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Li T, Dong F, Li N, Chang C, Wang Y. Maternal and perinatal outcomes of asthma exacerbation during pregnancy in a Chinese population: a retrospective cohort study. BMC Pulm Med 2024; 24:296. [PMID: 38918763 PMCID: PMC11197224 DOI: 10.1186/s12890-024-03112-8] [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: 02/21/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Asthma exacerbation (AE) is a significant clinical problem during pregnancy. This study aimed to identify maternal and perinatal outcomes associated with AE during pregnancy. METHODS We conducted a retrospective cohort study using the Peking University Third Hospital database from January 1, 2013 to December 31, 2020. We compared the clinical characteristics and maternal, perinatal and offspring outcomes of asthma with and without exacerbations among women who delivered during this period. The primary outcome was hypertensive disorders of pregnancy (HDP). Univariable and multivariable logistic regression analyses were used to analyze the clinical characteristics of AE during pregnancy and the association between AE and adverse maternal and perinatal outcomes. RESULTS The prevalence of asthma during pregnancy increased from 0.52% in 2013 to 0.98% in 2020. Of the 220 patients with asthma during pregnancy included in the study, 105 experienced AE during pregnancy: 62.9% (n = 66) had mild-to-moderate AE and 37.1% (n = 39) had severe AE. Pregnant women with allergic rhinitis have a higher risk of AE during pregnancy. Women who experienced AE were more at risk for hypertensive disorders of pregnancy than women who did not experience any exacerbation (12.4%vs3.5%, p < 0.05). CONCLUSIONS The prevalence of asthma among pregnant women in China is on the rise. There is a notable correlation between pregnant women who suffer from allergic rhinitis and an elevated risk of AE during pregnancy. Studies have shown that AE during pregnancy are associated with an increased risk of hypertensive disorders of pregnancy.
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Affiliation(s)
- Tongxin Li
- Department of General Practice, Peking University Third Hospital, Beijing, 100191, China
| | - Fawu Dong
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Nan Li
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, China.
| | - Yan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, PekingUniversity Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
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Gu J, Li T, Ding Y, Chang C, Yin S, Wang Y. Effects of Pregnancy-Onset Asthma on Perinatal Outcomes: A Retrospective Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00631-7. [PMID: 38880304 DOI: 10.1016/j.jaip.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND It is unknown whether women with pregnancy-onset asthma are predisposed to worse pregnancy outcomes compared with women with pre-pregnancy asthma. OBJECTIVE To explore whether pregnancy-onset asthma leads to worse perinatal outcomes compared with pre-pregnancy asthma. METHODS Women who were discharged with a diagnosis of asthma and gave birth to a live singleton were included in this retrospective cohort analysis. Women were separated into groups based on whether the asthma was diagnosed during or before pregnancy. We compared clinical characteristics, perinatal outcomes, and asthma exacerbations (AEs) between groups. RESULTS A total of 335 women were included in this study, 39 of whom (11.6%) had pregnancy-onset asthma and 296 had pre-pregnancy asthma. All pregnant women in the pregnancy-onset group experienced AEs during pregnancy. The proportion of chronic hypertension, chronic hypertension with superimposed preeclampsia, and spontaneous preterm births in the pregnancy-onset group was significantly higher than that in the pre-pregnancy asthma group. After adjusting for age, body mass index, onset of asthma during pregnancy, and severity of AEs through multivariate analysis, pregnancy-onset asthma was an independent risk factor for spontaneous preterm birth (adjusted odds ratio = 7.71; 95% CI, 1.30-46.12) and severe AE was an independent risk factor for gestational hypertension and preeclampsia (adjusted odds ratio = 3.58; 95% CI, 1.30-9.87). CONCLUSIONS During pregnancy, pregnancy-onset asthma in women is associated with an exacerbation of the condition. Obstetricians should be vigilant for signs of asthma onset during pregnancy. Other health care providers should watch for symptoms of gestational hypertension and preeclampsia in pregnant women with preexisting or new-onset asthma.
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Affiliation(s)
- Jinyu Gu
- Center for Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center on Obstetrics and Gynecology Disease, Beijing, China; Department of Obstetrics and Gynecology, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, China
| | - Tongxin Li
- Department of General Practice, Peking University Third Hospital, Beijing, China
| | - Yishan Ding
- Peking University School of Basic Medical Sciences, Beijing, China
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Siyuan Yin
- Peking University School of Basic Medical Sciences, Beijing, China
| | - Yan Wang
- Center for Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center on Obstetrics and Gynecology Disease, Beijing, China.
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Liu L, Hong Y, Ma C, Zhang F, Li Q, Li B, He H, Zhu J, Wang H, Chen L. Circular RNA Gtdc1 Protects Against Offspring Osteoarthritis Induced by Prenatal Prednisone Exposure by Regulating SRSF1-Fn1 Signaling. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307442. [PMID: 38520084 PMCID: PMC11132075 DOI: 10.1002/advs.202307442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/21/2024] [Indexed: 03/25/2024]
Abstract
Chondrodysplasia is closely associated with low birth weight and increased susceptibility to osteoarthritis in adulthood. Prenatal prednisone exposure (PPE) can cause low birth weight; however, its effect on offspring cartilage development remains unexplored. Herein, rats are administered clinical doses of prednisone intragastrically on gestational days (GDs) 0-20 and underwent long-distance running during postnatal weeks (PWs) 24-28. Knee cartilage is assayed for quality and related index changes on GD20, PW12, and PW28. In vitro experiments are performed to elucidate the mechanism. PPE decreased cartilage proliferation and matrix synthesis, causing offspring chondrodysplasia. Following long-distance running, the PPE group exhibited more typical osteoarthritis-like changes. Molecular analysis revealed that PPE caused cartilage circRNomics imbalance in which circGtdc1 decreased most significantly and persisted postnatally. Mechanistically, prednisolone reduced circGtdc1 expression and binding with Srsf1 to promote degradation of Srsf1 via K48-linked polyubiquitination. This further inhibited the formation of EDA/B+Fn1 and activation of PI3K/AKT and TGFβ pathways, reducing chondrocyte proliferation and matrix synthesis. Finally, intra-articular injection of offspring with AAV-circGtdc1 ameliorated PPE-induced chondrodysplasia, but this effect is reversed by Srsf1 knockout. Altogether, this study confirms that PPE causes chondrodysplasia and susceptibility to osteoarthritis by altering the circGtdc1-Srsf1-Fn1 axis; in vivo, overexpression of circGtdc1 can represent an effective intervention target for ameliorating PPE-induced chondrodysplasia.
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Affiliation(s)
- Liang Liu
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Yuntian Hong
- Department of GastroenterologyZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Chi Ma
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Fan Zhang
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Qingxian Li
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Bin Li
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
- Hubei Provincial Key Laboratory of Developmentally Originated DiseaseWuhan430071China
| | - Hangyuan He
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Jiayong Zhu
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Hui Wang
- Hubei Provincial Key Laboratory of Developmentally Originated DiseaseWuhan430071China
- Department of PharmacologyWuhan University School of Basic Medical SciencesWuhan430071China
| | - Liaobin Chen
- Department of Orthopedic SurgeryJoint Disease Research Center of Wuhan UniversityZhongnan Hospital of Wuhan UniversityWuhan430071China
- Hubei Provincial Key Laboratory of Developmentally Originated DiseaseWuhan430071China
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Haque MF, El-Nashar HAS, Akbor MS, Alfaifi M, Bappi MH, Chowdhury AK, Hossain MK, El-Shazly M, Albayouk T, Saleh N, Islam MT. Anti-inflammatory activity of d-pinitol possibly through inhibiting COX-2 enzyme: in vivo and in silico studies. Front Chem 2024; 12:1366844. [PMID: 38690012 PMCID: PMC11058972 DOI: 10.3389/fchem.2024.1366844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction: D-pinitol, a naturally occurring inositol, has diverse biological activities like antioxidant, antimicrobial and anticancer activities. This study aimed to evaluate anti-inflammatory effect of d-pinitol in a chick model. Additionally, in silico studies were performed to evaluate the molecular interactions with cyclooxygenase-2 (COX-2). Methods: The tested groups received d-pinitol (12.5, 25, and 50 mg/kg) and the standard drugs celecoxib and ketoprofen (42 mg/kg) via oral gavage prior to formalin injection. Then, the number of licks was counted for the first 10 min, and the paw edema diameter was measured at 60, 90, and 120 min. Results and Discussion: The d-pinitol groups significantly (p < 0.05) reduced the number of paw licks and paw edema diameters, compared to negative control. When d-pinitol was combined with celecoxib, it reduced inflammatory parameters more effectively than the individual groups. The in silico study showed a promising binding capacity of d-pinitol with COX-2. Taken together, d-pinitol exerted anti-inflammatory effects in a dose-dependent manner, possibly through COX-2 interaction pathway.
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Affiliation(s)
- Mst. Farjanamul Haque
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Heba A. S. El-Nashar
- Department of Pharmacognosy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Md. Showkoth Akbor
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Mohammed Alfaifi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mehedi Hasan Bappi
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | | | - Muhammad Kamal Hossain
- School of Pharmacy, Jeonbuk National University, Jeonju, Republic of Korea
- Department of Pharmacy, University of Science and Technology Chittagiong, Chittagong, Bangladesh
| | - Mohamed El-Shazly
- Department of Pharmacognosy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Tala Albayouk
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Na’il Saleh
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Muhammad Torequl Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
- Pharmacy Discipline, Khulna University, Khulna, Bangladesh
- BioLuster Research Center, Dhaka, Bangladesh
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Wen J, Liu J, Wan L, Wang F. Long noncoding RNA/circular RNA regulates competitive endogenous RNA networks in rheumatoid arthritis: molecular mechanisms and traditional Chinese medicine therapeutic significances. Ann Med 2023; 55:973-989. [PMID: 36905646 PMCID: PMC10795602 DOI: 10.1080/07853890.2023.2172605] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 03/13/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic and autoimmune disease that is mainly featured abnormal fibroblast-like synoviocyte (FLS) proliferation and inflammatory cell infiltration. Abnormal expression or function of long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs) are closely related to human diseases, including RA. There has been increasing evidence showing that in the competitive endogenous RNA (ceRNA) networks, both lncRNA and circRNA are vital in the biological functions of cells. Nevertheless, the exact mechanism of ceRNA in RA remains to be investigated. Herein, we summarized the molecular potencies of lncRNA/circRNA-mediated ceRNA networks in RA, with emphasis on the phenotypic regulation of ceRNA in the progression of RA, including regulation of proliferation, invasion, inflammation and apoptosis, as well as the role of ceRNA in traditional Chinese medicine (TCM) in the treatment of RA. In addition, we also discussed the future direction and potential clinical value of ceRNA in the treatment of RA, which may provide potential reference value for clinical trials of TCM therapy for the treatment of RA.Key messagesLong noncoding RNA/circular RNA can work as the competitive endogenous RNA sponge and participate in the pathogenesis of rheumatoid arthritis.Traditional Chinese medicine and its agents have shown potential roles in the prevention and treatment of rheumatoid arthritis via competitive endogenous RNA.
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Affiliation(s)
- Jianting Wen
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
- Key Laboratory of Xin’an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jian Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, China
| | - Lei Wan
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, China
| | - Fanfan Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
- Institute of Rheumatology, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
- Department of Internal Medicine Application Foundation Research and Development, Anhui Province—Key Laboratory of Modern Chinese Medicine, Hefei, Anhui, China
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de Melo LFM, Barbosa JDS, Cordeiro MLDS, Aquino-Martins VGDQ, da Silva AP, Paiva WDS, Silveira ER, dos Santos DYAC, Rocha HAO, Scortecci KC. The Antioxidant and Immunomodulatory Potential of Coccoloba alnifolia Leaf Extracts. Int J Mol Sci 2023; 24:15885. [PMID: 37958868 PMCID: PMC10650087 DOI: 10.3390/ijms242115885] [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: 10/09/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Oxidative stress has been associated with different diseases, and different medicinal plants have been used to treat or prevent this condition. The leaf ethanolic extract (EE) and aqueous extract (AE) from Coccoloba alnifolia have previously been characterized to have antioxidant potential in vitro and in vivo. In this study, we worked with EE and AE and two partition phases, AF (ethyl acetate) and BF (butanol), from AE extract. These extracts and partition phases did not display cytotoxicity. The EE and AE reduced NO production and ROS in all three concentrations tested. Furthermore, it was observed that EE and AE at 500 μg/mL concentration were able to reduce phagocytic activity by 30 and 50%, respectively. A scratch assay using a fibroblast cell line (NHI/3T3) showed that extracts and fractions induced cell migration with 60% wound recovery within 24 h, especially for BF. It was also observed that AF and BF had antioxidant potential in all the assays evaluated. In addition, copper chelation was observed. This activity was previously not detected in AE. The HPLC-DAD analysis showed the presence of phenolic compounds such as p-cumaric acid and vitexin for extracts, while the GNPS annotated the presence of isoorientin, vitexin, kanakugiol, and tryptamine in the BF partition phase. The data presented here demonstrated that the EE, AE, AF, and BF of C. alnifolia have potential immunomodulatory effects, antioxidant effects, as well as in vitro wound healing characteristics, which are important for dynamic inflammation process control.
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Affiliation(s)
- Luciana Fentanes Moura de Melo
- Laboratory of Plant Transformation and Microscopy Analysis (LPTAM), Cell Biology and Genetics Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (L.F.M.d.M.); (V.G.d.Q.A.-M.); (A.P.d.S.)
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Biochemistry and Molecular Biology Graduation School Programa de Pós-Graduação em Bioquímica, Federal University of Rio Grande do Norte (UFRN), Natal 59012-570, RN, Brazil
| | - Jefferson da Silva Barbosa
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Federal Institut of Education, Science and Technology of Rio Grande do Norte (IFRN), São Gonçalo do Amarante 59291-727, RN, Brazil
| | - Maria Lúcia da Silva Cordeiro
- Laboratory of Plant Transformation and Microscopy Analysis (LPTAM), Cell Biology and Genetics Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (L.F.M.d.M.); (V.G.d.Q.A.-M.); (A.P.d.S.)
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Biochemistry and Molecular Biology Graduation School Programa de Pós-Graduação em Bioquímica, Federal University of Rio Grande do Norte (UFRN), Natal 59012-570, RN, Brazil
| | - Verônica Giuliani de Queiroz Aquino-Martins
- Laboratory of Plant Transformation and Microscopy Analysis (LPTAM), Cell Biology and Genetics Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (L.F.M.d.M.); (V.G.d.Q.A.-M.); (A.P.d.S.)
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Biochemistry and Molecular Biology Graduation School Programa de Pós-Graduação em Bioquímica, Federal University of Rio Grande do Norte (UFRN), Natal 59012-570, RN, Brazil
| | - Ariana Pereira da Silva
- Laboratory of Plant Transformation and Microscopy Analysis (LPTAM), Cell Biology and Genetics Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (L.F.M.d.M.); (V.G.d.Q.A.-M.); (A.P.d.S.)
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
| | - Weslley de Souza Paiva
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Northeast Biotecnology Network (RENORBIO), Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil
| | - Elielson Rodrigo Silveira
- Phytochemistry Laboratory, Botany Departament, Bioscience Institut, São Paulo University, São Paulo 05508-070, SP, Brazil; (E.R.S.); (D.Y.A.C.d.S.)
| | - Déborah Yara A. Cursino dos Santos
- Phytochemistry Laboratory, Botany Departament, Bioscience Institut, São Paulo University, São Paulo 05508-070, SP, Brazil; (E.R.S.); (D.Y.A.C.d.S.)
| | - Hugo Alexandre Oliveira Rocha
- Laboratory of Biotechnology of Natural Polymers (BIOPOL), Biochemistry Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (J.d.S.B.); (W.d.S.P.); (H.A.O.R.)
- Biochemistry and Molecular Biology Graduation School Programa de Pós-Graduação em Bioquímica, Federal University of Rio Grande do Norte (UFRN), Natal 59012-570, RN, Brazil
| | - Kátia Castanho Scortecci
- Laboratory of Plant Transformation and Microscopy Analysis (LPTAM), Cell Biology and Genetics Department, Centro de Biociências, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (L.F.M.d.M.); (V.G.d.Q.A.-M.); (A.P.d.S.)
- Biochemistry and Molecular Biology Graduation School Programa de Pós-Graduação em Bioquímica, Federal University of Rio Grande do Norte (UFRN), Natal 59012-570, RN, Brazil
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Kohn SO, Azam A, Hamilton LE, Harrison SR, Graef ER, Young KJ, Marzo-Ortega H, Liew JW. Impact of sex and gender on axSpA diagnosis and outcomes. Best Pract Res Clin Rheumatol 2023; 37:101875. [PMID: 38008661 DOI: 10.1016/j.berh.2023.101875] [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: 06/30/2023] [Revised: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023]
Abstract
Axial spondyloarthritis (axSpA) was historically considered a disease of men, largely due to the recognition of a more severe, progressive phenotype, ankylosing spondylitis (AS; or radiographic axSpA, r-axSpA) aiding the clinical diagnosis [1,2]. Data demonstrating the near equal prevalence of axSpA in women only started to emerge in the last decades, highlighting intrinsic differences in disease phenotype, and clinical and imaging characteristics between sexes, which partly explain the issue of underdiagnosis in women. Similar to the evolving understanding of spondyloarthritis and the diseases that term describes, the concepts of gender and sex also warrant further clarification to accurately assess their potential role in disease pathophysiology and phenotypic expression. This narrative review delves into the most recent evidence from the literature on the true prevalence of sex differences in axSpA, and the impact of sex and gender on diagnosis, disease characteristics and treatment response in this, still underserved, chronic disease.
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Affiliation(s)
- Samantha O Kohn
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA; Banner University Internal Medicine Department, 1111 E McDowell Road, Phoenix, AZ, 85006, USA.
| | - Abeera Azam
- Department of Internal Medicine, University of Texas Health Science Center at Tyler, 11937 U.S. Hwy. 271 Tyler, TX 75708, USA.
| | - Lauren E Hamilton
- The University of Arizona College of Medicine Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA.
| | - Stephanie R Harrison
- Leeds Institute of Cardiovascular and Metabolic Medicine, Data Analytics and Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, 1(st) Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | - Elizabeth R Graef
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, 650 Albany St, X200 Boston, MA 02118, USA.
| | - Kristen J Young
- Division of Rheumatology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA; Banner University Medicine Rheumatology Clinic, 1441 N 12th St. 3rd floor, Phoenix, AZ, 85006, USA.
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, 1(st) Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Jean W Liew
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, 650 Albany St, X200 Boston, MA 02118, USA.
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8
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Sharma A, Goel A. Pathogenesis of rheumatoid arthritis and its treatment with anti-inflammatory natural products. Mol Biol Rep 2023; 50:4687-4706. [PMID: 37022525 DOI: 10.1007/s11033-023-08406-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
Introduction Rheumatoid arthritis (RA) is a common autoimmune disease across the globe that is chronic and systemic as well. The disease is linked with autoantibodies and is inflammatory, eventually targeting several molecules along with certain modified self-epitopes. The disease majorly affects the joints of an individual. Rheumatoid arthritis is manifested clinically by polyarthritis linked with the dysfunction of the joints. This chiefly affects the synovial joint lining and is linked with progressive dysfunction, premature death, along with socioeconomic implications. The macrophage activation, along with the activation of certain defense cells, results in a response to self-epitopes that helps in providing a better understanding of the disease pathogenesis. Material and methodology For this review article, papers have been retrieved and reviewed from database including PubMed, Scopus and Web of science. Relevant papers were taken fulfilling the criteria for writing this review article. Results This has resulted in the establishment of several new therapeutic techniques that serve as potential inhibitors of such cells. Researchers have gained an interest in understanding this disease to provide strategies for treatment in the last two decades. This also includes recognition followed by the treatment of the disease at its early stages. Various allopathic treatment approaches often have chronic and toxic teratogenic effects. However, to avoid this issue of toxicity followed by side effects, certain medicinal plants have been used in treating RA. Conclusion Medicinal plants possess active phytoconstituents that entail antioxidants as well as anti-inflammatory properties, making them a helpful alternative to allopathic drugs that are often linked with highly toxic effects. This review paper entails a thorough discussion of the epidemiology, pathophysiology, diagnosis, and management of RA. The paper will also focus on the use of herbal plants in the treatment of the disease to avoid the side effects that generally occur in allopathic treatment.
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Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Uttar Pradesh, 281406, Mathura, India
| | - Anjana Goel
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Uttar Pradesh, 281406, Mathura, India.
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Hasan MR, Alotaibi BS, Althafar ZM, Mujamammi AH, Jameela J. An Update on the Therapeutic Anticancer Potential of Ocimum sanctum L.: "Elixir of Life". Molecules 2023; 28:molecules28031193. [PMID: 36770859 PMCID: PMC9919305 DOI: 10.3390/molecules28031193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023] Open
Abstract
In most cases, cancer develops due to abnormal cell growth and subsequent tumour formation. Due to significant constraints with current treatments, natural compounds are being explored as potential alternatives. There are now around 30 natural compounds under clinical trials for the treatment of cancer. Tulsi, or Holy Basil, of the genus Ocimum, is one of the most widely available and cost-effective medicinal plants. In India, the tulsi plant has deep religious and medicinal significance. Tulsi essential oil contains a valuable source of bioactive compounds, such as camphor, eucalyptol, eugenol, alpha-bisabolene, beta-bisabolene, and beta-caryophyllene. These compounds are proposed to be responsible for the antimicrobial properties of the leaf extracts. The anticancer effects of tulsi (Ocimum sanctum L.) have earned it the title of "queen of herbs" and "Elixir of Life" in Ayurvedic treatment. Tulsi leaves, which have high concentrations of eugenol, have been shown to have anticancer properties. In a various cancers, eugenol exerts its antitumour effects through a number of different mechanisms. In light of this, the current review focuses on the anticancer benefits of tulsi and its primary phytoconstituent, eugenol, as apotential therapeutic agent against a wide range of cancer types. In recent years, tulsi has gained popularity due to its anticancer properties. In ongoing clinical trials, a number of tulsi plant compounds are being evaluated for their potential anticancer effects. This article discusses anticancer, chemopreventive, and antioxidant effects of tulsi.
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Affiliation(s)
- Mohammad Raghibul Hasan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Alquwayiyah 11971, Saudi Arabia
- Correspondence: ; Tel.: +966-56-241-6571
| | - Bader Saud Alotaibi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Alquwayiyah 11971, Saudi Arabia
| | - Ziyad Mohammed Althafar
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Alquwayiyah 11971, Saudi Arabia
| | - Ahmed Hussain Mujamammi
- Clinical Biochemistry Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Jafar Jameela
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Alquwayiyah 11971, Saudi Arabia
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10
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Liu Y, Peng J, Xiong X, Cheng L, Cheng X. Tofacitinib enhances IGF1 via inhibiting STAT6 transcriptionally activated-miR-425-5p to ameliorate inflammation in RA-FLS. Mol Cell Biochem 2022; 477:2335-2344. [PMID: 35536531 DOI: 10.1007/s11010-022-04444-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/08/2022] [Indexed: 12/14/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease, which has been reported closely associated with the dysfunction of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway. This study aims to explore the potential therapeutic effect of Tofacitinib, a putative JAK/STAT inhibitor, in RA. Tofacitinib suppressed proliferation and accelerated apoptosis of rheumatoid arthritis synovial fibroblasts (RA-FLS) as confirmed by CCK-8, EdU and Western blot assays. Tofacitinib significantly inhibited expression of pro-inflammatory factors including tumor necrosis factor-α (TNF-α), vascular endothelial growth factor A, matrix metalloproteinase 1, matrix metalloproteinase 3, interleukin-6 and interferon gamma in RA-FLS cells. mechanistically, tofacitinib decreased signal transducer and activator of transcription 6 (STAT6), which transcriptionally activates miR-425-5p, and thus increased insulin like growth factor 1 (IGF1) expression, a target of miR-425-5p in RA-FLS. Overexpression of STAT6 restored the expression of pro-inflammatory factors and proliferation inhibited by Tofacitinib in RA-FLS. Overall, Tofacitinib exerted inhibitory effect on proliferation and inflammation of RA-FLS through modulating STAT6/miR-425-5p/IGF1 signal axis. These findings shed light on the novel strategies for improving RA.
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Affiliation(s)
- Yingjie Liu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Peng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaochuan Xiong
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liang Cheng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Huangpu District, Shanghai, 200092, China.
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11
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Zari AT, Zari TA, Hakeem KR. Anticancer Properties of Eugenol: A Review. Molecules 2021; 26:molecules26237407. [PMID: 34885992 PMCID: PMC8659182 DOI: 10.3390/molecules26237407] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Conventional cancer treatments have shown several unfavourable adverse effects, as well as an increase in anticancer drug resistance, which worsens the impending cancer therapy. Thus, the emphasis is currently en route for natural products. There is currently great interest in the natural bioactive components from medicinal plants possessing anticancer characteristics. For example, clove (Syzygium aromaticum L.) (Family Myrtaceae) is a highly prized spice that has been historically utilized as a food preservative and for diverse medical uses. It is reckoned amongst the valued sources of phenolics. It is indigenous to Indonesia but currently is cultivated in various places of the world. Among diverse active components, eugenol, the principal active component of S. aromaticum, has optimistic properties comprising antioxidant, anti-inflammatory, and anticancer actions. Eugenol (4-allyl-2-methoxyphenol) is a musky oil that is mainly obtained from clove. It has long been utilized all over the world as a result of its broad properties like antioxidant, anticancer, anti-inflammatory, and antimicrobial activities. Eugenol continues to pique investigators’ interest because of its multidirectional activities, which suggests it could be used in medications to treat different ailments. Anticancer effects of eugenol are accomplished by various mechanisms like inducing cell death, cell cycle arrest, inhibition of migration, metastasis, and angiogenesis on several cancer cell lines. Besides, eugenol might be utilized as an adjunct remedy for patients who are treated with conventional chemotherapy. This combination leads to a boosted effectiveness with decreased toxicity. The present review focuses on the anticancer properties of eugenol to treat several cancer types and their possible mechanisms.
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12
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Killion JA, Chambers C, Smith C, Bandoli G. Prenatal acetaminophen use in women with autoimmune disorders and adverse pregnancy and birth outcomes. Rheumatology (Oxford) 2021; 61:1630-1638. [PMID: 34343244 DOI: 10.1093/rheumatology/keab623] [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: 05/13/2021] [Revised: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Most women may have temporary pain for which they use analgesics, but those with autoimmune disorders have chronic pain that may be exacerbated for some during pregnancy. This study aimed to determine whether prenatal acetaminophen use was associated with an increased risk of adverse pregnancy and birth outcomes in women with autoimmune disorders. METHODS Participants were enrolled between 2004 and 2018 in the MotherToBaby cohort study and limited to women with an autoimmune disorder (n = 1,821). Self-reported acetaminophen use was characterized over gestation for indication, timing of use and duration. Cumulative acetaminophen use through 20 and 32 weeks was categorized into quintiles, with no acetaminophen use as the reference category. The association between acetaminophen quintile and preeclampsia or pregnancy induced hypertension, small for gestational age (SGA), and preterm birth was examined using adjusted multiple log-linear regression. RESULTS Overall, 74% of women reported acetaminophen use during pregnancy. The most often reported indication for using acetaminophen was headache/migraines, followed by pain and injury. Risk of preeclampsia was 1.62 times greater for those in the fifth quintile of cumulative acetaminophen use through 20 weeks compared with those with no acetaminophen use (95% CI: 1.10, 2.40). There were no associations with lower use quintiles, nor for the other outcomes. CONCLUSION The highest quintile of cumulative acetaminophen was associated with a modestly increased risk for preeclampsia. Some women with autoimmune conditions have pain throughout pregnancy; clinicians and patients should discuss approaches to best avoid high levels of acetaminophen in their pain management strategies.
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Affiliation(s)
- Jordan A Killion
- School of Public Health, University of California, San Diego, La Jolla, CA, USA/School of Public Health, San Diego State University, San Diego, CA, USA
| | - Christina Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Chelsey Smith
- Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla, CA, USA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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13
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Zhang L, Zhang Y, Pan J. Immunopathogenic mechanisms of rheumatoid arthritis and the use of anti-inflammatory drugs. Intractable Rare Dis Res 2021; 10:154-164. [PMID: 34466337 PMCID: PMC8397820 DOI: 10.5582/irdr.2021.01022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/05/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease characterized by synovitis and symmetrical joint destruction. RA has become one of the key diseases endangering human health, but its etiology is not clear. Therefore, identifying the immunopathogenic mechanisms of RA and developing therapeutic drugs to treat autoimmune diseases have always been difficult. This article mainly reviews the immunopathogenic mechanism of RA and advances in the study of anti-inflammatory drugs in order to provide a reference for the treatment of RA and drug development in the future.
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Affiliation(s)
- Ling Zhang
- Biomedical Sciences College, Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Ji'nan, China
- Key Lab for Biotech-Drugs of National Health Commission, Shandong First Medical University, Ji'nan, China
- Key Lab for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University, Ji'nan, China
| | - Yihang Zhang
- Biomedical Sciences College, Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Ji'nan, China
- Key Lab for Biotech-Drugs of National Health Commission, Shandong First Medical University, Ji'nan, China
- Key Lab for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University, Ji'nan, China
| | - Jihong Pan
- Biomedical Sciences College, Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Ji'nan, China
- Key Lab for Biotech-Drugs of National Health Commission, Shandong First Medical University, Ji'nan, China
- Key Lab for Rare & Uncommon Diseases of Shandong Province, Shandong First Medical University, Ji'nan, China
- Address correspondence to:Pan Jihong, Biomedical Sciences College, Shandong Medicinal Biotechnology Centre, Shandong First Medical University, # 6699 Qingdao Road, Ji'nan 250117, China. E-mail:
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14
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The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy. Inflammopharmacology 2021; 29:987-1000. [PMID: 33844107 DOI: 10.1007/s10787-021-00808-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disorder that is mostly characterised by progressive symmetrical joint destruction, particularly in the wrist and fingers, while it may also affect additional joints and several organs, such as the skin, heart, blood vessels, and lungs. It is identified by raised anti-rheumatoid factor and anti-cyclic citrullinated peptide antibodies. The chemical mediators involved in the activity of RA are IL-1β, TNF-α, and IL-6. Pregnancy exerts a positive effect on RA that helps to modulate the disease condition. Different hypotheses are recommended to explain the ameliorating effect of pregnancy in RA. RA cannot be completely cured. The treatment goal is the attrition of pain and inflammation and the further progression of the disease. Long-term management of RA is carried out using disease-modifying antirheumatic drugs (DMARDs). Therapy of acute flares can be done with Non-steroidal anti-inflammatory drugs (NSAIDs) accompanied by ad interim usage of glucocorticoids. Biologic response modifiers are also available; they act by abolishing the activity of T- cells. However, it is necessary to select the correct treatment regimen when it comes to the management of RA in pregnancy.
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15
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Aykan DA, Ergün Y. Cross-sectional evaluation of prescription of valproate and other antiepileptic drugs to pregnant women. Acta Neurol Belg 2021; 121:503-508. [PMID: 31659713 DOI: 10.1007/s13760-019-01231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
Drug counseling is important in women with epilepsy since data about the effects of maternal antiepileptics on the developing fetus are limited. Although pregnant patients on the most teratogenic drugs are treated in accordance to the European Medicines Agency guidelines, a large amount of them may be exposed to the teratogenic medications unintentionally. We performed a tertiary center observational study about medications of pregnant women who were consulted to Teratology Information Service (TIS) unit for evidence-based teratogenic risk analysis. The registration records of 134 pregnant women between 2014 and 2018 were examined. We evaluated the diagnoses, prescriptions, usage of antiepileptic drugs, and distribution of drug subtypes and investigated the drug-related congenital anomalies after delivery. Women were recontacted after delivery to obtain information about health status of infants. We found that 33 women were diagnosed with neurological disorders. A total number of 60 neurologic drugs was prescribed, including 13 antiepileptics. Antiepileptic drugs covered 38.4% valproate (n = 5), 15.4% pregabalin/gabapentin (n = 2), 15.4% levetiracetam (n = 2), 15.4% lamotrigine (n = 2), 7.7% phenytoin (n = 1), and 7.7% carbamazepine (n = 1). Delivery outcomes revealed that valproate exposure resulted in one baby with congenital cataracts, one postnatal exitus with cardiac dysfunction, and one therapeutic abortion. Various antiepileptic drugs were prescribed to pregnant women prenatally or at different times of pregnancy and valproate was the most common antiepileptic drug consulted to TIS for teratogenic risk analysis. Disseminating TIS units and reporting the outcomes to the teratogenesis literature provide proper evaluation of teratogenic risks of drugs accordingly.
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16
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Lima ADF, Pegorin GS, Miranda MCR, Cachaneski-Lopes JP, Silva WDM, Borges FA, Guerra NB, Herculano RD, Batagin-Neto A. Ibuprofen-loaded biocompatible latex membrane for drug release: Characterization and molecular modeling. J Appl Biomater Funct Mater 2021; 19:22808000211005383. [PMID: 33781110 DOI: 10.1177/22808000211005383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The incorporation of drugs and bioactive compounds in the natural rubber latex (NRL) matrix has been an alternative for the development of transdermal release membranes. Ibuprofen (IBF) is known to be used to treat inflammatory diseases, but when administered orally, high concentrations can cause some adverse problems. In this work, the incorporation of IBF in the NRL membranes was evaluated by physical-chemical, in vitro permeation, hemocompatibility and molecular modeling assays. In addition, the in vitro release profile of IBF in acid and basic media was analyzed during 96 h. The IBF-NRL membrane exhibited the absence of intermolecular bonding that could hinder drug release and presented compatible mechanical properties for applications as a cutaneous adhesive (0.58 and 1.12 MPa to Young's modulus and rupture tension, respectively). The IBF-NRL system did not present a significant hemolysis degree (1.67%) within 24 h. The release test indicated that in the first hours of the study, 48.5% IBF was released at basic pH and 22.5% at acidic pH, which is characteristic of a burst effect. Then, a stable release profile was observed until the end of the assay, with total IBF release of 60% in alkaline medium and 50% in acidic medium. The drug permeation results indicated that the IBF-NRL membranes can be used for the local skin treatment with permeation of 3.11% of IBF. Dynamic Molecular simulations indicated a pronounced electric dipole in the ionized form of IBF, which suggests a more effective interaction with water, explaining the efficient drug release in alkaline solutions. In general, the results demonstrate that the IBF-NRL membrane has great potential for a new adhesive that can be used for the treatment of inflammatory processes and injuries.
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Affiliation(s)
- Aline de Freitas Lima
- Department of Biotechnology and Bioprocesses Engineering, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Giovana Sant'Ana Pegorin
- Department of Biotechnology and Bioprocesses Engineering, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.,Department of Biochemistry and Chemical Technology, Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | | | - João Paulo Cachaneski-Lopes
- School of Sciences, Post-Graduate Program in Science and Technology of Materials (POSMAT), São Paulo State University (UNESP), Bauru, Brazil
| | - William de Melo Silva
- Department of Bioprocess and Biotechnology, Institute of Biotechnology (IBTEC), São Paulo State University (UNESP), Botucatu, Brazil
| | - Felipe Azevedo Borges
- Department of Biotechnology and Bioprocesses Engineering, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Nayrim Brizuela Guerra
- Department of Exact Sciences and Engineering, University of Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Rondinelli Donizetti Herculano
- Department of Biotechnology and Bioprocesses Engineering, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Augusto Batagin-Neto
- Department of Biotechnology and Bioprocesses Engineering, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.,São Paulo State University (UNESP), Campus of Itapeva, Itapeva, Brazil
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17
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Khanna N, Kumar A, Pawar SV. A Review on Rheumatoid Arthritis Interventions and Current Developments. Curr Drug Targets 2021; 22:463-483. [PMID: 33243118 DOI: 10.2174/1389450121999201125200558] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Rheumatoid arthritis is a chronic autoimmune disorder characterized by inflammation, swelling, and joint destruction primarily affecting the peripheral joints. In recent years, RA has become an alarming concern affecting more than 1.5% of the population worldwide. The majority of the drugs in clinical trials for rheumatoid arthritis are immunomodulatory. The development of novel drugs for RA is impending and scientists are exploring new strategies through various innovative approaches for RA drug development. Treat-to-target and window of opportunity hypothesis are the new approaches that are used to treat, improve outcomes, and prevent long-term use of ineffective therapy, respectively. Novel therapeutic agents (e.g. GM-CSF inhibitors, Matrix metalloproteinase inhibitors) and delivery systems (e.g., Liposomes, Superparamagnetic iron oxide nano particles (SPIONs)) are under investigation for more target based therapy with reduced side effects and toxicity. The new drug discovery and repositioning of previously FDA-approved drugs are also being considered for chronic inflammatory disorder. The review encompasses a vast array of information, including genetics, etiology, clinical symptoms, current treatment, and newer therapeutics approaches, focused on the development of RA interventions. The introduction of the bioinformatics-based approach in RA has also been significantly discussed in the review. This review provides a general understanding of the challenges and uncertainties in the treatment of RA and summarizes the evolving scenario as well as innovative approaches taken into consideration for drug development in rheumatoid arthritis.
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Affiliation(s)
- Nikita Khanna
- University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh, India
| | - Anil Kumar
- University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh, India
| | - Sandip V Pawar
- University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh, India
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18
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Serati L, Carnovale C, Maestroni S, Brenna M, Smeriglia A, Massafra A, Bizzi E, Picchi C, Tombetti E, Brucato A. Management of acute and recurrent pericarditis in pregnancy. Panminerva Med 2021; 63:276-287. [PMID: 33687181 DOI: 10.23736/s0031-0808.21.04198-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review summarizes the currently available evidence on the management of acute and recurrent pericarditis during pregnancy, focusing on the safety of diagnostic procedures and treatment options for the mother and foetus. Family planning should be addressed in women with recurrent pericarditis of reproductive age and adjustment of therapy should be considered before a planned pregnancy. The treatment of pericarditis in pregnancy is similar to that for non-pregnant women but considers current knowledge on drug safety during pregnancy and lactation. The largest case series on this topic described 21 pregnancies with idiopathic recurrent pericarditis. Pregnancy should be planned in a phase of disease quiescence. Non-steroidal anti-inflammatory drugs can be used at high dosages until the 20th week of gestation (except low-dose aspirin 100 mg/die). Colchicine is allowed until gravindex positivity; after this period, administration of this drug during pregnancy and lactation should be discussed with the mother if its use is important to control recurrent pericarditis. Prednisone is safe if used at low-medium doses (2,5 - 10 mg/die). General outcomes of pregnancy in patients with pericarditis are good when the mothers are followed by a multidisciplinary team with experience in the field.
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Affiliation(s)
- Lisa Serati
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy -
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Silvia Maestroni
- Department of Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Martino Brenna
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Aurora Smeriglia
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Agnese Massafra
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Emanuele Bizzi
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Chiara Picchi
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Enrico Tombetti
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
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19
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Fertility and infertility implications in rheumatoid arthritis; state of the art. Inflamm Res 2020; 69:721-729. [PMID: 32458007 DOI: 10.1007/s00011-020-01362-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A bulk of investigations imply that women with rheumatoid arthritis (RA) deliver fewer children in comparison to healthy women. PURPOSE This review article attempts to clarify the involvement of infertility-related issues in both RA men and women. Moreover, the effect of RA disease on the fertility quality and quantity will be discussed. RESULTS Declined fertility rate in RA women seems to stem from modified inflammatory settings, advanced maternal age, limited sexual activity, and adverse effects of drugs on ovarian function. Women with RA may have smaller families and seem to be slower to conceive relative to their peer women. The chance of gestation in RA women may drop due to suppressed sexual function through pain and fatigue. In addition, treatment of RA women with non-steroidal anti-inflammatory drugs (NSAIDs) may prevent ovulation and therefore hinder the conception. CONCLUSIONS A complex interaction between RA disease and fertility related issues is present. Despite an increase rate of infertility in RA females or males, the mechanisms involved in this outcome is still unknown. Plausible causes of the decreased fertility rate in RA patients might be due to inflammatory cytokines, suppressed sexual activity, drug treatments, mother age, personal choice, or a combination of these elements.
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20
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Wang M, He W, Li M, Li F, Jiang L, Wang J, Wang H, Liu X, Yang K, Qiu J. Maternal asthma and the risk of hypertensive disorders of pregnancy: a systematic review and meta-analysis of cohort studies. Hypertens Pregnancy 2019; 39:12-24. [PMID: 31762345 DOI: 10.1080/10641955.2019.1693591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: The aim of this study was to demonstrate the association between maternal asthma and the risk of hypertensive disorders of pregnancy.Methods: A systematic search of seven databases was conducted. A meta-analysis was performed to calculate risk ratios and 95% CI using random-effects models.Results: Asthma was associated with an increased risk of pregnancy-induced hypertension (RR 1.45, 95%CI 1.29-1.63), transient hypertension of pregnancy (RR 2.00, 95%CI 1.52-2.63), preeclampsia or eclampsia (RR 1.28, 95%CI 1.25-1.32), preeclampsia (RR 1.43, 95%CI 1.31-1.57) and eclampsia (RR 1.56, 95%CI 1.13-2.15).Conclusion: The meta-analysis illustrated that asthma was significantly increased risk of hypertension during pregnancy.
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Affiliation(s)
- Meng Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Wenbo He
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fuyun Li
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Lili Jiang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiabin Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Hui Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xudong Liu
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Kehu Yang
- School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jie Qiu
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
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21
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Black E, Khor KE, Kennedy D, Chutatape A, Sharma S, Vancaillie T, Demirkol A. Medication Use and Pain Management in Pregnancy: A Critical Review. Pain Pract 2019; 19:875-899. [PMID: 31242344 DOI: 10.1111/papr.12814] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence-based recommendations for managing pain in pregnancy. METHODS A comprehensive literature search was conducted to assess pregnancy safety data for pharmacological and nonpharmacological pain management methods. Relevant clinical trials and observational studies were identified using multiple medical databases, and included studies were evaluated for quality and possible biases. RESULTS Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are appropriate for mild to moderate pain, but NSAIDs should be avoided in the third trimester due to established risks. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors have limited but overall reassuring safety data. Many of the included studies were limited by methodological issues. CONCLUSIONS Findings from this review can guide clinicians in their decision to prescribe analgesics for pregnant women. Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response. Further research is required to better understand the safety profile of various analgesics in pregnancy.
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Affiliation(s)
- Eleanor Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kok Eng Khor
- Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Debra Kennedy
- MotherSafe, The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Anuntapon Chutatape
- Department of Pain Medicine, Singapore General Hospital, Singapore, Singapore
| | - Swapnil Sharma
- Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Thierry Vancaillie
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Women's Health and Research Institute of Australia, Sydney, NSW, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia
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Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018. ACTA ACUST UNITED AC 2019; 17:215-228. [PMID: 31103432 DOI: 10.1016/j.reuma.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. OBJECTIVE To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. METHOD Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. RESULTS Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. CONCLUSIONS The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.
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Challenges in the treatment of Rheumatoid Arthritis. Autoimmun Rev 2019; 18:706-713. [PMID: 31059844 DOI: 10.1016/j.autrev.2019.05.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/10/2019] [Indexed: 12/16/2022]
Abstract
Rheumatoid Arthritis (RA) is a chronic inflammatory disease characterized by a heterogeneous clinical response to the different treatments. Some patients are difficult to treat and do not reach the treatment targets as clinical remission or low disease activity. Known negative prognostic factors, such as the presence of auto-antiantibodies and joint erosion, the presence of a genetic profile, comorbidities and extra-articular manifestations, pregnancy or a pregnancy wish may concur to the treatment failure. In this review we aimed at identify difficult to treat RA patients and define the optimal therapeutic and environmental targets. Genetic markers of severity such as HLA-DRB1, TRAF1, PSORS1C1 and microRNA 146a are differently associated with joint damage; other gene polymorphisms seem to be associated with response to biologic disease modifying anti-rheumatic drugs (bDMARDs). The presence of comorbidities and/or extra-articular manifestations may influence the therapeutic choice; overweight and obese patients are less responsive to TNF inhibitors. In this context the patient profiling can improve the clinical outcome. Targeting different pathways, molecules, and cells involved in the pathogenesis of RA may in part justify the lack response of some patients. An overview of the future therapeutic targets, including bDMARDs (inhibitors of IL-6, GM-CSF, matrix metalloproteinases, chemokines) and targeted synthetic DMARDs (filgotinib, ABT-494, pefacitinib, decernotinib), and environmental targets is addressed. Environmental factors, such as diet and cigarette smoke, may influence susceptibility to autoimmune diseases and interfere with inflammatory pathways. Mediterranean diet, low salt intake, cocoa, curcumin, and physical activity seem to show beneficial effects, however studies of dose finding, safety and efficacy in RA need to be performed.
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Brucato A, Pluymaekers N, Tombetti E, Rampello S, Maestroni S, Lucianetti M, Valenti A, Adler Y, Imazio M. Management of idiopathic recurrent pericarditis during pregnancy. Int J Cardiol 2019; 282:60-65. [PMID: 30773267 DOI: 10.1016/j.ijcard.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Data concerning idiopathic recurrent pericarditis in pregnancy are scarce. OBJECTIVES To evaluate the management and outcome of idiopathic recurrent pericarditis during pregnancy. METHODS AND RESULTS Twenty-one pregnancies were evaluated in fourteen women with a history of recurrent idiopathic pericarditis (mean maternal age 31.5 years, mean gestational age 39.0 weeks), and subdivided in 2 cohorts: eight pregnancies were analyzed retrospectively (2002-2010), thirteen (2011-2017) prospectively and followed according a predefined management protocol. Ten pregnancies were uneventful, three ended in spontaneous early abortion, one fetal death occurred at 19 weeks. Recurrences of pericarditis occurred in eight and were treated by adding NSAIDs in two cases; in five cases the dose of corticosteroids was increased and in two cases aspirin was started/increased; paracetamol was always allowed. Colchicine was used in two cases in the prospective cohort. HELLP syndrome occurred in one patient, which resolved after delivery, and one patient experienced arterial hypertension and elevated transaminase. All infants had a good outcome (mean birth weight 3114 g, 10 males). Birth weight was significantly lower in the retrospective cohort (respectively 2806 g vs. 3320 g, p-value 0.017) in which higher doses of corticosteroids were used (median dose respectively 10.0 mg vs. 2.5 mg, p-value 0.048). Five recurrences of pericarditis occurred after delivery, easily treated with standard therapy. CONCLUSION General outcomes of pregnancy in patients with idiopathic recurrent pericarditis is good, especially when patients are carefully followed by multidisciplinary teams according to standardized protocols.
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Affiliation(s)
- Antonio Brucato
- Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Italy
| | - Nikki Pluymaekers
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Enrico Tombetti
- Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Italy
| | - Stefania Rampello
- Department of Obstetrics and Gynaecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Maestroni
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Marzia Lucianetti
- Department of Obstetrics and Gynaecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Valenti
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Yehuda Adler
- The Gertner Institute, Sheba Medical Center, affiliated to Sackler Medical school, Tel Aviv University and the College for Academic Studies, Israel
| | - Massimo Imazio
- University Cardiology AOU, Città della Salute e della Scienza di Torino, Torino, Italy
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Tanaka MJ, Szymanski LM, Dale JL, Dixit S, Jones LC. Team Approach: Treatment of Injuries in the Female Athlete: Multidisciplinary Considerations for Women's Sports Medicine Programs. JBJS Rev 2019; 7:e7. [PMID: 30672778 DOI: 10.2106/jbjs.rvw.18.00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Miho J Tanaka
- Departments of Orthopaedic Surgery (M.J.T., S.D., and L.C.J.), Gynecology and Obstetrics (L.M.S.), and Physical Medicine and Rehabilitation (J.L.D.), Johns Hopkins University, Baltimore, Maryland
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An Overview on the Anti-inflammatory Potential and Antioxidant Profile of Eugenol. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3957262. [PMID: 30425782 PMCID: PMC6217746 DOI: 10.1155/2018/3957262] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022]
Abstract
The bioactive compounds found in foods and medicinal plants are attractive molecules for the development of new drugs with action against several diseases, such as those associated with inflammatory processes, which are commonly related to oxidative stress. Many of these compounds have an appreciable inhibitory effect on oxidative stress and inflammatory response, and may contribute in a preventive way to improve the quality of life through the use of a diet rich in these compounds. Eugenol is a natural compound that has several pharmacological activities, action on the redox status, and applications in the food and pharmaceutical industry. Considering the importance of this compound, the present review discusses its anti-inflammatory and antioxidant properties, demonstrating its mechanisms of action and therapeutic potential for the treatment of inflammatory diseases.
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Borisow N, Hellwig K, Paul F. Neuromyelitis optica spectrum disorders and pregnancy: relapse-preventive measures and personalized treatment strategies. EPMA J 2018; 9:249-256. [PMID: 30174761 PMCID: PMC6107451 DOI: 10.1007/s13167-018-0143-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking. Pregnancies in NMOSD patients are associated with increased disease activity and more severe disability postpartum. Some studies found higher risks of pregnancy complications, e.g., miscarriages and preeclampsia. Acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. A decision to either stop or continue immunosuppressive therapy with azathioprine or rituximab during pregnancy should be evaluated carefully and factor in the patient's history of disease activity. To this end, involving neuroimmunological specialist centers in the treatment and care of pregnant NMOSD patients is recommended, particularly in specific situations like pregnancy.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Kerstin Hellwig
- Clinic for Neurology, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
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Jayashree S, Nirekshana K, Guha G, Bhakta-Guha D. Cancer chemotherapeutics in rheumatoid arthritis: A convoluted connection. Biomed Pharmacother 2018; 102:894-911. [PMID: 29710545 DOI: 10.1016/j.biopha.2018.03.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy is one of the most popular therapeutic strategies to treat cancer. However, cancer chemotherapeutics have often been associated with impairment of the immune system, which might consequently lead to an augmented risk of autoimmune disorders, such as rheumatoid arthritis. Though the accurate mechanistic facets of rheumatoid arthritis induction have not been interpreted yet, a conglomeration of genetic and environmental factors might promote its etiology. What makes the scenario more challenging is that patients with rheumatoid arthritis are at a significantly elevated risk of developing various types of cancer. It is intriguing to note that diverse cancer chemotherapy drugs are also commonly used to treat symptoms of rheumatoid arthritis. However, a colossal multitude of such cancer therapeutics has demonstrated highly varied results in rheumatoid arthritis patients, including both beneficial and adverse effects. Herein, we attempt to present a holistic account of the variegated modalities of this complex tripartite cross-talk between cancer, rheumatoid arthritis and chemotherapy drugs in order to decode the sinuous correlation between these two appalling pathological conditions.
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Affiliation(s)
- S Jayashree
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - K Nirekshana
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - Gunjan Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
| | - Dipita Bhakta-Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
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Borisow N, Hellwig K, Paul F. [Neuromyelitis optica spectrum disorder and pregnancy]. DER NERVENARZT 2018; 89:666-673. [PMID: 29383411 DOI: 10.1007/s00115-018-0486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that mainly affect women. In some of these patients NMOSD occurs during fertile age. For this reason, treating physicians may be confronted with questions concerning family planning, pregnancy and birth. OBJECTIVE This study provides an overview on the influence of NMOSD on fertility, pregnancy complications and pregnancy outcome. The effect of pregnancy on NMOSD course and therapy options during pregnancy are discussed. MATERIAL AND METHODS A search of the current literature was carried out using the PubMed database. RESULTS AND CONCLUSION Animal studies have shown lower fertility rates in NMOSD; however, studies investigating fertility in NMOSD patients are lacking. Pregnancy in NMOSD patients are associated with an increase in postpartum disease activity and a higher grade of disability after pregnancy. Some studies showed higher risks of pregnancy complications e. g. spontaneous abortions and preeclampsia. With a few limitations, acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. Stopping or continuing immunosuppressive therapy with azathioprine or rituximab during pregnancy should be critically weighed considering previous and current disease activity. Therefore, a joint supervision by a specialized center is recommended, particularly in specific situations such as pregnancy.
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Affiliation(s)
- N Borisow
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - K Hellwig
- Klinik für Neurologie, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Bérard A, Zhao JP, Shui I, Colilla S. Leflunomide use during pregnancy and the risk of adverse pregnancy outcomes. Ann Rheum Dis 2017; 77:500-509. [DOI: 10.1136/annrheumdis-2017-212078] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/10/2017] [Accepted: 10/22/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesLeflunomide is known to be embryotoxic and teratogenic in rodents. However, there is less evidence in humans. We quantified the risk of major congenital malformation (MCM), prematurity, low birth weight (LBW) and spontaneous abortion associated with leflunomide exposure during pregnancy in humans.MethodsFrom a cohort of 289 688 pregnancies in Montreal, Quebec, Canada, from 1998 to 2015, first-trimester leflunomide exposure and other antirheumatic drug exposures were studied for their association with MCM and spontaneous abortions. Also second or third-trimester leflunomide exposures were examined for associations with prematurity and LBW. Logistic regression model-based generalised estimating equations were used.Results51 pregnancies were exposed to leflunomide during the first trimester, and 21 during the second/third trimesters. Adjusting for potential confounders, use of leflunomide during the first trimester of pregnancy was not associated with the risk of MCM (adjusted OR (aOR) 0.97, 95% CI 0.81 to 1.16; 5 exposed cases). No association was found between second/third-trimester exposure to leflunomide and the risk of prematurity (aOR 4.03, 95% CI 0.91 to 17.85; 7 exposed cases) nor LBW (aOR 1.06, 95%CI 0.90 to 1.25; 8 exposed cases). Pregnancy exposure to leflunomide was also not associated with the risk of spontaneous abortion (aOR 1.09, 95% CI 0.90 to 1.32; 11 exposed cases).ConclusionsMaternal exposure to leflunomide during pregnancy was not associated with statistically significant increased risk of MCMs, prematurity, LBW or spontaneous abortions. However, given that relatively few women were exposed to leflunomide during pregnancy in this cohort, caution remains warranted.
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Shen XF, Zeng Y, Li JC, Tang C, Zhang Y, Meng XL. The anti-arthritic activity of total glycosides from Pterocephalus hookeri, a traditional Tibetan herbal medicine. PHARMACEUTICAL BIOLOGY 2017; 55:560-570. [PMID: 27937009 PMCID: PMC6130749 DOI: 10.1080/13880209.2016.1263869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/06/2016] [Accepted: 11/05/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Pterocephalus hookeri (C. B. Clarke) Hock., a traditional Tibetan herbal medicine rich in glycosides, has been used to treat several diseases including rheumatoid arthritis. OBJECTIVE To evaluate the anti-arthritic activity of total glycosides from P. hookeri, and its possible mechanisms of action. MATERIALS AND METHODS Anti-arthritic activity of total glycosides from P. hookeri (oral administration for 30 days at 14-56 mg/kg) was evaluated using paw swelling, arthritis scores and histopathological measurement in adjuvant-induced arthritis (AA) Sprague-Dawley rats. The NF-κB p65 expression in synovial tissues, and serum superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) levels was measured in AA rats, respectively. Further assessment of anti-inflammatory and analgesic activities of these glycosides were carried out using inflammation and hyperalgesia models induced by xylene, carrageenan, agar and acetic acid, respectively. RESULTS Total glycosides (56 mg/kg) decreased the paw swelling (38.0%, p < 0.01), arthritis scores (25.3%, p < 0.01) and synovial inflammation in AA rats. The glycosides significantly (p < 0.05-0.01) attenuated the inflammation induced by xylene, carrageenan, acetic acid and agar, increased the pain threshold in acetic acid-induced writhing in mice and mechanical stimuli-induced hyperalgia in AA rats. The glycosides (14, 28, 56 mg/kg) also suppressed the NF-κB p65 expression (33.1-78.2%, p < 0.05-0.01), reduced MDA (21.3-35.9%, p < 0.01) and NO (20.3-32.4%, p < 0.05-0.01) levels, respectively, enhanced the SOD activity (7.8%, p < 0.05) at 56 mg/kg in AA rats. DISCUSSION AND CONCLUSION Our findings confirmed the anti-arthritic property of the total glycosides from P. hookeri, which may be attributed to its inhibition on NF-κB signalling and oxidative stress.
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Affiliation(s)
- Xiao-fei Shen
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yong Zeng
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jia-chuan Li
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ce Tang
- College of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yi Zhang
- College of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xian-li Meng
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Gamez J, Salvado M, Casellas M, Manrique S, Castillo F. Intravenous immunoglobulin as monotherapy for myasthenia gravis during pregnancy. J Neurol Sci 2017; 383:118-122. [PMID: 29246598 DOI: 10.1016/j.jns.2017.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Pregnant women with myasthenia gravis (MG) are at increased risk of complications and adverse outcomes, including the teratogenic effects of many drugs used to treat MG women of childbearing age. The effectiveness of intravenous immunoglobulins (IVIg) on other autoimmune mediated diseases has been extensively reported in recent years, although little is known about the role of IVIg in the treatment of MG during pregnancy. We designed this study to determine the effectiveness of IVIg as monotherapy during pregnancy for women with MG. MATERIAL AND METHODS Five pregnant MG patients (mean age at delivery 36.4years, SD 5.8, range 29.4-45.2) were studied in 2013-14. Their treatment was switched to monthly IVIg cycles 2months before the pregnancy. Follow-up included monthly neurological QMG throughout the pregnancy and postpartum, obstetrical monitoring during monthly visits in the first two trimesters of the pregnancy, fortnightly visits between week 32 and week 36, and weekly visits after 36weeks, and neonatal follow-up after delivery. RESULTS We observed no exacerbations during pregnancy, delivery or post-partum. The mean QMG score at baseline (before pregnancy) was 7.4 points in five women with generalized forms of MG. The maximum mean value reached during pregnancy was 8.6 points. The mean pregnancy duration was 38 w+5 d. No infant with transient neonatal myasthenia gravis. CONCLUSIONS These results suggest that monotherapy with IVIg during pregnancy in MG patients could be promising, although confirmation is required in studies with larger populations.
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Affiliation(s)
- Josep Gamez
- Myasthenia Gravis Unit, Neurology Department, Vall d'Hebron University Hospital, VHIR, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Department of Medicine, UAB, Barcelona, Spain.
| | - Maria Salvado
- Myasthenia Gravis Unit, Neurology Department, Vall d'Hebron University Hospital, VHIR, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Department of Medicine, UAB, Barcelona, Spain
| | - Manel Casellas
- Myasthenia Gravis Unit, Obstetrics Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Susana Manrique
- Myasthenia Gravis Unit, Anesthetics Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Felix Castillo
- Myasthenia Gravis Unit, Neonatology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Ince-Askan H, Hazes JMW, Dolhain RJEM. Identifying Clinical Factors Associated With Low Disease Activity and Remission of Rheumatoid Arthritis During Pregnancy. Arthritis Care Res (Hoboken) 2017; 69:1297-1303. [PMID: 27813290 DOI: 10.1002/acr.23143] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify a combination of clinical factors associated with low disease activity and remission in the third trimester during pregnancy in women with rheumatoid arthritis (RA). METHODS This study is embedded in the Pregnancy-Induced Amelioration of Rheumatoid Arthritis study, a prospective cohort study. There were data available on 190 pregnancies from first trimester until delivery. Multivariate regression analyses were performed on the disease activity (Disease Activity Score in 28 joints [DAS28] using the C-reactive protein [CRP] level) in the third trimester. Independent covariates were the DAS28-CRP-3 in first trimester, prednisone and sulfasalazine use in the first trimester, parity, methotrexate use in the past, autoantibody status, the presence of erosions, and RA disease duration. RESULTS In multivariate regression models, the DAS28-CRP-3, use of prednisone in the first trimester, and the presence of autoantibodies were negatively associated with low disease activity (DAS28-CRP-3 <3.2) in the third trimester (P < 0.05), and the DAS28-CRP-3 and presence of autoantibodies were also associated with remission (DAS28-CRP-3 <2.6) (P < 0.001). Subgroup analysis revealed that the associations of prednisone use and presence of autoantibodies were only present in patients with moderate-to-high disease activity (DAS28-CRP-3 ≥3.2) in the first trimester. CONCLUSION RA patients who have a low DAS28-CRP-3 in the first trimester (irrespective of autoantibody status or prednisone use) are likely to have low disease activity or remission in the third trimester. Also, women with higher disease activity who are not taking prednisone and who express no autoantibodies still have a fair chance of low disease activity in the last trimester.
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Abstract
Fertility is impaired in women with rheumatoid arthritis (RA), whereas less is known about male fertility problems. Pregnancy outcome in patients with RA is slightly less favorable compared with the general population, especially in patients with active disease. Disease activity usually improves during pregnancy, but less than previously thought. Although several antirheumatic drugs are contraindicated in pregnancy, more treatment options are available. There is evidence on the safety of TNF inhibitors in pregnancy. Given the impact of active disease on fertility and pregnancy outcome, a treat-to-target strategy is recommended for patients who are pregnant or have a wish to conceive.
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Hladunewich MA, Bramham K, Jim B, Maynard S. Managing glomerular disease in pregnancy. Nephrol Dial Transplant 2017; 32:i48-i56. [DOI: 10.1093/ndt/gfw319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/28/2016] [Indexed: 02/07/2023] Open
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Zare-Shahabadi A, Langroodi HG, Azimi AR, Sahraian MA, Harirchian MH, Baghbanian SM. Neuromyelitis optica and pregnancy. Acta Neurol Belg 2016; 116:431-438. [PMID: 27306993 DOI: 10.1007/s13760-016-0654-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022]
Abstract
Neuromyelitis optica (NMO) and the associated NMO spectrum disorders are demyelinating disorders affecting the spinal cord and optic nerves. It has prominent female predominance and many of these patients are in their childbearing years. As pregnancy seems to have a major impact on this disease course, in this review, recent studies with a focus on this disease and pregnancy and safety of available treatment options during this period are discussed.
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Affiliation(s)
- Ameneh Zare-Shahabadi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghalyanchi Langroodi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Amir Reza Azimi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Mohammad Ali Sahraian
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Researches, Imam Khomeini Hospital, Tehran University of Medical Science, Keshavarz Blvd., Tehran, Iran
| | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Science, Pasdaran Boulevard, Sari, Iran.
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Integrative Therapies for Women with a High Risk Pregnancy During Antepartum Hospitalization. MCN Am J Matern Child Nurs 2016; 41:356-362. [DOI: 10.1097/nmc.0000000000000279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pregnancy and autoimmune connective tissue diseases. Best Pract Res Clin Rheumatol 2016; 30:63-80. [PMID: 27421217 DOI: 10.1016/j.berh.2016.05.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/24/2016] [Accepted: 05/29/2016] [Indexed: 12/28/2022]
Abstract
Autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before pregnancy, during pregnancy, and in the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy.
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Martínez López JA, García Vivar ML, Cáliz R, Freire M, Galindo M, Hernández MV, López Longo FJ, Martínez Taboada V, Pego Reigosa JM, Rubio E, Trujillo E, Vela-Casasempere P. Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding. ACTA ACUST UNITED AC 2016; 13:264-281. [PMID: 27321859 DOI: 10.1016/j.reuma.2016.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/02/2016] [Accepted: 05/07/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To develop recommendations on the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, post-partum and breastfeeding based on the best evidence and experience. METHODS Recommendations were generated using nominal group and Delphi techniques. An expert panel of 12 rheumatologists was established. A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in its 1st meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinement. A national survey analyzing different aspects of this topic was undertaken separately, followed by a Delphi process (2 rounds). Agreement with each recommendation was ranked on a scale of 1 (total disagreement) to 10 (total agreement), and was considered to be achieved if at least 70% voted≥7. The level of evidence and grade of recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS A total of 14 recommendations were generated for the preconception period (oral and hormonal contraception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High-risk situations such as lupus or antiphospholipid syndrome were included. A consensus>90% was reached for all but one recommendation. CONCLUSIONS These recommendations are intended to provide rheumatologists, patients, families and other stakeholders with a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding.
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Affiliation(s)
| | - M Luz García Vivar
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, España
| | - Rafael Cáliz
- Unidad de Gestión de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Mercedes Freire
- Servicio de Reumatología, Complexo hospitalario Universitario A Coruña (CHUAC), A Coruña, España
| | - María Galindo
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Víctor Martínez Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España
| | - Jose María Pego Reigosa
- Servicio de Reumatología, Hospital Meixoeiro-Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - Esteban Rubio
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Elisa Trujillo
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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Gerosa M, Schioppo T, Meroni PL. Challenges and treatment options for rheumatoid arthritis during pregnancy. Expert Opin Pharmacother 2016; 17:1539-47. [DOI: 10.1080/14656566.2016.1197204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wan J, Imadojemu S, Werth VP. Management of rheumatic and autoimmune blistering disease in pregnancy and postpartum. Clin Dermatol 2016; 34:344-52. [DOI: 10.1016/j.clindermatol.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ngian GS, Briggs AM, Ackerman IN, Van Doornum S. Safety of anti-rheumatic drugs for rheumatoid arthritis in pregnancy and lactation. Int J Rheum Dis 2016; 19:834-43. [PMID: 27125255 DOI: 10.1111/1756-185x.12860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Women with rheumatoid arthritis (RA) are often of childbearing age and therefore questions regarding reproductive health and the use of medications, including disease-modifying anti-rheumatic drugs (DMARDs) may arise during the clinical consultation. Each patient requires individual assessment in order to effectively manage the disease while minimizing any treatment-associated risks to the fetus. Although good-quality controlled trials are lacking, there is an increasing volume of evidence surrounding the use of immunosuppressive therapies in pregnancy and lactation. This review summarizes the currently available information which can be of benefit to clinicians guiding patients and their families through the risks and benefits of continuing RA therapy during pregnancy and lactation. Further studies and ongoing surveillance of drug safety in pregnancy are required to resolve the uncertainties that remain regarding synthetic and biologic DMARDs.
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Affiliation(s)
- Gene-Siew Ngian
- Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Arthritis and Osteoporosis Victoria, Melbourne, Victoria, Australia
| | - Ilana N Ackerman
- Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne EpiCentre, Melbourne Health, Melbourne, Victoria, Australia
| | - Sharon Van Doornum
- Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia. .,Melbourne EpiCentre, Melbourne Health, Melbourne, Victoria, Australia.
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Schneider AP, Kubat C, Zainer CM. Appreciation for Analysis of how Levonorgestrel Works and Reservations with the use of Meloxicam as Emergency Contraception. Linacre Q 2016; 83:52-68. [DOI: 10.1080/00243639.2016.1145894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
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Affiliation(s)
| | - Christopher Kubat
- Catholic Social Services of Southern Nebraska, Lincoln, Nebraska, USA
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Ngian G, Briggs AM, Ackerman IN, Van Doornum S. Management of pregnancy in women with rheumatoid arthritis. Med J Aust 2016; 204:62-3. [DOI: 10.5694/mja15.00365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Gene‐Siew Ngian
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC
| | - Andrew M Briggs
- Arthritis and Osteoporosis Victoria, Research and Knowledge, Melbourne, VIC
| | - Ilana N Ackerman
- Melbourne EpiCentre, Melbourne Health and University of Melbourne, Melbourne, VIC
| | - Sharon Van Doornum
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC
- Melbourne EpiCentre, Melbourne Health and University of Melbourne, Melbourne, VIC
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Ehrmann Feldman D, Vinet É, Bernatsky S, Duffy C, Hazel B, Meshefedjian G, Sylvestre MP, Bérard A. Birth Outcomes in Women with a History of Juvenile Idiopathic Arthritis. J Rheumatol 2016; 43:804-9. [PMID: 26834215 DOI: 10.3899/jrheum.150592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether children born to women who had juvenile idiopathic arthritis (JIA) had more adverse birth outcomes than children born to mothers who never had JIA. METHODS Our cohort study used data from physician billing and hospitalizations covering the province of Quebec, Canada. We identified all women with JIA with a first-time birth between January 1, 1983, and December 31, 2010, and assembled a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, maternal age, and area of residence. We compared outcomes (stillbirth, prematurity, small for gestational age, and major congenital anomalies) in the JIA versus non-JIA groups using logistic regression. RESULTS Mean age at delivery was 24.7 years in the JIA group (n = 1681) and 25.0 years for the non-JIA group (n = 6724). Women who had JIA were at higher risk for a premature baby [adjusted relative risk (RR) 1.20, 95% CI 1.01-1.42], a baby small for gestational age (adjusted RR 1.19, 95% CI 1.04-1.37), and a child with a congenital malformation (adjusted RR 6.51, 95% CI 5.05-8.39). Neural tube defects were higher in the JIA offspring: 1.61% (95% CI 1.11-2.33) versus 0.03% (95% CI 0.01-0.11) in the non-JIA group, as were congenital heart defects: 1.07% (95% CI 0.68-1.69) versus 0.58% (95% CI 0.42-0.79). CONCLUSION Most women with JIA will deliver a normal baby, even though they are at higher risk for having a child with adverse birth outcomes. Research is needed to understand pathophysiologic mechanisms and to investigate the effects of medications during childhood and youth on future birth outcomes.
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Affiliation(s)
- Debbie Ehrmann Feldman
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine.
| | - Évelyne Vinet
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Sasha Bernatsky
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Ciarán Duffy
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Beth Hazel
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Garbis Meshefedjian
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Marie-Pierre Sylvestre
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Anick Bérard
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
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Ackerman IN, Ngian GS, Van Doornum S, Briggs AM. A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis. Clin Rheumatol 2015; 35:33-41. [DOI: 10.1007/s10067-015-3131-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 12/16/2022]
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Reum Son A, Kim DY, Hun Park S, Yong Jang J, Kim K, Ju Kim B, Yun Yin X, Ho Kim J, Hyun Min B, Keun Han D, Suk Kim M. Direct chemotherapeutic dual drug delivery through intra-articular injection for synergistic enhancement of rheumatoid arthritis treatment. Sci Rep 2015; 5:14713. [PMID: 26424611 PMCID: PMC4589689 DOI: 10.1038/srep14713] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/17/2015] [Indexed: 12/04/2022] Open
Abstract
The effectiveness of systemic rheumatoid arthritis (RA) treatments is limited by difficulties in achieving therapeutic doses within articular joints. We evaluated the ability of intra-articular administration of injectable formulations to synergistically enhance repair of RA joints. Methotrexate-loaded hyaluronic acid (Met-HA), dexamethasone-loaded microcapsules (Dex-M), and Dex-M dispersed inside Met-HA were prepared as viscous emulsions and injected into articular joints using a needle to form a drug depot. By near-infrared (NIR) fluorescence imaging, we confirmed the local release of NIR from the depot injected into the articular joint over an extended period. In comparison with the subjects treated with Met-HA or Dex-M alone, subjects treated simultaneously with Met-HA and Dex-M exhibited faster and more significant RA repair. Collectively, these results indicated that the drug depot formed after intra-articular injection of Met-HA/Dex-M induced long-lasting drug release and allowed Met and Dex to effectively act in the articular joint, resulting in enhanced RA repair.
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Affiliation(s)
- A Reum Son
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Da Yeon Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Seung Hun Park
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Ja Yong Jang
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Kyungsook Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Byoung Ju Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Xiang Yun Yin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon 443-759, Korea
| | - Jae Ho Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
| | - Byoung Hyun Min
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon 443-759, Korea
| | - Dong Keun Han
- Biomaterials Research Center, Korea Institute of Science and Technology, Seoul 130-650, Korea
| | - Moon Suk Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 443-759, Korea
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Abstract
Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited. Evidence is accumulating that tumor necrosis factor (TNF) blockers can be safely used during pregnancy, particularly during the first trimester and the beginning of the second trimester. Far less is known about the problems faced by male RA patients who wish to conceive, in terms of not only fertility and pregnancy outcome but also the safety of medication. In this paper, the fertility issues in patients with RA, the pregnancy-associated improvement of RA, the pregnancy outcomes, including the long-term effects on the offspring, and treatment options, including those during lactation and for male patients wishing to conceive, will be reviewed.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Ackerman IN, Jordan JE, Van Doornum S, Ricardo M, Briggs AM. Understanding the information needs of women with rheumatoid arthritis concerning pregnancy, post-natal care and early parenting: A mixed-methods study. BMC Musculoskelet Disord 2015; 16:194. [PMID: 26285693 PMCID: PMC4545539 DOI: 10.1186/s12891-015-0657-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although women with rheumatoid arthritis (RA) face a number of challenges in negotiating the journey to parenthood, no studies have explored the information needs of women with RA in relation to their childbearing years. This study aimed to determine the need for (and preferred mode/s of delivery of) information regarding pregnancy, post-natal care and early parenting among women with RA. Methods Interviews and focus groups were conducted with 27 women with RA who were pregnant in the last 5 years, currently pregnant or planning pregnancy. Verbatim transcripts were analysed using both inductive and deductive approaches. Two validated instruments were used to quantify information needs and preferences: the Educational Needs Assessment Tool (ENAT, range 0-156, higher scores indicate higher educational needs) and the Autonomy Preference Index (API, range 0-100, higher scores indicate stronger preferences). Results Lack of information about medication safety, access to physical/emotional support services and practical strategies for coping with daily challenges related to parenting were the most prominent of the six key themes identified. Rheumatologists were the primary source for information regarding treatment decisions while arthritis consumer organisations were perceived as critical ‘resource hubs’. There was strong preference for information delivered electronically, especially among rural participants. Quantitative outcomes supported the qualitative findings; on average, participants reported high educational needs (mean ENAT score 97.2, SD 30.8) and API scores indicated that desire for information (mean 89.8, SD 5.6) was greater than the need for involvement in treatment decision-making (mean 68.4, SD 8.2). Conclusions Many women with RA struggle to find adequate information on pregnancy planning, pregnancy and early parenting in relation to their chronic condition, and there is a clear need to develop accessible information that is consumer-focused and evidence-based. Although most participants trusted their rheumatologist as their primary information source, there was consistent demand for more information, particularly regarding the safety of RA medications during pregnancy and breastfeeding, and the importance of learning from other women’s personal experiences was strongly emphasised. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0657-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ilana N Ackerman
- Melbourne EpiCentre, The University of Melbourne and Melbourne Health, 7East, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
| | | | - Sharon Van Doornum
- Melbourne EpiCentre, The University of Melbourne and Melbourne Health, 7East, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
| | | | - Andrew M Briggs
- Arthritis and Osteoporosis Victoria, Melbourne, Australia. .,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
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