veterinary Medicine and Research Institute of Life Sciences, Gyeongsang National University, Jinju 52828, Korea
| | - Eun-yeong Bok
- College of Veterinary Medicine and Research Institute of Life Sciences, Gyeongsang National University, Jinju 52828, Korea
| | - Mingyo Kim
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Young Sun Suh
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon 51427, Korea
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Yun-Hong Cheon
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Hyun-Ok Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon 51427, Korea
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Suhee Kim
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Sung Hak Chun
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Jung Min Park
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
| | - Young Jin Lee
- Cell Therapy Center, Daewoong Pharmaceutical, Co., Ltd., Yongin 17028, Korea
| | - Sang-Il Lee
- Department of Internal Medicine and Institute of Medical Science, Gyeongsang National University School of Medicine and Hospital, Jinju 52727, Korea
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15
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Inoue M, Maeda S, Ohashi H. [A case of total hip arthroplasty for femoral head necrosis while using satralizumab for neuromyelitis optica spectrum disorders]. Rinsho Shinkeigaku 2023; 63:592-595. [PMID: 37648476 DOI: 10.5692/clinicalneurol.cn-001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
A 47-year-old woman developed right femoral head necrosis during long-term steroid use for neuromyelitis optica spectrum disorder. She underwent a total hip arthroplasty because her right hip pain persisted after satralizumab treatment. There were no postoperative infections. Under oral administration of tacrolimus 3 mg, prednisolone 11 mg, and acetaminophen 2,275 mg, her postoperative body temperature was less than 38°C and normalized in about 2 days after the operation. No parameters indicating worsening of inflammation were observed in the blood test. In satralizumab-treated patients, infection cannot be ruled out even without inflammatory findings. In particular, if a slight fever of the 37°C-range or a mildly high white blood cell count persists, paying attention to signs of infection and actively investigating the presence or absence of infection using medical image diagnostic devices are necessary.
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Affiliation(s)
- Manabu Inoue
- Department of Neurology, Osaka Saiseikai Nakatsu Hospital
| | - Shingo Maeda
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital
| | - Hirotsugu Ohashi
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital
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16
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Kunishita Y, Ichikawa K, Uzawa Y, Mitsuhashi M, Yoshioka Y, Okubo T, Nagaoka S. Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy. Ther Adv Musculoskelet Dis 2023; 15:1759720X231186874. [PMID: 37539016 PMCID: PMC10395174 DOI: 10.1177/1759720x231186874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
Background Abatacept (ABT) is known to lower infection risk than other biologics and is effective and safe in elderly patients with rheumatoid arthritis (RA). However, there were inconsistent reports on the impact of ABT on malignancies which are more common in the elderly and strongly related to prognosis. Objectives This study aimed to evaluate the efficacy and safety of ABT in patients with RA with previous malignancy in clinical practice. Design A multicenter, retrospective study. Methods Patients who received ABT for RA in two hospitals in Yokohama until May 2022 were included in this study. The patients were divided into two groups according to the presence or absence of a history of malignancy (no previous malignancy: NP group, previous malignancy: PM group). The collected parameters were compared between the groups using propensity score matching. Results In this study, 312 patients were included, of whom 73 had previous malignancies when starting ABT. The age at ABT initiation was significantly higher in the PM group, the rate of methotrexate use was significantly lower in the PM group, and the Steinbrocker stage was significantly higher in the PM group. After matching these 3 factors, 68 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. In addition to these factors, when matched for smoking history, interstitial lung disease, disease duration, sex, and inflammatory status, which are known risk factors for malignancy in RA, 40 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. Conclusion In our clinical practice, ABT was as effective and safe in patients with a history of malignancy as in those without.
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Affiliation(s)
- Yosuke Kunishita
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-Ku, Yokohama, Kanagawa 236-0037, Japan
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kento Ichikawa
- Department of Hematology and Clinical Immunology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuji Uzawa
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Masaki Mitsuhashi
- Department of Rheumatology, Saiseikai Yokohama-Shi Nanbu Hospital, Yokohama, Japan
| | - Yuji Yoshioka
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadanobu Okubo
- Department of Rheumatology, Saiseikai Yokohama-Shi Nanbu Hospital, Yokohama, Japan
| | - Shouhei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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Sonomoto K, Tanaka Y. Malignancies and rheumatoid arthritis, csDMARDs, biological DMARDs, and JAK inhibitors: challenge and outlook. Expert Rev Clin Immunol 2023; 19:1325-1342. [PMID: 37578325 DOI: 10.1080/1744666x.2023.2247158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune disorder necessitating immunosuppressive therapy. Remarkable progress has been made in the treatment of RA over recent decades, particularly with the development of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi). Nonetheless, the development of new drugs has been accompanied by concerns regarding the association between these novel therapies and the risk of malignancy. AREAS COVERED This narrative review aims to discuss the understanding of RA, conventional synthetic (cs) DMARDs, bDMARDs, JAKi, and their association with malignancy. Furthermore, the review discusses the management of malignancy in patients receiving b/tsDMARDs. EXPERT OPINION Although recent studies suggest that the potential risk of malignancy of methotrexate and a JAKi tofacitinib, it is essential to avoid indiscriminate withholding of treatment by those agents, as this may lead functional impairment and increased mortality. Therefore, the adoption of a Treat-to-Target (T2T) approach considering individual patient characteristics, becomes of utmost importance. Rheumatologists should maintain a vigilant stance regarding malignancy in this context, recognizing the importance of early detection and management. Implementing a screening program for malignancies is indispensable, and the use of computed tomography screening may enhance the effectiveness of management strategies.
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Affiliation(s)
- Koshiro Sonomoto
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health Japan, Fukuoka, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Fukuoka, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Fukuoka, Japan
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Buchbinder R, Glennon V, Johnston RV, Brennan SE, Fong C, Edward May S, O'Neill S, Smitham P, Trevena L, Whittaker G, Wluka A, Whittle SL. Australian recommendations on perioperative use of disease-modifying anti-rheumatic drugs in people with inflammatory arthritis undergoing elective surgery. Intern Med J 2023; 53:1248-1255. [PMID: 37067924 PMCID: PMC10946831 DOI: 10.1111/imj.16073] [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: 10/23/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
Disease-modifying anti-rheumatic drugs (DMARDs) are effective treatments for inflammatory arthritis but carry an increased risk of infection. For patients undergoing surgery, there is a need to consider the trade-off between a theoretical increased risk of infection with continuation of DMARDs perioperatively versus an increased risk of disease flare if they are temporarily withheld. We used the Grading of Recommendations Assessment, Development and Evaluation methodology to develop recommendations for perioperative use of DMARDs for people with inflammatory arthritis undergoing elective surgery. The recommendations form part of the National Health and Medical Research Council-endorsed Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. Conditional recommendations were made against routinely discontinuing conventional synthetic and biologic (b) DMARDs in the perioperative period but to consider temporary discontinuation of bDMARDs in individuals with a high risk of infection or where the impact of infection would be severe. A conditional recommendation was made in favour of temporary discontinuation of targeted synthetic DMARDs in the perioperative period.
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Affiliation(s)
- Rachelle Buchbinder
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Vanessa Glennon
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Renea V. Johnston
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Sue E. Brennan
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Chris Fong
- Eastern Clinical Research UnitEastern Health Box Hill Hospital and Monash UniversityVictoriaMelbourneAustralia
| | - Suzie Edward May
- Consumer Representative, Giving VoiceWestern AustraliaPerthAustralia
| | - Sean O'Neill
- Sydney Musculoskeletal Health FlagshipUniversity of Sydney Northern Clinical School and Royal North Shore HospitalNew South WalesSydneyAustralia
| | - Peter Smitham
- Orthopaedic & Trauma Department, Royal Adelaide Hospital & Discipline of OrthopaedicsUniversity of AdelaideSouth AustraliaAdelaideAustralia
| | - Lyndal Trevena
- Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Glen Whittaker
- Discipline of Podiatry, School of Allied Health, Human Services and SportLa Trobe UniversityVictoriaMelbourneAustralia
| | - Anita Wluka
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Samuel L. Whittle
- School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
- Rheumatology UnitQueen Elizabeth HospitalSouth AustraliaAdelaideAustralia
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19
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Khader SG, Hussain WHZ, Moorthy A. Rheumatology patients on immunosuppressive treatment and their perioperative management: Review of recommendations. Musculoskeletal Care 2023; 21:571-575. [PMID: 36461920 DOI: 10.1002/msc.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Affiliation(s)
| | | | - Arumugam Moorthy
- University Hospitals of Leicester NHS Trust, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
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Mochizuki T, Yano K, Ikari K, Okazaki K. Radiological evaluation of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept or JAK inhibitors for 1 year. Respir Investig 2023; 61:359-363. [PMID: 37031622 DOI: 10.1016/j.resinv.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND We evaluated the radiological deterioration of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) treated with abatacept (ABT) or Janus-kinase inhibitors (JAKi) for 1 year. METHODS This study enrolled 84 patients with RA who had started treatment with ABT (48 patients) or JAKi (36 patients) between 2017 and 2020. All patients underwent chest CT before administration and at 1 year post-treatment. RESULTS In all patients, the rate of deterioration of ILD in ABT and JAKi was 4.2% and 5.6%, respectively (p = 0.847). In the patients with pre-existing ILD, the rates of deterioration of ILD in the ABT and JAKi groups were 10.5% and 18.2%, respectively (p = 0.611). Meanwhile, newly developed ILD did not occur in the two groups without pre-existing ILD. CONCLUSION The present study demonstrated that the safety of pulmonary toxicity with ABT and JAKi treatments was similar in patients with RA. JAKi may be a potentially acceptable treatment option for patients with RA.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopaedic Surgery and Rheumatology, Kamagaya General Hospital, 929-6 Hatsutomi, Kamagaya, 273-0121, Chiba, Japan.
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
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Lee SK, Shin K, Jung JY, Suh CH, Kim JW, Kim HA. Retention Rate and Safety of Biologic and Targeted Synthetic DMARDs in Patients with RA-Associated Interstitial Lung Disease: A KOBIO Registry Study. BioDrugs 2023; 37:247-257. [PMID: 36757601 DOI: 10.1007/s40259-023-00578-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVES This study aimed to evaluate the long-term retention and safety of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) and identify the factors associated with drug withdrawal in patients with rheumatoid arthritis (RA) with interstitial lung disease (ILD) enrolled in the Korean College of Rheumatology Biologics and Targeted Therapy registry. METHODS We investigated adults with RA (n = 2266) administered with bDMARDs or tsDMARDs between 2012 and 2021. Propensity score matching (1:3) was performed between patients with RA with ILD (RA-ILD) and without ILD (RA-no ILD). The Kaplan-Meier method was used to analyse drug survival and a logistic regression model to identify withdrawal-related factors in RA-ILD. RESULTS One hundred and fifty-nine patients with RA-ILD were matched with 477 patients with RA-no ILD. The 5-year drug retention rate was lower in RA-ILD than in RA-no ILD (log-rank p = 0.020), and both the ILD and no-ILD groups had statistical differences of drug retention rate among agents (log-rank p = 0.019 and 0.020, respectively). In the RA-ILD group, Janus kinase inhibitors had the highest drug retention rate (64.3%), and tumour necrosis factor-α inhibitors showed the lowest retention rate (30.6%). Approximately 58.5% and 48.4% of the patients with RA-ILD and RA-no ILD, respectively, withdrew from their regimen, and the main cause of withdrawal in RA-ILD was adverse events, followed by inefficacy. In the logistic regression analysis, current smoking had a negative effect on drug retention (odds ratio [OR]: 9.938, 95% confidence interval [CI]: 2.550-38.733; p < 0.001), while concomitant corticosteroid use had a protective effect against withdrawal (OR: 0.284, 95% CI: 0.008-0.917; p = 0.035) in RA-ILD. CONCLUSION The patients with RA-ILD had lower bDMARD and tsDMARD retention rates than those with RA-no ILD. In the RA-ILD group, current smoking and concomitant corticosteroid use were associated factors affecting drug withdrawal.
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Affiliation(s)
- Sun-Kyung Lee
- Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
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22
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Hamilton F, Schurz H, Yates TA, Gilchrist JJ, Möller M, Naranbhai V, Ghazal P, Timpson NJ, Parks T, Pollara G. Altered IL-6 signalling and risk of tuberculosis disease: a meta-analysis and Mendelian randomisation study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.07.23285472. [PMID: 36798349 PMCID: PMC9934798 DOI: 10.1101/2023.02.07.23285472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
IL-6 responses are ubiquitous in Mycobacterium tuberculosis (Mtb) infections, but their role in determining human tuberculosis (TB) disease risk is unknown. We used single nucleotide polymorphisms (SNPs) in and near the IL-6 receptor (IL6R) gene, focusing on the non-synonymous variant, rs2228145, associated with reduced classical IL-6 signalling, to assess the effect of altered IL-6 activity on TB disease risk. We identified 16 genome wide association studies (GWAS) of TB disease collating 17,982 cases of TB disease and 972,389 controls across 4 continents. Meta-analyses and Mendelian randomisation analyses revealed that reduced classical IL-6 signalling was associated with lower odds of TB disease, a finding replicated using multiple, independent SNP instruments and 2 separate exposure variables. Our findings establish a causal relationship between IL-6 signalling and the outcome of Mtb infection, suggesting IL-6 antagonists do not increase the risk of TB disease and should be investigated as adjuncts in treatment.
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Affiliation(s)
- Fergus Hamilton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Haiko Schurz
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tom A. Yates
- Division of Infection and Immunity, University College London, London, UK
| | - James J. Gilchrist
- Wellcome Trust Centre for Human Genetics, Oxford, UK
- Department of Paediatrics, University of Oxford, UK
| | - Marlo Möller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vivek Naranbhai
- Wellcome Trust Centre for Human Genetics, Oxford, UK
- Massachusetts General Hospital, Boston, USA
- Dana-Farber Cancer Institute, Boston, USA
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Harvard Medical School, Boston, USA
| | | | | | - Tom Parks
- Wellcome Trust Centre for Human Genetics, Oxford, UK
- Department of Infectious Diseases Imperial College London, London, UK
| | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London, UK
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23
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Malik M, Jones B, Williams E, Kurukulaaratchy R, Holroyd C, Mason A. Dual biologic therapy for the treatment of rheumatic diseases and asthma: a case series. Rheumatol Adv Pract 2023; 7:rkad018. [PMID: 36789243 PMCID: PMC9923700 DOI: 10.1093/rap/rkad018] [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: 07/07/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Objective Combination biological therapies are being considered increasingly for patients with multiple co-morbidities requiring biologics. There are limited data available on this approach, and concerns remain about the possible risk of adverse events, particularly infection. Methods We present three patients on dual biologics for rheumatic disease and asthma. The biologic combinations used were etanercept and mepolizumab, infliximab and omalizumab, and etanercept and omalizumab. The time on combination biologic therapies ranged from 24 to 36 months. Patients were monitored for any serious adverse events. Results All three patients were able to tolerate combined biologic therapies, with no serious adverse events. All three patients gained improvement in their rheumatic and asthma disease control, with reduction in disease activity scores and reduction in steroid usage. Conclusion The decision to start dual biologic therapy should be considered carefully, on a case-by-case basis. The number of patients who are on combination biological therapy is small, and data are sparse. Real-world data are needed to examine the long-term benefits and risks of different forms of combination biologic therapies.
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Affiliation(s)
- Mariam Malik
- Rheumatology Department, University Hospital Southampton, Southampton, UK
| | - Bryony Jones
- Rheumatology Department, University Hospital Southampton, Southampton, UK
| | - Emma Williams
- Rheumatology Department, Royal Hampshire County Hospital, Winchester, UK
| | - Ramesh Kurukulaaratchy
- Correspondence to: Ramesh Kurukulaaratchy, Department of Respiratory Medicine, Southampton General Hospital, Mailpoint 810, F-Level, South Academic Block, Tremona Road, Southampton SO16 6YD, UK. E-mail:
| | - Chris Holroyd
- Rheumatology Department, University Hospital Southampton, Southampton, UK
| | - Alice Mason
- Rheumatology Department, University Hospital Southampton, Southampton, UK
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24
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Evolution of Rheumatoid-Arthritis-Associated Interstitial Lung Disease in Patients Treated with JAK Inhibitors: A Retrospective Exploratory Study. J Clin Med 2023; 12:jcm12030957. [PMID: 36769604 PMCID: PMC9917598 DOI: 10.3390/jcm12030957] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The aim of this multicenter retrospective study was to investigate the effectiveness and safety of the available JAK-inhibitors (JAKi) in patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). METHODS We retrospectively analyzed patients with classified RA and RA-ILD undergoing JAKi in 6 Italian tertiary centers from April 2018 to June 2022. We included patients with at least 6 months of active therapy and one high-resolution chest tomography (HRCT) carried out within 3 months of the start of JAKi treatment. The HRCT was then compared to the most recent one carried out within 3 months before the last available follow-up appointment. We also kept track of the pulmonary function tests. RESULTS We included 43 patients with RA-ILD and 23 males (53.48%) with a median age (interquartile range, IQR) of 68.87 (61.46-75.78) treated with JAKi. The median follow-up was 19.1 months (11.03-34.43). The forced vital capacity remained stable in 22/28 (78.57%) patients, improved in 3/28 (10.71%) and worsened in 3/28 (10.71%). The diffusing capacity of lung for carbon monoxide showed a similar trend, remaining stable in 18/25 (72%) patients, improving in 2/25 (8%) and worsening in 5/25 (20%). The HRCT remained stable in 37/43 (86.05) cases, worsened in 4/43 (9.30%) and improved in the last 2 (4.65%). DISCUSSION This study suggests that JAKi therapy might be a safe therapeutic option for patients with RA-ILD in a short-term follow-up.
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25
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Rath E, Bonelli M, Duftner C, Gruber J, Mandl P, Moazedi-Furst F, Pieringer H, Puchner R, Flick H, Salzer HJF, Weiss G, Winkler S, Skvara H, Moschen A, Hofer H, Feurstein J, Sautner J. [National consensus statement by the Austrian Societies for Rheumatology, Pulmonology, Infectiology, Dermatology and Gastroenterology regarding the management of latent tuberculosis and the associated utilization of biologic and targeted synthetic DMARDS (disease modifying antirheumatic drugs)]. Z Rheumatol 2023; 82:163-174. [PMID: 36342525 PMCID: PMC9981509 DOI: 10.1007/s00393-022-01274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/09/2022]
Abstract
This nationwide Austrian consensus statement summarizes the recommendations on the management of latent tuberculosis by treatment with biologic and targeted synthetic DMARDs. The essential questions with respect to screening and preventive treatment were discussed by experts from the disciplines of rheumatology, pneumology, infectious diseases, dermatology and gastroenterology, based on the available data, and then a joint consensus was formed by agreement. This involved a differentiated discussion on the various forms of treatment, and clear recommendations were formulated.
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Affiliation(s)
- Eva Rath
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.413662.40000 0000 8987 03441. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich
| | - Michael Bonelli
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.22937.3d0000 0000 9259 8492Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, Medizinische Universität Wien, Wien, Österreich
| | - Christina Duftner
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.5361.10000 0000 8853 2677Universitätsklinik für Innere Medizin II, Department für Innere Medizin, Medizinische Universität Innsbruck/Tirol Kliniken, Innsbruck, Österreich
| | - Johann Gruber
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.5361.10000 0000 8853 2677Universitätsklinik für Innere Medizin II, Department für Innere Medizin, Medizinische Universität Innsbruck/Tirol Kliniken, Innsbruck, Österreich
| | - Peter Mandl
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.22937.3d0000 0000 9259 8492Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, Medizinische Universität Wien, Wien, Österreich
| | - Florentine Moazedi-Furst
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.11598.340000 0000 8988 2476Universitätsklinik für Innere Medizin, Klinische Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Graz, Österreich
| | - Herwig Pieringer
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,Klinik Diakonissen Linz, Linz, Österreich
| | - Rudolf Puchner
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,Ordination Wels, Wels, Österreich
| | - Holger Flick
- Österreichische Gesellschaft für Pulmologie (ÖGP), Wien, Österreich ,Österreichische Gesellschaft für Infektionskrankheiten und Tropenmedizin (ÖGIT), Kottingbrunn, Österreich ,grid.11598.340000 0000 8988 2476Universitätsklinik für Innere Medizin, Klinische Abteilung für Pulmonologie, Medizinische Universität Graz, Graz, Österreich
| | - Helmut J. F. Salzer
- Österreichische Gesellschaft für Pulmologie (ÖGP), Wien, Österreich ,grid.473675.4Klinik für Lungenheilkunde, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Günter Weiss
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,Österreichische Gesellschaft für Infektionskrankheiten und Tropenmedizin (ÖGIT), Kottingbrunn, Österreich ,grid.5361.10000 0000 8853 2677Universitätsklinik für Innere Medizin II, Department für Innere Medizin, Medizinische Universität Innsbruck/Tirol Kliniken, Innsbruck, Österreich
| | - Stefan Winkler
- Österreichische Gesellschaft für Infektionskrankheiten und Tropenmedizin (ÖGIT), Kottingbrunn, Österreich ,grid.22937.3d0000 0000 9259 8492Universitätsklinik für Innere Medizin I, Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Hans Skvara
- Österreichische Gesellschaft für Dermatologie und Venerologie (ÖGDV), Wien, Österreich ,Abteilung für Dermatologie und Venerologie, Landesklinikum Wiener Neustadt, Wien, Österreich
| | - Alexander Moschen
- Österreichische Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH), Wien, Österreich ,grid.473675.4Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie/Hepatologie, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Harald Hofer
- Österreichische Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH), Wien, Österreich ,grid.459707.80000 0004 0522 7001Abteilung für Innere Medizin 1, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Julia Feurstein
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich ,grid.413662.40000 0000 8987 03441. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich
| | - Judith Sautner
- Österreichische Gesellschaft für Rheumatologie und Rehabilitation (ÖGR), Wien, Österreich. .,Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, Medizinische Universität Wien, Wien, Österreich. .,2. Medizinische Abteilung mit Schwerpunkt Rheumatologie, Karl Landsteiner Institut für klinische Rheumatologie, Landesklinikum Korneuburg-Stockerau, Landstr. 18, 2000, Stockerau, Österreich.
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26
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Nasonov EL, Ananyeva LP, Avdeev SN. Interstitial lung disease in rheumatoid arthritis: A multidisciplinary problem in rheumatology and pulmonology. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rheumatoid arthritis (RA) is an immune-mediated rheumatic disease (IMRDs) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. A particularly important place among the systemic manifestations of RA is occupied by interstitial lung diseases (ILD) – the most severe form of pulmonary pathology in RA, defined as RA-ILD, which is pathogenetically associated with risk factors (smoking, etc.) and autoimmune mechanisms underlying RA. RA-ILD is a subtype of RA characterized by a severe course and a poor prognosis и неблагоприятным прогнозом. The review presents new data regarding risk factors and biomarkers for RA-ILD; modern diagnostic capabilities based on the use of functional lung tests, high-resolution computed tomography, ultrasound examination of the lungs. Particular attention is paid to the efficacy and safety of pharmacotherapy, including methotrexate, biologics, JAK inhibitors, and antifibrotic therapy. An algorithm for the pharmacotherapy of RA-ILD has been proposed.
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
| | | | - S. N. Avdeev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
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27
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Wu D, Luo Y, Li T, Zhao X, Lv T, Fang G, Ou P, Li H, Luo X, Huang A, Pang Y. Systemic complications of rheumatoid arthritis: Focus on pathogenesis and treatment. Front Immunol 2022; 13:1051082. [PMID: 36618407 PMCID: PMC9817137 DOI: 10.3389/fimmu.2022.1051082] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
As a systemic autoimmune disease, rheumatoid arthritis (RA) usually causes damage not only to joints, but also to other tissues and organs including the heart, kidneys, lungs, digestive system, eyes, skin, and nervous system. Excessive complications are closely related to the prognosis of RA patients and even lead to increased mortality. This article summarizes the serious complications of RA, focusing on its incidence, pathogenesis, clinical features, and treatment methods, aiming to provide a reference for clinicians to better manage the complications of RA.
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Affiliation(s)
- Di Wu
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yehao Luo
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Tong Li
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xinyi Zhao
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Ting Lv
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Gang Fang
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Peiqi Ou
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Hongyi Li
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xiaofan Luo
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - An Huang
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China,*Correspondence: An Huang, ; Yuzhou Pang,
| | - Yuzhou Pang
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, Guangxi, China,*Correspondence: An Huang, ; Yuzhou Pang,
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28
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El Miedany Y, Abu-Zaid MH, El Gaafary M, Mansour M, Fathy N, Hassan W, Mortada M, Eissa M, Tabra SA, Galal S, Foad N, Ibrahim RA, Medhat B, El Olemy G, Adel Y, Ghaleb R, Saber S, GadAllah N. Egyptian guidelines for the treatment of Rheumatoid Arthritis — 2022 update. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Abstract
Background
Busy rheumatologists, and busy patients as well as policy makers, require accurate, succinct, transparent, easily digested summaries of evidence and recommendations for management. Our objective was to develop an up-to-date evidence-based, consensus, clinical practice guidelines for treat-to-target management of rheumatoid arthritis in adults.
Results
Ninety-four (94.7%) of the expert committee completed the 2-round e-Delphi surveys. A total of 33 recommendation items, addressing the main rheumatoid arthritis (RA) domains, were identified. The level of agreement (rate 7–9), for the statements which reached consensus, ranged from 85 to 100%. Consensus was achieved on the wording of all the clinical practice guidelines identified by the scientific committee. A management algorithm for the management of rheumatoid arthritis have been developed.
Conclusion
These updated recommendations reflect the most recent evidence for the management of RA. It also outlines the multidisciplinary team role in enhancing the RA patients’ care. The recommendations offer strategies to achieve optimum treat-to-target outcomes. However, standards of care are defined based on the clinical data obtained for individual patients and are prone to modification. High-quality, broad scope evidence-based clinical practice guidelines offer a path for bridging the gap between best practice, policy, local settings and patients’ choice.
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29
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Fragoulis GE, Nikiphorou E, Dey M, Zhao SS, Courvoisier DS, Arnaud L, Atzeni F, Behrens GM, Bijlsma JW, Böhm P, Constantinou CA, Garcia-Diaz S, Kapetanovic MC, Lauper K, Luís M, Morel J, Nagy G, Polverino E, van Rompay J, Sebastiani M, Strangfeld A, de Thurah A, Galloway J, Hyrich KL. 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2022; 82:742-753. [PMID: 36328476 DOI: 10.1136/ard-2022-223335] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
ObjectivesTo develop EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).MethodsAn international Task Force (TF) (22 members/15 countries) formulated recommendations, supported by systematic literature review findings. Level of evidence and grade of recommendation were assigned for each recommendation. Level of agreement was provided anonymously by each TF member.ResultsFour overarching principles (OAP) and eight recommendations were developed. The OAPs highlight the need for infections to be discussed with patients and with other medical specialties, in accordance with national regulations. In addition to biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before conventional synthetic DMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) antiviral treatment should be guided by HBV status defined prior to starting antirheumatic drugs. All patients positive for hepatitis-C-RNA should be referred for antiviral treatment. Also, patients who are non-immune to varicella zoster virus should be informed about the availability of postexposure prophylaxis should they have contact with this pathogen. Prophylaxis againstPneumocystis jiroveciiseems to be beneficial in patients treated with daily doses >15–30 mg of prednisolone or equivalent for >2–4 weeks.ConclusionsThese recommendations provide guidance on the screening and prevention of chronic and opportunistic infections. Their adoption in clinical practice is recommended to standardise and optimise care to reduce the burden of opportunistic infections in people living with AIIRD.
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Affiliation(s)
- George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College London, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Rheumatology Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, The University of Manchester, Manchester, UK
| | | | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Diseases (RESO), University Hospitals Strasbourg, Strasbourg, France
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Georg Mn Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Johannes Wj Bijlsma
- Dept of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter Böhm
- Forschungspartner, German League against rheumatism, Bonn, Germany
| | | | - Silvia Garcia-Diaz
- Rheumatology Department, Complex Hospitalari Moises Broggi, Barcelona, Spain
| | | | - Kim Lauper
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, The University of Manchester, Manchester, UK
- Division of Rheumatology, University of Geneva, Geneva, Switzerland
| | - Mariana Luís
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Jacques Morel
- Department of Rheumatology, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Ciber de Enfermedades Respiratorias CIBERES, Barcelona, Spain
| | - Jef van Rompay
- Belgium Patient Partner Program, EULAR People with Arthritis/Rheumatism across Europe (PARE), Antwerpen, Belgium
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Centre (DRFZ) Berlin and Charite University Medicine, Berlin, Germany
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College London, London, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester NHS Foundation Trust, Manchester, UK
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30
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Pham JP, Allen N, Smith A. Efficacy of ustekinumab and guselkumab in treatment refractory pityriasis rubra pilaris: A case series. Australas J Dermatol 2022; 63:522-524. [PMID: 36129444 DOI: 10.1111/ajd.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/13/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- James P Pham
- St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,School of Clinical Medicine, St Vincent's Clinical School, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Nicholas Allen
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Annika Smith
- St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
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31
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Rath E, Bonelli M, Duftner C, Gruber J, Mandl P, Moazedi-Furst F, Pieringer H, Puchner R, Flick H, Salzer HJF, Weiss G, Winkler S, Skvara H, Moschen A, Hofer H, Feurstein J, Sautner J. National consensus statement by the Austrian Societies for Rheumatology, Pulmonology, Infectiology, Dermatology and Gastroenterology regarding the management of latent tuberculosis and the associated utilization of biologic and targeted synthetic disease modifying antirheumatic drugs (DMARDs). Wien Klin Wochenschr 2022; 134:751-765. [PMID: 36036323 DOI: 10.1007/s00508-022-02062-7] [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: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
This publication provides a thorough analysis of the most relevant topics concerning the management of latent tuberculosis when using biologic and targeted synthetic Disease Modifying Antirheumatic Drugs (DMARDs) by a multidisciplinary, select committee of Austrian physicians. The committee includes members of the Austrian Societies for Rheumatology and Rehabilitation, Pulmonology, Infectiology, Dermatology and Gastroenterology. Consensus was reached on issues regarding screening and treatment of latent tuberculosis and includes separate recommendations for each biologic and targeted synthetic DMARD.
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Affiliation(s)
- Eva Rath
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,1. Medical Department, Hanusch Hospital, Vienna, Austria
| | - Michael Bonelli
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Department of Medicine III, rheumatology, Medical University of Vienna, Vienna, Austria
| | - Christina Duftner
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Gruber
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Mandl
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Department of Medicine III, rheumatology, Medical University of Vienna, Vienna, Austria
| | - Florentine Moazedi-Furst
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Herwig Pieringer
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Diakonissen Hospital, Linz, Austria
| | - Rudolf Puchner
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Private practice, Wels, Austria
| | - Holger Flick
- Austrian Society for Pulmonology (ÖGP), Vienna, Austria.,Department of Pulmonology, Medical University of Graz, Graz, Austria
| | - Helmut J F Salzer
- Austrian Society for Pulmonology (ÖGP), Vienna, Austria.,Department of Pulmonology, Kepler Medical University, Linz, Austria
| | - Günter Weiss
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,Austrian Society for Infectiology (ÖGIT), Kottingbrunn, Austria.,Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Winkler
- Austrian Society for Infectiology (ÖGIT), Kottingbrunn, Austria.,Department of Infectiology and Tropical Diseases, Medical University of Vienna, Vienna, Austria
| | - Hans Skvara
- Austrian Society for Dermatology and Venerology (ÖGDV), Vienna, Austria.,Department of Dermatology, State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Alexander Moschen
- Austrian Society for Gastroenterology and Hepatology (ÖGGH), Vienna, Austria.,Department of Gastroenterology and Hepatology, Kepler Medical University, Linz, Austria
| | - Harald Hofer
- Austrian Society for Gastroenterology and Hepatology (ÖGGH), Vienna, Austria.,Department of Medicine 1, Wels-Grieskirchen Clinics, Wels, Austria
| | - Julia Feurstein
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria.,1. Medical Department, Hanusch Hospital, Vienna, Austria
| | - Judith Sautner
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Vienna, Austria. .,Department of Medicine II, Lower Austrian Centre for Rheumatology, Karl Landsteiner Institute for Clinical Rheumatology, State Hospital Stockerau, Landstr. 18, 2000, Stockerau, Austria. .,Medical University of Vienna, Vienna, Austria.
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Chen JW, Deng GS, Zhang WS, Zhang MY, Guan T, Xu Q. Case report: Safety and efficacy of adalimumab in treating difficult-to-treat rheumatoid arthritis in a human immunodeficiency virus-positive patient, one year follow-up. Front Immunol 2022; 13:942642. [PMID: 35990692 PMCID: PMC9382239 DOI: 10.3389/fimmu.2022.942642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a joint-disabling inflammatory disease associated with the pathology of synovitis. Some patients with RA are difficult to treat, using disease-modifying anti-rheumatic drugs (DMARDs). Biology and targeted synthetic DMARDs (b/tsDMARDs) are options for patients with RA. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). Adalimumab is an anti-tumor necrosis factor therapy commonly used in patients with RA. However, there are no reports or related data on patients with RA-HIV/AIDS treated with adalimumab are available. In this report, we described the first successful case of a 60-year-old HIV-positive woman with difficult-to-treat RA treated with ADA after being screened for hepatitis virus, latent tuberculosis (LTBI), and other infections. She contracted HIV from sexual exposure while on adalimumab therapy. As the patient was resistant to first-line DMARDs, she continued adalimumab along with the initiation of highly active antiretroviral therapy (HAART). The patient was treated with adalimumab therapy for a year; her CD4+ lymphocyte count was normal, HIV-1 RNA decreased, and no new infections were triggered. The patient achieved clinical remission of RA. In conclusion, adalimumab is a safe option for patients with RA-HIV and may slow the progression of HIV infection. Furthermore, HAART has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.
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Affiliation(s)
- Jing-Wen Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-Shu Deng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Shuang Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Ying Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tong Guan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Tong Guan, ; Qiang Xu,
| | - Qiang Xu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Tong Guan, ; Qiang Xu,
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Russell LA, Craig C, Flores EK, Wainaina JN, Keshock M, Kasten MJ, Hepner DL, Edwards AF, Urman RD, Mauck KF, Oprea AD. Preoperative Management of Medications for Rheumatologic and HIV Diseases: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc 2022; 97:1551-1571. [PMID: 35933139 DOI: 10.1016/j.mayocp.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/21/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022]
Abstract
Perioperative medical management is challenging because of the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources use recommendations derived from individual studies and do not include a multidisciplinary focus on formal consensus. The Society for Perioperative Assessment and Quality Improvement identified a lack of authoritative clinical guidance as an opportunity to use its multidisciplinary membership to improve evidence-based perioperative care. The Society for Perioperative Assessment and Quality Improvement seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of immunosuppressive, biologic, antiretroviral, and anti-inflammatory medications. A panel of experts including hospitalists, anesthesiologists, internal medicine physicians, infectious disease specialists, and rheumatologists was appointed to identify the common medications in each of these categories. The authors then used a modified Delphi process to critically review the literature and to generate consensus recommendations.
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Affiliation(s)
- Linda A Russell
- Department of Rheumatology, Hospital for Special Surgery, New York, NY.
| | - Chad Craig
- Department of Medicine, Medical College of Wisconsin, Madison, NY
| | - Eva K Flores
- Section of Hospital Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - J Njeri Wainaina
- Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI
| | - Maureen Keshock
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mary J Kasten
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen F Mauck
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Adriana D Oprea
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
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Personalized Medicine and Machine Learning: A Roadmap for the Future. J Clin Med 2022; 11:jcm11144110. [PMID: 35887873 PMCID: PMC9317385 DOI: 10.3390/jcm11144110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
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Wang R, Horwich P, Sandulache VC, Hernandez DJ, Hornig J, Graboyes EM, Liou NE, Skoner J, Haskins AD, Ranasinghe V, Day TA, Sturgis EM, Huang AT. Safety of microvascular free tissue transfer reconstruction of the head and neck in the setting of chronic pharmacologic immunosuppression. Head Neck 2022; 44:1520-1527. [PMID: 35437907 DOI: 10.1002/hed.27049] [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: 01/12/2022] [Revised: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patients on chronic pharmacologic immunosuppressive therapy are at increased risk of wound infection and complications after surgery. There is a paucity of data examining perioperative complications after microvascular free tissue transfer (MVFTT) reconstruction of the head and neck in this patient population. METHODS Retrospective cohort study performed at two tertiary referral centers between August 2016 and May 2020. RESULTS Nine hundred and seventy-nine patients underwent MVFTT during the study period; of these 47 (5%) patients were taking chronic immunosuppressive medications. The most common indications for immunosuppression were solid organ transplant and autoimmune disease. Fourteen (30%) patients had surgical complications within 30 days of surgery: 8 (17%) wound dehiscences, 6 (12%) hematomas, and 2 (4%) surgical site infections. There was one total and one partial flap failure with a 30-day reoperation rate of 4%. CONCLUSIONS MVFTT of the head and neck appears to be safe in patients on chronic pharmacologic immunosuppression.
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Affiliation(s)
- Ray Wang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Horwich
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vlad C Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Joshua Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nelson E Liou
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Judith Skoner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angela D Haskins
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Viran Ranasinghe
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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36
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van Duren BH, Wignall A, Goodman S, Hewitt C, Mankia K, Pandit H. The Effect of Perioperative Biologic Disease-Modifying Anti-Rheumatic Drugs on the Risk of Postoperative Complications: Surgical Site Infection, Delayed Wound Healing, and Disease Flares Following Orthopaedic Surgical Procedures. J Bone Joint Surg Am 2022; 104:1116-1126. [PMID: 35175994 DOI: 10.2106/jbjs.21.00811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are effective in treating inflammatory diseases and have been increasingly utilized over the past decade. Patients who receive bDMARDs have been shown to be at an increased risk for surgical site infection following surgical procedures. The severe consequences of infection following orthopaedic surgery have led to the practice of withholding bDMARDs perioperatively; however, there has been no definitive evidence showing a clear benefit of withholding the use of bDMARDs, and in doing so, patients may be at an increased risk for higher disease activity. As such, the purpose of the present study was to compare the risk of infection, delayed wound healing, and disease flares associated with the use of bDMARDs in patients undergoing orthopaedic surgical procedures. METHODS We performed a systematic literature search of MEDLINE, Embase, and PubMed CENTRAL databases for studies comparing continuing and withholding the use of bDMARDs in patients undergoing orthopaedic procedures. Inclusion criteria were established following the PICO (Population, Intervention, Comparison, and Outcomes) approach: Population = patients who underwent orthopaedic surgical procedures and who were taking bDMARDs. Intervention = withholding the use of bDMARDs. Comparator = continuing the use of bDMARDs. Outcomes = surgical site infection, delayed wound healing, and disease flares. Article titles and abstracts were screened prior to review of the full text. Overall odds ratios (ORs) and associated 95% confidence intervals (CIs) for pooled effects were calculated. RESULTS Eleven studies met the inclusion criteria, providing data for 7,344 patients, including 2,385 patients who continued and 4,959 who withheld their bDMARDs perioperatively. Continuing bDMARDs was associated with a significantly lower risk of disease flares (OR, 0.22; 95% CI, 0.05 to 0.95; p = 0.04) and nonsignificant increases in surgical site infections (OR, 1.11; 95% CI, 0.82 to 1.49; p = 0.49) and wound complications (OR, 2.16; 95% CI, 0.48 to 9.85; p = 0.32). CONCLUSIONS The present systematic review highlights the limited evidence supporting the current practice of stopping bDMARDs perioperatively. These findings suggest that patients may not be at an increased risk for developing infection or wound complications if bDMARDs are continued but are at an increased risk for disease flare if bDMARDs are withheld. However, our conclusions are limited by the retrospective and heterogenous nature of the data, and possibly by a lack of study power. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bernard H van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Alice Wignall
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Susan Goodman
- Weill Cornell Medicine, New York, NY.,Integrative Rheumatology and Orthopedics Center of Excellence, Combined Arthritis Program, Hospital for Special Surgery, New York, NY
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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Actualización práctica de las recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPS) para el tratamiento de la psoriasis con terapia biológica. Parte 2 «Manejo de poblaciones especiales, pacientes con comorbilidad y gestión del riesgo». ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:583-609. [DOI: 10.1016/j.ad.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022] Open
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38
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Carrascosa JM, Puig L, Romero IB, Salgado-Boquete L, Del Alcázar E, Lencina JJA, Moreno D, de la Cueva P. [Translated article] Practical Update of the Guidelines Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis With Biologic Agents: Part 2-Management of Special Populations, Patients With Comorbid Conditions, and Risk. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T583-T609. [PMID: 35748004 DOI: 10.1016/j.ad.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since its inception, the Psoriasis Group (GPs) of the Spanish Academy of Dermatology and Venereology (AEDV) has worked to continuously update recommendations for the treatment of psoriasis based on the best available evidence and incorporating proposals arising from and aimed at clinical practice. An updated GPs consensus document on the treatment of moderate to severe psoriasis was needed because of changes in the treatment paradigm and the approval in recent years of a large number of new biologic agents. METHODOLOGY The consensus document was developed using the nominal group technique complemented by a scoping review. First, a designated coordinator selected a group of GPs members for the panel based on their experience and knowledge of psoriasis. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. The coordinator then drew up a set of proposed recommendations, which were discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted. RESULTS The present guidelines include updated recommendations on assessing the severity of psoriasis and criteria for the indication of systemic treatment. They also include general principles for the treatment of patients with moderate to severe psoriasis and define treatment goals for these patients as well as criteria for the indication and selection of initial and subsequent therapies Practical issues, such as treatment failure and maintenance of response, are also addressed.
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Affiliation(s)
- J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain.
| | - L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I B Romero
- Departamento de Dermatología, Hospital General Universitario de Alicante-ISABIAL - Universidad Miguel Hernández de Elche, Alicante, Spain
| | - L Salgado-Boquete
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - E Del Alcázar
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - J J A Lencina
- Servicio de Dermatología, Hospital Universitario Vega Baja, Alicante, Spain
| | - D Moreno
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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Hepatitis Virus Reactivation in Patients with Psoriasis Treated with Secukinumab in a Real-World Setting of Hepatitis B or Hepatitis C Infection. Clin Drug Investig 2022; 42:525-531. [PMID: 35633470 PMCID: PMC9188589 DOI: 10.1007/s40261-022-01163-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Biologics for psoriasis, especially anti-tumor necrosis factor-α therapies, may reactivate hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, as well in inactive carriers or patients with occult infection. However, some biologics, including anti-interleukin-17 therapies such as secukinumab, seem to be less likely to cause hepatitis reactivation. This study assessed the safety of secukinumab treatment in patients with psoriasis with HBV or HBC infection. METHODS This was a retrospective cohort study of patients with moderate-to-severe psoriasis treated with secukinumab at seven Italian centers. Patients serologically positive for one or more of the following viral hepatitis markers were included: HCV antibody (± HCV-RNA positivity) and/or hepatitis B surface antigen, and/or HBV core antibody and/or HBV surface antibody (± HBV-DNA positivity). Patients received secukinumab 300 mg subcutaneously at week 0/1/2/3/4 then every 4 weeks; prophylactic therapy before starting secukinumab was prescribed where indicated. The primary study endpoint was the reactivation of hepatitis viral infection, defined as conversion to HBV-DNA or HCV-RNA positivity, with or without elevation of transaminases. RESULTS Sixty patients (17 with concomitant psoriatic arthritis) were included. Thirteen subjects were hepatitis B surface antigen positive, 19 were HBV core antibody positive, and 30 were positive for the HCV antibody; however, all were HCV-RNA negative. After 53.5 ± 37.5 weeks of secukinumab therapy, hepatitis reactivation occurred in only one patient, who had a reactivation of both hepatitis B and hepatitis C. This patient had not undergone hepatitis B prophylaxis or hepatitis C treatment before secukinumab. CONCLUSIONS These real-world data support the safety of secukinumab in patients with positive markers of HBV or HCV infection, when administered together with dedicated prophylaxis.
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40
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A retrospective study of the efficacy of JAK inhibitors or abatacept on rheumatoid arthritis-interstitial lung disease. Inflammopharmacology 2022; 30:705-712. [PMID: 35462572 PMCID: PMC9135879 DOI: 10.1007/s10787-022-00936-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 12/15/2022]
Abstract
Objectives To examine the effectiveness of Janus-kinase inhibitors (JAKis) or abatacept (ABA) in patients with rheumatoid arthritis-interstitial lung disease (RA-ILD). Methods Patients with RA-ILD receiving JAKis or ABA were retrospectively evaluated at baseline and after 18 months of treatment. A computer-aided method (CaM) was used to assess the extent of high-resolution computed tomography (HRCT) fibrosis percentage. According to HRCT fibrosis changes, patients were classified as “worsened” (progression of 15% or more), “stable” (changes within 15%) or “improved” (reduction of 15% or more). Correlations between RA characteristics and JAKis or ABA responses were studied using a multivariate regression model. Results Seventy-five patients (69.3% women) were evaluated, 31 received a JAKi while 44 received ABA. In the JAKis group, five patients (16.1%) showed RA-ILD progression, 20 patients (64.5%) were considered stable, and six patients (19.4%) demonstrated RA-ILD improvement. In the ABA group, five patients (11.3%) showed RA-ILD progression, 32 patients (72.7%) were stable, and seven patients (16.0%) demonstrated RA-ILD improvement. In both groups, the percentage of current smokers was different between those classified as "worsened" and those classified as "improved/stable" (p = 0.01). In multivariate regression analysis, current smoking habit (p = 0.0051) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in ABA-treated patients, whereas in JAKis-treated patients, the only RA-ILD progression-related variable was disease duration of RA (p < 0.001). Conclusions Treatment with JAKis or ABA was related to stability or improvement of RA-ILD in 83.9% and 88.6% of patients, respectively. RA duration is the only variable associated with worsening RA-ILD in JAKis-treated patients.
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Bhat S, Patel M, Duly K, Choi D. Adalimumab-Adbm: The First Interchangeable Biosimilar for the Treatment of Inflammatory Diseases. Ann Pharmacother 2022; 56:1356-1364. [PMID: 35392668 DOI: 10.1177/10600280221082196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of the study was to review the pharmacologic and clinical profile of adalimumab-adbm (BI 695501), the first interchangeable biosimilar for treatment of inflammatory diseases. DATA SOURCES A PubMed search was conducted from inception to December 2021 using the keywords BI 695501 and adalimumab-adbm. Information was also obtained from published abstracts and package inserts. STUDY SELECTION AND DATA EXTRACTION Phase 1, 2 and 3 studies plus relevant literature on adalimumab-adbm pharmacologic and clinical profile were reviewed. DATA SYNTHESIS Adalimumab-adbm approval was based on a series of phase 3 VOLTAIRE trials, which evaluated the biosimilar's efficacy and safety in the treatment of moderate to severe Crohn's disease, rheumatoid arthritis, and psoriasis. Interchangeability status was granted based on data from the VOLTAIRE-X trial. The VOLTAIRE and VOLTAIRE-X studies demonstrated comparable efficacy and safety between adalimumab-adbm and reference adalimumab. Common adverse events included infections and injection site reactions. Similar to reference adalimumab, adalimumab-adbm contains black box warnings related to serious infections and malignancy. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Adalimumab-adbm is the first interchangeable biosimilar to be approved for inflammatory diseases and has the potential to improve patient access to treatment while decreasing medication-related costs. However, it will not be commercially available for patient use until 2023 and its adoption into clinical practice may face potential barriers seen with other biosimilars. CONCLUSION As an interchangeable biosimilar with comparable efficacy and safety to reference adalimumab, adalimumab-adbm is an important advance toward cost-effective management of inflammatory diseases.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy and Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Maitri Patel
- Department of Pharmacy and Dermatology, University of Chicago Medicine, Chicago, IL, USA
| | - Kristine Duly
- Department of Pharmacy and Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Choi
- Department of Pharmacy and Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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42
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Megna M, Patruno C, Bongiorno MR, Gambardella A, Guarneri C, Foti C, Lembo S, Loconsole F, Fabbrocini G. Lack of reactivation of tuberculosis in patients with psoriasis treated with secukinumab in a real-world setting of latent tuberculosis infection. J DERMATOL TREAT 2022; 33:2629-2633. [PMID: 35385362 DOI: 10.1080/09546634.2022.2062280] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Some biologics for psoriasis, especially anti-tumor necrosis factor (TNF)-α therapies, may re-activate latent tuberculosis (TBC) infection with consequent morbidity and mortality. However, there is a low reported incidence of conversion to positive TBC status among patients with psoriasis treated with second-generation biologic therapies, particularly anti-interleukin (IL)-17 therapies such as secukinumab. OBJECTIVES To evaluate the safety profile of secukinumab in psoriasis patients with latent TBC infection. METHODS Real-life data were collected by retrospective chart review on patients with moderate-to-severe psoriasis who showed positivity for TBC screening at baseline and underwent secukinumab treatment for psoriasis at six Italian centers. Patients received secukinumab 300 mg at week 0/1/2/3/4, then every 4 weeks. RESULTS Fifty-nine patients were enrolled; 30.5% also had psoriatic arthritis and other comorbidities were common. At baseline, the mean psoriasis duration was 14.5 years. Ten (17%) patients did not undergo prophylaxis before starting secukinumab. Conversely, isoniazid ± rifampicin or rifampicin alone prophylaxis was administered in 49/59 (83.1%) patients. After a mean treatment duration of 84 weeks, there were no cases of TBC reactivation and no unexpected safety signals. CONCLUSIONS Secukinumab use over an extended period was safe in psoriasis patients with latent TBC, even in patients who did not receive chemoprophylaxis.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Rita Bongiorno
- Section of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" (PROMISE). University of Palermo, Palermo, Italy
| | | | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging (BIOMORF), Section of Dermatology, University of Messina, Messina, Italy
| | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Salerno, Italy
| | - Francesco Loconsole
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Kon OM, Beare N, Connell D, Damato E, Gorsuch T, Hagan G, Perrin F, Petrushkin H, Potter J, Sethi C, Stanford M. BTS clinical statement for the diagnosis and management of ocular tuberculosis. BMJ Open Respir Res 2022; 9:9/1/e001225. [PMID: 35379660 PMCID: PMC9021811 DOI: 10.1136/bmjresp-2022-001225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022] Open
Abstract
The BTS clinical statement for the diagnosis and management of ocular tuberculosis (TB) draws on the expertise of both TB and and ophthalmic specialists to outline the current understanding of disease pathogenesis, diagnosis and management in adults. Published literature lacks high-quality evidence to inform clinical practice and there is also a paucity of data from animal models to elucidate mechanisms of disease. However, in order to improve and standardise patient care, this statement provides consensus points with the currently available data and agreed best practice.
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Affiliation(s)
- Onn Min Kon
- Chest and Allergy Clinic, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Nicholas Beare
- St Paul's Eye Unit, Liverpool University Hospitals, Liverpool, UK
- Department of Eye and Vision Research, University of Liverpool, Liverpool, UK
| | - David Connell
- Respiratory Medicine, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Erika Damato
- Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Gorsuch
- Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Guy Hagan
- Respiratory Medicine, City Hospital, Birmingham, UK
| | - Felicity Perrin
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Harry Petrushkin
- Ophthalmology, Moorfields Eye Hospital City Road Campus, London, UK
| | - Jessica Potter
- Respiratory Medicine, North Middlesex University Hospital NHS Trust, London, UK
| | - Charanjit Sethi
- Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Miles Stanford
- Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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44
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Cole WW, Familia M, Miskimin C, Mulcahey MK. Preoperative Optimization and Tips to Avoiding Surgical Complications Before the Incision. Sports Med Arthrosc Rev 2022; 30:2-9. [PMID: 35113836 DOI: 10.1097/jsa.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision.
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Affiliation(s)
- Wendell W Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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45
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Akiyama M, Kaneko Y. Pathogenesis, clinical features, and treatment strategy for rheumatoid arthritis-associated interstitial lung disease. Clin Exp Rheumatol 2022; 21:103056. [PMID: 35121155 DOI: 10.1016/j.autrev.2022.103056] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis is an autoimmune disease that primarily affects the joints. The emergence of highly effective anti-rheumatic drugs such as biologic agents and janus kinase inhibitors has dramatically improved the management of the disease by preventing irreversible joint destruction and disability. This disease can manifest the serious extra-articular involvements including interstitial lung disease, which has the significant impact on the patients' morbidity and mortality. However, treatment strategy specific for rheumatoid arthritis-associated interstitial lung disease (RA-ILD) has not been yet established. Therefore, understanding the pathogenesis and clinical features of RA-ILD is critical to provide the better management and improve the prognosis of the patients. Accumulation of evidence suggest that it is essentially important to achieve remission or at least low disease activity of arthritis to prevent new emergence, progression, or acute exacerbation of RA-ILD. RA-ILD patients frequently show high titers of autoantibodies including rheumatoid factor and anti-CCP antibody, and the excessive formation of tertiary lymphoid organs is found in the local affected lungs, indicating the adaptive immune response as a key pathogenic inducer. In this regard, non-TNF inhibitors targeting adaptive immune responses such as abatacept and rituximab were reported to be promising for the stabilization and improvement of RA-ILD. Nintedanib, an anti-fibrotic agent, was shown to be effective for reducing the decline of forced vital capacity in RA-ILD. In this review, we summarized the current evidence in the pathogenesis, clinical features, and treatments for RA-ILD and provide future prospects.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 1608582 Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 1608582 Tokyo, Japan.
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46
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Acute exacerbation of interstitial lung disease associated with rheumatic disease. Nat Rev Rheumatol 2022; 18:85-96. [PMID: 34876670 DOI: 10.1038/s41584-021-00721-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
Interstitial lung disease (ILD) is a cause of morbidity and mortality in patients with rheumatic diseases, such as connective-tissue diseases, rheumatoid arthritis and systemic vasculitis. Some patients with ILD secondary to rheumatic disease (RD-ILD) experience acute exacerbations, with sudden ILD progression and high mortality during or immediately after the exacerbation, and a very low 1-year survival rate. In the ILD subtype idiopathic pulmonary fibrosis (IPF), an acute exacerbation is defined as acute worsening or development of dyspnoea associated with new bilateral ground-glass opacities and/or consolidations at high-resolution CT, superimposed on a background pattern consistent with fibrosing ILD. However, acute exacerbation in RD-ILD (AE-RD-ILD) currently has no specific definition. The aetiology and pathogenesis of AE-RD-ILD remain unclear, but distinct triggers might include infection, mechanical stress, microaspiration and DMARD treatment. At this time, no effective evidence-based therapeutic strategies for AE-RD-ILD are available. In clinical practice, AE-RD-ILD is often empirically treated with high-dose systemic steroids and antibiotics, with or without immunosuppressive drugs. In this Review, we summarize the clinical features, diagnosis, management and prognosis of AE-RD-ILD, enabling the similarities and differences with acute exacerbation in IPF to be critically assessed.
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47
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Conway R, Nikiphorou E. Efficacy and safety of conventional synthetic, biologic and targeted synthetic DMARDs in RA-ILD: A narrative review. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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48
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Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric uveitis: Role of the pediatrician. Front Pediatr 2022; 10:874711. [PMID: 35979409 PMCID: PMC9376387 DOI: 10.3389/fped.2022.874711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.
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Affiliation(s)
- Abhay Shivpuri
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Inga Turtsevich
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ameenat Lola Solebo
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom.,University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sandrine Compeyrot-Lacassagne
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom
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49
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Kurosawa Y, Ito S, Sakai S, Hasegawa E, Kobayashi D, Abe A, Otani H, Nakazono K, Murasawa A, Narita I, Ishikawa H. Effectiveness and Safety of Golimumab for Patients ≥75 Years Old with Rheumatoid Arthritis. Intern Med 2022; 61:2117-2125. [PMID: 35850986 PMCID: PMC9381335 DOI: 10.2169/internalmedicine.8497-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Treatment of elderly patients with rheumatoid arthritis (RA) has been controversial because they often have serious comorbidities and cannot use methotrexate (MTX). In Japan, golimumab (GLM) 100 mg without MTX is approved. We investigated the effectiveness and safety of GLM in elderly patients with RA. Methods The GLM survival rate was evaluated using the Kaplan-Meier method. Disease activities, laboratory findings, and treatments were evaluated. Patients We enrolled 168 patients with RA in our hospital. Using age ≥75 years old to identify elderly patients, younger (n=111) and elderly (n=57) groups were established. Elderly patients were divided into 2 groups according to the MTX treatment status (with, n=27; without, n=25). Results The GLM survival rates were 80.8% and 82.3% in elderly and younger patients, respectively (p=0.762). At 52 weeks, the Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) was improved in elderly patients (4.26 vs. 3.31, p<0.001); the Health Assessment Questionnaire Disability Index (HAQ-DI) was unchanged (1.12 vs. 0.88, p=0.694). When elderly patients were compared according to the MTX treatment status, the DAS28-ESR had improved in both groups (with MTX: 3.82 vs. 2.68, p<0.001; without MTX: 4.76 vs. 4.25, p=0.026); however, the HAQ-DI had not. The GLM survival rates at 52 weeks were 85% and 76% in patients with and without MTX, respectively. Conclusion In elderly patients with RA, GLM was effective, regardless of MTX treatment status, but it did not affect the HAQ-DI. GLM survival rates were comparable between elderly and younger patients. GLM may be a suitable option for elderly patients with RA who cannot use MTX.
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Affiliation(s)
- Yoichi Kurosawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Shunsuke Sakai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Eriko Hasegawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | | | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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50
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Giblin GT, Murphy L, Stewart GC, Desai AS, Di Carli MF, Blankstein R, Givertz MM, Tedrow UB, Sauer WH, Hunninghake GM, Dellaripa PF, Divakaran S, Lakdawala NK. Cardiac Sarcoidosis: When and How to Treat Inflammation. Card Fail Rev 2021; 7:e17. [PMID: 34950507 PMCID: PMC8674699 DOI: 10.15420/cfr.2021.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/18/2021] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a complex, multisystem inflammatory disease with a heterogeneous clinical spectrum. Approximately 25% of patients with systemic sarcoidosis will have cardiac involvement that portends a poorer outcome. The diagnosis, particularly of isolated cardiac sarcoidosis, can be challenging. A paucity of randomised data exist on who, when and how to treat myocardial inflammation in cardiac sarcoidosis. Despite this, corticosteroids continue to be the mainstay of therapy for the inflammatory phase, with an evolving role for steroid-sparing and biological agents. This review explores the immunopathogenesis of inflammation in sarcoidosis, current evidence-based treatment indications and commonly used immunosuppression agents. It explores a multidisciplinary treatment and monitoring approach to myocardial inflammation and outlines current gaps in our understanding of this condition, emerging research and future directions in this field.
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Affiliation(s)
- Gerard T Giblin
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Laura Murphy
- Cardiovascular Imaging Program and Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Garrick C Stewart
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Akshay S Desai
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program and Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Ron Blankstein
- Cardiovascular Imaging Program and Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Michael M Givertz
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - William H Sauer
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Gary M Hunninghake
- Interstitial Lung Disease Program, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Paul F Dellaripa
- Interstitial Lung Disease Program, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Sanjay Divakaran
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
| | - Neal K Lakdawala
- Center for Advanced Heart Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA, US
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