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Abstract
Rheumatoid arthritis (RA) is a common condition affecting approximately 1% of the general population. RA is a multisystem disorder that causes progressive articular destruction through synovial inflammation. One of the most common extraarticular manifestations of RA is pulmonary involvement, where all compartments of the pulmonary system can be impacted (e.g., pulmonary vasculature, pleura, parenchyma, and the airways). Although it has been known for decades that a portion of patients with RA develop interstitial lung disease, and recent advancements in understanding the genetic risk and treatment for RA-interstitial lung disease have drawn attention, more recent data have begun to highlight the significance of airway disease in patients with RA. Yet, little is known about the underlying pathogenesis, clinical impact, or optimal treatment strategies for airway disease in RA. This review will focus on airway disease involvement in patients with RA by highlighting areas of clinical inquiry for pulmonologists and rheumatologists and discuss areas for future research. Finally, we discuss a potential screening algorithm for providers when approaching patients with RA with respiratory complaints.
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Bergsøe CM, Sivapalan P, Saeed MI, Eklöf J, Saghir Z, Sørensen R, Biering-Sørensen T, Jensen JUS. Risk of Chronic Obstructive Pulmonary Disease Exacerbation in Patients Who Use Methotrexate-A Nationwide Study of 58,580 Outpatients. Biomedicines 2021; 9:604. [PMID: 34073252 PMCID: PMC8229017 DOI: 10.3390/biomedicines9060604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with severe chronic obstructive pulmonary disease (COPD) experience frequent acute exacerbations and require repeated courses of corticosteroid therapy, which may lead to adverse effects. Methotrexate (MTX) has anti-inflammatory properties. The objective of this study was to describe the risk of COPD exacerbation in patients exposed to MTX. In this nationwide cohort study of 58,580 COPD outpatients, we compared the risk of hospitalization-requiring COPD exacerbation or death within 180 days in MTX vs. non-MTX users in a propensity-score matched study population as well as an unmatched cohort, in which we adjusted for confounders. The use of MTX was associated with a reduction in risk of COPD exacerbation in the propensity-score matched population at 180 days follow-up (HR 0.66, CI 0.66-0.66, p < 0.001). Similar results were shown in our sensitivity analyses at 180-day follow-up on unmatched population and 365-day follow-up on matched and unmatched population (HR 0.76 CI 0.59-0.99, HR 0.81 CI 0.81-0.82 and HR 0.92 CI 0.76-1.11, respectively). MTX was associated with a lower risk of COPD exacerbation within the first six months after study entry. The finding seems biologically plausible and could potentially be a part of the management of COPD patients with many exacerbations.
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Affiliation(s)
- Christina Marisa Bergsøe
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
- Department of Internal Medicine, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Mohamad Isam Saeed
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
| | - Josefin Eklöf
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
| | - Zaigham Saghir
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark;
| | - Jens-Ulrik Stæhr Jensen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark; (C.M.B.); (M.I.S.); (J.E.); (Z.S.); (J.-U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
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Hamamoto Filho PT, Fragoso G, Sciutto E, Fleury A. Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions. Expert Rev Anti Infect Ther 2021; 19:1503-1518. [PMID: 33794119 DOI: 10.1080/14787210.2021.1912592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neurocysticercosis is caused by the localization of Taenia solium larvae in the central nervous system. The disease remains endemic in most countries of Latin America, Asia and Africa. While major improvements have been made in its diagnosis and treatment, uncertainties persist regarding the clinical implications and treatment of the inflammatory reaction associated with the disease. AREAS COVERED In this review, based on PubMed searches, the authors describe the characteristics of the immune-inflammatory response in patients with neurocysticercosis, its clinical implications and the treatment currently administered. The dual role of inflammation (participating in both, the death of the parasite, and the precipitation of serious complications) is discussed. New therapeutic strategies of potential interest are presented. EXPERT OPINION Inflammatory reaction is the main pathogenic mechanism associated to neurocysticercosis. Its management is mainly based on corticosteroids administration. This strategy had improved prognostic of patients as it allows for the control of most of the inflammatory complications. On the other side, it might be involved in the persistence of parasites in some patients, despite cysticidal treatment, due to its immunosuppressive properties. New strategies are needed to improve therapeutical management, particularly in the severest presentations.
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Affiliation(s)
- Pedro T Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, UNESP-Univ Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Gladis Fragoso
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Edda Sciutto
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Neurocysticercosis Clinic, Instituto Nacional de Neurología Y Neurocirugía, Ciudad de México, Mexico, mexico.,Neuroinflammation Unit, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/INNN/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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Strategies to reduce corticosteroid-related adverse events in asthma. Curr Opin Allergy Clin Immunol 2019; 19:61-67. [PMID: 30407207 DOI: 10.1097/aci.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. RECENT FINDINGS Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). SUMMARY The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
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Taieb Y, Baum S, Ben Amitai D, Barzilai A, Greenberger S. The use of methotrexate for treating childhood atopic dermatitis: a multicenter retrospective study. J DERMATOL TREAT 2018; 30:240-244. [PMID: 30109960 DOI: 10.1080/09546634.2018.1508816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronic inflammatory skin disease. Methotrexate is an off-label systemic agent for treating uncontrolled atopic dermatitis. OBJECTIVE This study assessed the safety and efficacy of methotrexate in pediatric patients with atopic dermatitis. METHODS This multicenter, retrospective study assessed pediatric patients with atopic dermatitis who were treated with methotrexate. RESULTS Medical records of 26 pediatric patients with atopic dermatitis were reviewed. All the patients had Investigator Global Assessment (IGA) scores of 3-4 and had received systemic therapy before receiving methotrexate. In all, 53.85% patients showed clinical improvement at 3 and 6 months after methotrexate initiation. The IGA scores of the patients decreased significantly at 3 months after methotrexate initiation compared with those at baseline; moreover, the IGA scores of the patients at 6 months after methotrexate initiation were lower than those at 3 months after methotrexate initiation. In all, 54% study patients are still undergoing methotrexate treatment. Median satisfaction rate with methotrexate was 7.5/10. However, 10.35% patients developed adverse events, of which only one patient discontinued the treatment. CONCLUSIONS Our results indicate that methotrexate is a tolerable and effective agent for treating refractory childhood atopic dermatitis.
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Affiliation(s)
- Yossi Taieb
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Baum
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Dan Ben Amitai
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Dermatology Unit , Schneider Children's Medical Center of Israel , Petah Tikva , Israel
| | - Aviv Barzilai
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Shoshana Greenberger
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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