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Rojkovich B, Németh D, Dinya E, Nagy E, Török E, Lázár I, Perduk A, Géher P, Nagy G. [COVID-19 infections and effectiveness of the vaccination among healthcare workers]. Orv Hetil 2023; 164:163-171. [PMID: 36739547 DOI: 10.1556/650.2023.32709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION New variants of the SARS-CoV-2 coronavirus are constantly appearing, causing the COVID-19 pandemic. From November 2021, most infections were caused by the Omicron coronavirus variant. OBJECTIVE The aim of this prospective observational cohort study was to estimate the incidence of COVID-19 infections in the high-risk healthcare workers after two BNT162b2 mRNA Pfizer-BioNTech vaccines and the subsequent booster vaccine, as well as the effectiveness, the safety and the humoral immune response of the vaccines. METHOD We started the two Pfizer-BioNTech ((BNT162b29) vaccinations of healthcare workers of the Polyclinic of the Hospitaller Brothers of St. John between January 07 and March 08, 2021. The choice of the type and timing of the third booster vaccination was voluntary. The workers were followed up between January 07, 2021 and June 29, 2022. The infection rate, adverse events of the vaccination, risk factors to infection and the kinetics of anti-spike (S) antibody and anti-nucleocapsid (N) antibody serum level were evaluated. RESULTS The data of 294 healthcare workers - 96 medical doctors, 127 nurses and 71 workers in hospital - who had at least three antibody level measurements were analyzed. The third booster vaccine was given to 280 workers, the distribution of the vaccines was the following: Pfizer-BioNTech (BNT162b29) vaccine (n = 210), Moderna COVID-19 (mRNA-1273) vaccine (n = 37), Sinopharm COVID-19 vaccine (n = 21), Janssen COVID-19 (n = 10), AstraZeneca (ChAdOx1 nCoV-19) vaccine (n = 2). Infection occurred in 121 cases (41%) during the observation period. The course of the COVID-19 infections was mostly mild (97%) and recovered within a week. During the observational period, 2 workers died: a 56-year-old woman died after two vaccinations for reason unrelated to COVID-19 infection, and a 58-year-old man died after the booster vaccination, following COVID-19 infection. The incidence of infection did not correlate with age, sex, comorbidities, smoking, occupation and BMI. The median titre of anti-S antibody serum level increased one month after the second vaccination of the basic immunization (1173.0 U/ml) and decreased slowly until the 8th month (678.5-625.8-538.0 U/ml) after the basic vaccination. One month after the booster vaccination, the median titre of anti-S antibody serum level increased significantly (16 535 U/ml), and showed a decreasing trend in the 3rd month after the booster vaccination (9697.7 U/ml). An exceptionally high S antibody serum level increasing after the basic (>10 000 U/mL) and booster (>60 000 U/m) vaccination showed a correlation with prior COVID-19 infection. The median cut-off index (COI) of anti-N antibody was not affected by vaccination, the increasing of the titre is related to the infection. CONCLUSION The booster vaccination had less effect on the infection caused by Omicron variant, but the course of the infection was milder. Compared to the basic immunisation, the booster vaccination caused a significant increase in the S antibody level. An exceptionally high S antibody level correlated with prior COVID-19 infection. Orv Hetil. 2023; 164(5): 163-171.
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Affiliation(s)
- Bernadette Rojkovich
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - Dóra Németh
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Reumatológiai és Klinikai Immunológiai Tanszék Budapest Magyarország
| | - Elek Dinya
- 3 Semmelweis Egyetem, Egészségügyi Közszolgálati Kar, Digitális Egészségtudományi Intézet Budapest Magyarország
| | - Erzsébet Nagy
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - Eszter Török
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - Imre Lázár
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - András Perduk
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - Pál Géher
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország
| | - György Nagy
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza Budapest, Árpád fejedelem útja 7., 1023 Magyarország.,2 Semmelweis Egyetem, Általános Orvostudományi Kar, Reumatológiai és Klinikai Immunológiai Tanszék Budapest Magyarország
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2
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Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RBM, Van den Bosch FE, Boteva B, Bremander A, Carron P, Ciurea A, van Gaalen FA, Géher P, Gensler L, Hermann J, de Hooge M, Husakova M, Kiltz U, López-Medina C, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Nissen MJ, Pimentel-Santos FM, Poddubnyy D, Proft F, Rudwaleit M, Telkman M, Zhao SS, Ziade N, van der Heijde D. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82:19-34. [PMID: 36270658 DOI: 10.1136/ard-2022-223296] [Citation(s) in RCA: 180] [Impact Index Per Article: 180.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). METHODS Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. RESULTS Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. CONCLUSIONS The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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Affiliation(s)
- Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Elena Nikiphorou
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Rheumatic Diseases, King's College London, London, UK
| | - Alexandre Sepriano
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Nova Medical School, CHRC Campus, Lisbon, Portugal
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Robert B M Landewé
- Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
- Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Boryana Boteva
- Patient Research Partner, European Alliance of Associations for Rheumatology, Sofia, Bulgaria
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Lund University, Lund, Sweden
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
- Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Adrian Ciurea
- Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | - Lianne Gensler
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Josef Hermann
- Internal Medicine, Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
| | - Marketa Husakova
- First Faculty of Medicine Charles University and Rheumatology Institute, Prague, Czech Republic
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK
- Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Rheumatology, Paris Descartes University, Cochin Hospital, AP-HP, and INSERM (U1153), PRES Sorbonne Paris-Cité, Université Paris-Cité, Paris, France
| | | | | | | | - Denis Poddubnyy
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Mark Telkman
- Patients with Arthritis and Rheumatism (PARE) working group, European Alliance of Associations for Rheumatology, Patient Research Partner, Oxford, UK
| | - Sizheng Steven Zhao
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nelly Ziade
- Rheumatology, Hotel-Dieu De France, Achrafieh, Lebanon
- Rheumatology, Saint Joseph University, Beirut, Lebanon
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Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RBM, Van den Bosch FE, Boteva B, Bremander A, Carron P, Ciurea A, van Gaalen FA, Géher P, Gensler L, Hermann J, de Hooge M, Husakova M, Kiltz U, López-Medina C, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Nissen MJ, Pimentel-Santos FM, Poddubnyy D, Proft F, Rudwaleit M, Telkman M, Zhao SS, Ziade N, van der Heijde D. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023. [PMID: 36270658 DOI: 10.1136/ard-2022-223296:ard-2022-223296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). METHODS Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. RESULTS Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. CONCLUSIONS The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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Affiliation(s)
- Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Elena Nikiphorou
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Center for Rheumatic Diseases, King's College London, London, UK
| | - Alexandre Sepriano
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Nova Medical School, CHRC Campus, Lisbon, Portugal
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Robert B M Landewé
- Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium.,Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Boryana Boteva
- Patient Research Partner, European Alliance of Associations for Rheumatology, Sofia, Bulgaria
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Lund University, Lund, Sweden
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium.,Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Adrian Ciurea
- Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | - Lianne Gensler
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Josef Hermann
- Internal Medicine, Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
| | - Marketa Husakova
- First Faculty of Medicine Charles University and Rheumatology Institute, Prague, Czech Republic
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Rheumatology, Paris Descartes University, Cochin Hospital, AP-HP, and INSERM (U1153), PRES Sorbonne Paris-Cité, Université Paris-Cité, Paris, France
| | | | | | | | - Denis Poddubnyy
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Mark Telkman
- Patients with Arthritis and Rheumatism (PARE) working group, European Alliance of Associations for Rheumatology, Patient Research Partner, Oxford, UK
| | - Sizheng Steven Zhao
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nelly Ziade
- Rheumatology, Hotel-Dieu De France, Achrafieh, Lebanon.,Rheumatology, Saint Joseph University, Beirut, Lebanon
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Szentesi M, VAN DEN Wyngaert T, Géher P, Farbaky Z, Takács E, Csőre G, Kampen WU. Long-term clinical results from 10 years follow-up after radiosynoviorthesis: a prospective observational study. Q J Nucl Med Mol Imaging 2022; 66:324-333. [PMID: 36106912 DOI: 10.23736/s1824-4785.22.03473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to assess the long-term anti-inflammatory effect and safety of 90-Yttrium and 166-Holmium radiosynoviorthesis (RSO) for treating chronic knee synovitis of various origins. METHODS A total of 820 patients were included in this study and were followed up to 10 years after the procedure for objective and subjective changes in signs and symptoms of inflammation. RESULTS Five years after RSO, excellent and good results were seen in 71% (95% CI 67-74%) of patients. Six, seven, eight and nine years following RSO, efficacy did not decrease significantly. Ten years after RSO, the effectiveness of the therapy fell to 65% (95% CI 59-71%). Overall, 64% of patients did not need another joint puncture ten years after RSO. We achieved excellent to good results at 5 years in 79% of patients with rheumatoid arthritis, 59% with ankylosing spondylitis, and 62% with osteoarthritis. Efficacy was mainly affected by the local X-ray stage of the knee joint. A significant association was also found between the diagnosis of the underlying disease and the success of radiosynoviorthesis. Efficacy, however, was not substantially affected by any of the following factors: the duration of synovitis, the number of punctures before radiosynoviorthesis, the number of intraarticular steroid injections before the procedure, or the number of interventions before radiosynoviorthesis (radiotherapy, surgery). CONCLUSIONS Radiosynoviorthesis is an effective long-term method of treating chronic synovitis. The treatment showed the most favorable effects in patients with rheumatoid arthritis and those with mild to moderate degenerative osseous changes.
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Affiliation(s)
- Margit Szentesi
- Department of Rheumatology and Clinical Immunology, Polyclinic of the Hospitaller Brothers of St. John in God, Semmelweis University, Budapest, Hungary -
| | - Tim VAN DEN Wyngaert
- Nuclear Medicine UZA, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA - IPPON), University of Antwerp, Wilrijk, Belgium
| | - Pál Géher
- Department of Rheumatology and Clinical Immunology, Polyclinic of the Hospitaller Brothers of St. John in God, Semmelweis University, Budapest, Hungary
| | - Zsófia Farbaky
- Department of Radiology, Polyclinic of the Hospitaller Brothers of St. John in God, Budapest, Hungary
| | - Edit Takács
- Department of Nuclear Medicine, Polyclinic of the Hospitaller Brothers of St. John in God, Budapest, Hungary
| | - Gyula Csőre
- St. Andrew Clinics of Rheumatology, Hévíz, Hungary
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Nagy G, Géher P, Tamási L, Drescher E, Keszthelyi P, Pulai J, Czirják L, Szekanecz Z, Kiss G, Kovács L. Real-world evidence on methotrexate-free subcutaneous tocilizumab therapy in patients with rheumatoid arthritis: 24-week data from the SIMPACT study. Rheumatol Adv Pract 2022; 6:rkac038. [PMID: 35663154 PMCID: PMC9154320 DOI: 10.1093/rap/rkac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The SIMPACT study aimed to evaluate the efficacy and safety of methotrexate (MTX)-free subcutaneous tocilizumab (TCZ) therapy in rheumatoid arthritis (RA) patients.
Methods
SIMPACT was an open-label, non-controlled, non-randomised, non-interventional study, where RA patients, for whom the treating physicians ordered subcutaneous TCZ, were observed during a 24-week treatment period in Hungarian centres. While the use of methotrexate (MTX) was avoided during the study period, other conventional synthetic disease modifying anti-rheumatoid drugs (DMARDs), oral steroid and non-steroid anti-inflammatory agents were allowed. Study endpoints included the change in Disease Activity Score-28 (DAS28) and Clinical Activity Index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history—and age, weight or gender post-hoc. The extent of supplementary medication use was monitored.
Results
337 RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured both by DAS28 (p = 0.0001) and CDAI (p = 0.0001). Clinical response was more pronounced in biological-naïve patients, and was lower in patients above 75 years. In the whole population DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. Below 45 years CDAI remission rate doubled (67.86%). Significant decrease in the frequency of co-administered medication was reported including oral steroids and DMARDs.
Conclusion
Real-world clinical evidence on subcutaneous TCZ reported here is in-line with the efficacy outcomes of randomised clinical trials (RCTs). Subgroup analysis revealed that TCZ was more effective in biological-naïve and <75 years patients.
Trial registration
ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT02402686
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Affiliation(s)
- György Nagy
- Dept. of Rheumatology & Clinical Immunology, Dept. of Internal Medicine & Oncology, Semmelweis University, Budapest, Hungary
- Dept. of Genetics, Cell & Immunobiology, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Géher
- Dept. of Rheumatology & Clinical Immunology, Dept. of Internal Medicine & Oncology, Semmelweis University, Budapest, Hungary
| | - László Tamási
- Dept. of Rheumatology, BAZ County Central Hospital, Miskolc, Hungary
| | - Edit Drescher
- Dept. of Rheumatology, Csolnoky Ferenc Hospital, Veszprém, Hungary
| | - Péter Keszthelyi
- Dept. of Rheumatology, Békés County Central Hospital, Gyula, Hungary
| | - Judit Pulai
- Dept. of Rheumatology, Fejér County Saint George Hospital, Székesfehérvár, Hungary
| | - László Czirják
- Rheumatology & Immunology Clinic, Univ. of Pécs Clinical Centre, Pécs, Hungary
| | - Zoltán Szekanecz
- Dept. of Int. Medicine, Rheumatology, Univ. of Debrecen Clinical Centre, Debrecen, Hungary
| | | | - László Kovács
- Rheumatology & Immunology Clinic, Univ. of Szeged Clinical Centre, Szeged, Hungary
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Rojkovich B, Németh D, Török E, Szabó B, Pintér Á, Juhász I, Weidl M, Lányi É, Pável-Szecskó J, Lázár I, Perduk A, Reiter J, Nagy G, Nagy E, Géher P. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in healthcare workers. Orv Hetil 2021; 162:1551-1557. [PMID: 34570721 DOI: 10.1556/650.2021.32363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A SARS-CoV-2 koronavírus okozta COVID-19 általános egészségügyi és gazdasági krízist idézett elő. Célkitűzés: A megfigyeléses vizsgálat célja a BNT162b2 mRNS-Pfizer-BioNTech-vakcina hatásosságának, biztonságosságának és immunogenitásának igazolása a Budai Irgalmasrendi Kórház dolgozóin. Módszer: A vakcina adása után elemeztük a COVID-19-fertőzés előfordulását, az oltások utáni reakciókat, valamint a "spike" (S-) protein és a nukleokapszid (N)-protein elleni ellenanyag szintjének változását. Eredmények: A felmérésben részt vevő 295 dolgozó közül az oltást megelőzően 36 dolgozó esett át COVID-19-fertőzésen (COVID-19-pozitív csoport). A második oltás után a megfigyelési időszak három hónapjában COVID-19-fertőzés nem alakult ki a felmérésben részt vevő oltott dolgozók körében. Az oltási reakciók enyhék voltak. A COVID-19-pozitív csoportban az N-antitestek medián küszöbértékindexe az első vakcina után 4 héttel mérve szignifikánsan magasabb volt (28,37), mint a COVID-19-negatív (0,085) csoportban (p<0,0001). Az első vakcina után 4 héttel az S-antitestek medián értéke (8015 U/ml) a COVID-19-pozitív csoportban szignifikánsan magasabb volt (p<0,0001), mint a COVID-19-negatív csoportban (23,18 U/ml). A COVID-19-negatív csoport S-antitest-középértéke a második vakcina után szignifikáns (p<0,0001), mintegy 500×-os emelkedést mutatott (23,18 U/ml ről 1173 U/ml-re). Egy vakcina hatásosságát a fertőzések terjedésének megakadályozása igazolja. Következtetések: A második vakcina utáni megfigyelési időszakban új COVID-19-fertőzés nem volt az oltott dolgozók körében. A fertőzésen át nem esett COVID-19-negatív egyének esetén az S-antitest emelkedése mérsékelt az első oltás után, míg a második oltás után lényegesen emelkedik. A COVID-19-fertőzésen átesett egyének csoportjában már az első vakcina is jelentős S-antitest-termelődést vált ki. Orv Hetil. 2021; 162(39): 1551-1557. SUMMARY INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic caused global public health and economic crises. OBJECTIVE The aim of this observation study was to estimate the effectiveness, safety and elicited immune response of the BNT162b2 mRNA Pfizer-BioNTech vaccine in healthcare workers of the Buda Hospital of the Hospitaller Order of St. John of God. METHOD After vaccination, the infection rate, adverse events and the kinetics of anti-SARS-CoV-2 spike (S) protein and anti-SARS-CoV-2 nucleocapsid (N) protein antibodies were evaluated. RESULTS Before vaccination, from the 295 healthcare workers 36 recovered from prior COVID-19 infection (COVID-19-positive group). After the second vaccination, there was no COVID-19 infection during the three-month follow-up period. The adverse events were mild. In the COVID-19-positive group, the median cut-off index of anti-N antibodies measured at 4 weeks after the first vaccination were significantly (p<0.0001) higher (28.37) than in the COVID-19-negative group (0.085). After the first vaccine, the median titer of anti-S antibodies was significantly higher (p<0.0001) in the COVID-19-positive group (8015 U/ml) compared to the COVID-19-negative group (23.18 U/ml). In the COVID-19-negative group, the median titer of anti-S antibodies increased significantly (p<0.0001) after the second vaccine (from 23.18 U/ml to 1173 U/ml), showing an increase of 500×. CONCLUSIONS After the second vaccination, there was no COVID-19 infection during the follow-up. In the COVID-19-negative group, the anti-S antibody titer is moderate after the first vaccination and increases significantly after the second vaccine. In the COVID-19-positive group, the first vaccine induces significant anti-S antibody production. Orv Hetil. 2021; 162(39): 1551-1557.
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Affiliation(s)
- Bernadette Rojkovich
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Dóra Németh
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Eszter Török
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Bernadette Szabó
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Ágnes Pintér
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - István Juhász
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Márton Weidl
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Éva Lányi
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Judit Pável-Szecskó
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Imre Lázár
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - András Perduk
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - József Reiter
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - György Nagy
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Erzsébet Nagy
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
| | - Pál Géher
- 1 A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Budapest, Árpád fejedelem útja 7., 1023
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López-Medina C, Chevret S, Moltó A, Sieper J, Duruöz MT, Kiltz U, Zorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compán V, Luo SF, Biglia A, Kim TJ, Kishimoto M, Pimentel Dos Santos F, Gu J, Muntean L, Van Gaalen FA, Géher P, Magrey M, Ibáñez S, Bautista-Molano W, Maksymowych WP, Machado PM, Landewé RBM, Van der Heijde D, Dougados M. OP0047 IDENTIFICATION OF CLINICAL PHENOTYPES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS ACCORDING TO PERIPHERAL MUSCULOSKELETAL MANIFESTATIONS: A CLUSTER ANALYSIS IN THE INTERNATIONAL ASAS-PERSPA STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.Objectives:To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.Methods:Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.Results:4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).Figure 1.Distribution of the peripheral involvement across clustersThree clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.Conclusion:These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.Acknowledgements:This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.Disclosure of Interests:None declared
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Végh E, Gaál J, Géher P, Gömöri E, Kovács A, Kovács L, Nagy K, Posta EF, Tamási L, Tóth E, Varga E, Domján A, Szekanecz Z, Szűcs G. Assessing the risk of rapid radiographic progression in Hungarian rheumatoid arthritis patients. BMC Musculoskelet Disord 2021; 22:325. [PMID: 33794855 PMCID: PMC8017697 DOI: 10.1186/s12891-021-04192-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background The outcome of rheumatoid arthritis (RA) should be determined early. Rapid radiological progression (RRP) is > or = 5 units increase according to the van der Heijde-Sharp score within a year. The risk of RRP can be estimated by a matrix model using non-radiographic indicators, such as C-reactive protein (CRP), rheumatoid factor (RF) and swollen joint count (SJC). Patients and methods A non-interventional, cross-sectional, retrospective study was conducted in eleven Hungarian arthritis centres. We assessed RRP risk in biologic-naïve RA patients with the prevalence of high RRP risk as primary endpoint. RRP was calculated according to this matrix model. As a secondary endpoint, we compared RRP in methotrexate (MTX) responders vs non-responders. Results We analyzed data from 1356 patients. Mean CRP was 17.7 mg/l, RF was 139.3 IU/ml, mean 28-joint disease activity score (DAS28) was 5.00 and mean SJC was 6.56. Altogether 18.2% of patients had high risk (≥40%) of RRP. RA patients with high RRP risk of RRP (n = 247) had significantly lower age compared to those with RRP < 40% (n = 1109). MTX non-response (OR: 16.84), male gender (OR: 1.67), erosions at baseline (OR: 1.50) and ACPA seropositivity (OR: 2.18) were independent predictors of high-risk RRP. Male gender (OR: 5.20), ACPA seropositivity (OR: 4.67) and erosions (OR: 7.98) were independent predictors of high RRP risk in MTX responders. Conclusions In this Hungarian study, high RRP risk occurred in 18% of RA patients. These patients differ from others in various parameters. RRP was associated with non-response to MTX.
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Affiliation(s)
- Edit Végh
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary
| | - János Gaál
- Department of Rheumatology, University of Debrecen Kenézy Teaching Hospital, Debrecen, Hungary
| | - Pál Géher
- Department of Rheumatology and Immunology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Edina Gömöri
- Department of Rheumatology, Pándy Hospital, Gyula, Hungary.,Department of Rheumatology, Aladár Petz Hospital, Győr, Hungary
| | - Attila Kovács
- Department of Rheumatology, Hospital of State Railways, Szolnok, Hungary.,Semmelweis Hospital, Kiskunhalas, Hungary
| | - László Kovács
- Department of Rheumatology and Immunology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Katalin Nagy
- Department of Rheumatology, Ferenc Markhot Hospital, Eger, Hungary
| | - Edit Feketéné Posta
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary.,Department of Rheumatology, András Jósa Hospital, Nyiregyháza, Hungary
| | - László Tamási
- Department of Rheumatology, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Edit Tóth
- Department of Rheumatology, Ferenc Flór Hospital, Kistarcsa, Hungary
| | - Eszter Varga
- Department of Rheumatology, Markusovszky Hospital, Szombathely, Hungary
| | - Andrea Domján
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary.
| | - Gabriella Szűcs
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary
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Szentesi M, Nagy Z, Géher P, Papp I, Kampen WU. Yttrium-90 radiosynoviorthesis hosszú távú (10 éves) eredményei inflammált térdarthrosisban. Orv Hetil 2020; 161:1831-1839. [DOI: 10.1556/650.2020.31728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022]
Abstract
Absztrakt:
Bevezetés: A radiosynoviorthesist (RSO) fájdalmas,
terápiarezisztens, krónikus synovitis kezelésére alkalmazzuk az 1950-es évek
óta, de a hosszú távú hatások felmérésére eddig nem készültek prospektív
ellenőrzött vizsgálatok. Célkitűzés: Ennek a prospektív,
obszervációs vizsgálatnak az volt a célkitűzése, hogy felmérje az izotópos
synovectomia hatékonyságát inflammált térdosteoarthritisben (OA) 10 éves nyomon
követésben. Módszer: Alapos előkészítés után a
radionuklid-kezelést 90-Yttrium-citráttal végeztük Kellgren–Lawrence I–II. (n =
69) és III. stádiumú (n = 72) osteoarthritises betegekben, intraarticularis
injekció formájában. Eredmények: A korai radiológiai stádiumban
levő osteoarthritises betegekben „kiváló/jó” eredményeket értünk el már 1 év
után az esetek 82,5%-ában, és 73,7%-ot a 8 éves kontrollvizsgálatokon. A
felmérés az ízületi fájdalomra, a mobilitásra és a mozgásfunkciók megtartására
vonatkozott. 10 évvel a beadás után az eredményesség 50%-ra csökkent,
feltehetően a korral járó degeneratív folyamatok progressziója miatt. A III.
stádiumú betegekben (akiknél az osteoarthritis előrehaladottabb volt) kezdetben
45,9%-os eredményt értünk el, és ez 41,2%-ra esett vissza a 8 éves utánkövetés
során. Ebben a csoportban a betegek száma csökkent a 8–10. évre, azaz a 8. évben
51 beteg maradt, majd a 9. évben 30 beteg, a 10. évben pedig 9 beteg. Az utolsó
évben az alacsony betegszám miatt a klinikai válaszok nem voltak biztonságosan
megítélhetők. Következtetés: Az osteoarthritises ízületekben
alkalmazott RSO hosszú távú eredménye a legtöbb betegben „kiváló” vagy „jó”
volt. A radiokolloid hatása hosszú távon fennmarad, a 8–10. éves gyengébb
eredmények az életkor előrehaladásával jelentkező degeneratív folyamatoknak és
az alacsony betegszámnak tudható be. Ismert, hogy a hatékonyság függ a kezdeti
diagnózistól (OA, RA, SpA, PsA, AHA, ReA stb.), a radiológiai stádiumtól
(Kellgren–Lawrence I–IV.), illetve a synovitis score-tól. Eredményeink a
nemzetközi tapasztalatokhoz hasonlóan arra utaltak, hogy a radiációs
synovectomia alkalmazása elsősorban az alacsonyabb radiológiai stádiumban levő
betegeknek javallott. Orv Hetil. 2020; 161(43): 1831–1839.
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Affiliation(s)
- Margit Szentesi
- 1 Reumatológiai Centrum, Semmelweis Egyetem, III. Belgyógyászati Klinika, Reumatológiai Tanszéki Csoport, Budai Irgalmasrendi Kórház, Budapest, Árpád fejedelem útja 7., 1027
| | - Zoltán Nagy
- 2 Nukleáris Medicina Osztály, Budai Irgalmasrendi Kórház, Budapest
| | - Pál Géher
- 1 Reumatológiai Centrum, Semmelweis Egyetem, III. Belgyógyászati Klinika, Reumatológiai Tanszéki Csoport, Budai Irgalmasrendi Kórház, Budapest, Árpád fejedelem útja 7., 1027
| | - István Papp
- 3 Egészségtudományi Kar, Doktori Iskola, XV. ker. Háziorvosi Rendelő, Pécsi Tudományegyetem, Pécs
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Szentesi M, Nagy Z, Karoly Mangel Z, Csőre G, Géher P. AB0359 TNF ALFA THERAPY AND RADIOSYNOVIORTHESIS IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The treatment of patients with rheumatoid arthritis (RA) has been spectaculary changed since the 1950’s. Introduction of the steroid compounds and their local application, the chemical and radionuclide synovectomy, surgical synovectomy, use of non steroid drugs, the basic treatment and the spread of biological therapy are the most important steps. Introduction of the biological therapy has changed the quality of life for these patients.Objectives:During biological therapy sometimes 1 or 2 joints could be affected by inflammation. In this cases always the question is how to solve the problem. Change of the biological or basic therapy, use surgical synovectomy or radiosynovectomy (RSO)?Methods:In our reumatological department 2100 patients with RA were treated with biological therapy between 2002 and 2018. In 100 patients we applied RSO because of the inflammation of the knee joint during biological therapy. We made a long term follow-up in 82 patient. All participants provided written informed consent. 82 participants inflammatory knee joint disease was diagnosed on the basis of the American College of Rheumatology. 70 of 82 patients with rheumatoid arthritis were seropositive, 12 seronegative. Steinbrocker functional stadium II was observed in 72, stadium III in 10. Mean age of 18 male and 76 female patients was 51.4 years (range 24-79) years. In 42 patients the right knee, in 40 the left knee was treated by radiosynovectomy. Mean duration of disease was 8.3 years (range 0.5-25), of synovitis (6.3month (range 3-8) Mean number of punctions of the treated joint prior to radiosynovectomy was 4,2 per patient and of steroid administrations prior to radiosynovectomy 3,0. In 15 patients a systemic steroid therapy has been performed.Results:During the study period, inflammation decreased. In the first 3 years excellent and good results were recorded in 81,2%. 3 years after radiosynoviorthesis 82.2% of patients did not need another punction.Before the knee inflammation patients were in complete remission which status has been achieved after RSO as well. DAS: 2,4+-0,4.Conclusion:1. RSO is an effective method to treat the inflammation of the knees.2. The RSO performed during biological tehrapy is as effective as in the case of patients without biological therapy.3. In case of a successful RSO there is no need for biological or basic therapy neither for surgical synovectomy.4. However an intraarticular injection has a low risk for infection it is recommended to avoid the biological therapy during the RSO.References:[1]WHO Scientific Group, 2003[2]Szekanecz Z.: Célzott terápia a reumatológiában. Klinikum és Tudomány, MOTESZ Magazin; 2010;XVIII(2):31–44.[3]McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol. 2007 Jun;7(6):429-42[4]Klippel JH. Primer on the Rheumatic Disease. 12th ed. 2001.[5]Lipsky PE. Harrison’s Principles of Internal Medicine. 16th ed. 2005[6]EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update[7]Fellinger K. and Schmid J.: Die lokale Behandlung der rheumatischen Erkrankungen. Z. Inn. Med. 33. 351. 1952.[8]Watanabe M., Takeda S., Ikeuchi H.: Atlas of arthroscopy 2nd ed. Tokyo: Igaku Shoin 1969.[9]Stucki G., Bozzone P., Treuer E., Wassmer P. and Felder M.: Efficacy and safety of radiation synovectomy with Yttrium-90: A retrospective long term analysis of 164 applications in 82 patients. British J. of Rheumatology 32. 5. 383-386. 1993.[10]Combe B., Krause E. and Sany J.: Treatment of chronic knee synovitis with arthroscopic synovectomy after failure of intra-articular injection of radionuclide. Arthritis Rheum. 32. 1. 10-14. 1989.Disclosure of Interests:None declared
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Hodinka L, Bálint G, Budai E, Géher P, Papp R, Somogyi P, Szántó S, Vereckei E. [Peroral and transdermal application of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of regional musculoskeletal pain syndromes]. Orv Hetil 2018; 158:3-30. [PMID: 29307215 DOI: 10.1556/650.2017.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.
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Affiliation(s)
- László Hodinka
- Országos Reumatológiai és Fizioterápiás Intézet Budapest
| | - Géza Bálint
- Országos Reumatológiai és Fizioterápiás Intézet Budapest
| | | | - Pál Géher
- III. Belgyógyászati Klinika, II. Tanszéki Csoport, Budai Irgalmasrendi Kórház, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Renáta Papp
- Magyar Általános Orvosok Tudományos Egyesülete Budapest
| | | | - Sándor Szántó
- Belgyógyászati Intézet, Reumatológiai Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Edit Vereckei
- Országos Reumatológiai és Fizioterápiás Intézet Budapest
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Géher P. Gömör Béla professzor 80 éves. Orv Hetil 2018; 159:123. [DOI: 10.1556/650.2018.ho2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Khan NA, Spencer HJ, Nikiphorou E, Naranjo A, Alten R, Chirieac RM, Drosos AA, Géher P, Inanc N, Kerzberg E, Ancuta CM, Müller R, Ørnbjerg L, Sokka T. Intercentre variance in patient reported outcomes is lower than objective rheumatoid arthritis activity measures: a cross-sectional study. Rheumatology (Oxford) 2017; 56:1395-1400. [PMID: 28575509 DOI: 10.1093/rheumatology/kex076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 01/18/2023] Open
Abstract
Objective To assess intercentre variability in the ACR core set measures, DAS28 based on three variables (DAS28v3) and Routine Assessment of Patient Index Data 3 in a multinational study. Methods Seven thousand and twenty-three patients were recruited (84 centres; 30 countries) using a standard protocol in the Quantitative Standard Monitoring of Patients with RA study. Analysis of variance (ANOVA) and mixed-effect analysis of covariance models were used to model the relationship between study centre and different patient-reported and physician-reported RA activity measures. These models were built to adjust for the remaining ACR core set measure (for each ACR core set measure or each composite index), socio-demographics and medical characteristics. ANOVA and analysis of covariance models yielded similar results, and ANOVA tables were used to present variance attributable to recruiting centre. Results The proportion of variances attributable to recruiting centre was lower for patient reported outcomes (PROs: pain, HAQ, patient global) compared with objective measures (joint counts, ESR, physician global) in all models. In the full model, variance in PROs attributable to recruiting centre ranged from 1.53% for patient global to 3.71% for HAQ compared with objective measures that ranged from 5.92% for physician global to 9.25% for ESR; and was lower for Routine Assessment of Patient Index Data 3 (2.6%) compared with DAS28v3 (11.75%). Conclusion Intercentre variability in PROs is lower than objective measures of RA activity demonstrating that PROs may be more comparable across centres, and the need for standardization of objective measures.
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Affiliation(s)
- Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences.,Central Arkansas Veterans Healthcare System
| | - Horace Jack Spencer
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Elena Nikiphorou
- Department of Rheumatology, The Whittington Hospital NHS Trust, London, UK
| | - Antonio Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, University of Las Palmas, Las Palmas, Spain
| | - Rieki Alten
- Department of Internal Medicine, Rheumatology, Schlosspark-Klinik, Teaching Hospital Charite, Berlin, Germany
| | | | - Alexandros A Drosos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Pál Géher
- 1st Department of Rheumatology, Hospitaller Brothers of St John of God, Budapest, Hungary
| | - Nevsun Inanc
- Division of Rheumatology, School of Medicine, University of Marmara, Istanbul, Turkey
| | - Eduardo Kerzberg
- Department of Rheumatology, University of Buenos Aires, Buenos Aires, Argentina
| | - Codrina Mihaela Ancuta
- Rheumatology 2 Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Rüediger Müller
- Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Lykke Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark
| | - Tuulliki Sokka
- University of Eastern Finland, Faculty of Health Sciences, Kuopio and Jyvaskyla Central Hospital, Jyvaskyla, Finland
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van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76:978-991. [PMID: 28087505 DOI: 10.1136/annrheumdis-2016-210770] [Citation(s) in RCA: 958] [Impact Index Per Article: 136.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022]
Abstract
To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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Affiliation(s)
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Filip Van den Bosch
- Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich Switzerland
| | | | - Maxime Dougados
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | | | | | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Pedro M Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | | | - Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | - John Reveille
- The University of Texas-Health McGovern Medical School, Dallas, USA
| | - Martin Rudwaleit
- Klinikum Bielefeld, Bielefeld, Germany
- Gent University, Gent, Belgium
- Charité University Medicine, Berlin, Germany
| | - Jochen Sieper
- Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | | | - Dieter Wiek
- EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
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Kiltz U, van der Heijde D, Boonen A, Bautista-Molano W, Burgos-Vargas R, Chiowchanwisawakit P, Duruoz T, El-Zorkany B, Essers I, Gaydukova I, Géher P, Gossec L, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Olivieri I, Patrikos D, Pimentel-Santos FM, Schirmer M, van den Bosch F, Weber U, Zochling J, Braun J. Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages. RMD Open 2016; 2:e000311. [PMID: 27752358 PMCID: PMC5051462 DOI: 10.1136/rmdopen-2016-000311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. Methods Translation and cross-cultural adaptation has been carried out following the forward–backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. Results The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option ‘not applicable’ was added to two items of the ASAS HI to improve appropriateness. Discussion This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet , Herne , Germany
| | - D van der Heijde
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - A Boonen
- Division of Rheumatology, Department of Internal Medicine , Maastricht University Medical Center , Maastricht , The Netherlands
| | - W Bautista-Molano
- Rheumatology Department, Faculty of Medicine , HMC/UMNG , Bogota , Colombia
| | - R Burgos-Vargas
- Department of Rheumatology , Hospital General de Mexico and Universidad Nacional Autonoma de Mexico , Mexico City , Mexico
| | | | - T Duruoz
- PM&R Department, Rheumatology Division , Marmara University, School of Medicine , Istanbul , Turkey
| | - B El-Zorkany
- Rheumatology Department , Cairo University , Cairo , Egypt
| | - I Essers
- Division of Rheumatology, Department of Internal Medicine , Maastricht University Medical Center , Maastricht , The Netherlands
| | - I Gaydukova
- Saratov State Medical University , Saratov , Russian Federation
| | - P Géher
- Semmelweis University , Budapest , Hungary
| | - L Gossec
- Department of Rheumatology , Sorbonne Universités, UPMC Univ, Paris 06, Institut Pierre Louis d'Epidémiologie et de, Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP,Pitié Salpêtrière Hospital , Paris , France
| | - S Grazio
- Sisters of Mercy University Hospital , Zagreb , Croatia
| | - J Gu
- Department of Rheumatology , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - M A Khan
- Case Western Reserve University Cleveland , Cleveland, Ohio , USA
| | - T J Kim
- Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , South Korea
| | - W P Maksymowych
- Division of Rheumatology, Department of Medicine , University of Alberta , Edmonton, Alberta , Canada
| | - H Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Alberton Hospital , Leeds , UK
| | | | - I Olivieri
- Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy
| | | | - F M Pimentel-Santos
- NOVA Medical School and CEDOC, Chronic Diseases, NOVA University of Lisbon , Lisboa , Portugal
| | - M Schirmer
- Department of Internal Medicine VI , Medical University of Innsbruck , Innsbruck , Austria
| | | | - U Weber
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J Zochling
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - J Braun
- Rheumazentrum Ruhrgebiet , Herne , Germany
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Szántó S, Poór G, Opris D, Iaremenko O, Procházková L, Kuuse R, Nagy O, Chernyshov V, Géher P. Improved clinical, functional and work outcomes in spondyloarthritides during real-life adalimumab treatment in central-eastern Europe. J Comp Eff Res 2016; 5:475-85. [PMID: 27417564 DOI: 10.2217/cer-2016-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Adalimumab effectiveness on clinical, functional and work-related outcomes was evaluated in patients with active ankylosing spondylitis or psoriatic arthritis treated in routine clinical practice in central-eastern Europe. METHODS Patients (n = 555) were followed for 12 months. Primary end point was percentage of patients with a treatment response (≥50% decrease from baseline in Bath Ankylosing Spondylitis Disease Activity Index or ≥1.2 point decrease from baseline in Disease Activity Index-28 joint for axial or peripheral symptoms, respectively). Functional status was evaluated by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire Disability Index. Working ability was evaluated by the Work Productivity and Activity Impairment Questionnaire - Specific Health Problem. RESULTS 76.1% of patients with axial symptoms and 83.5% with peripheral symptoms achieved a treatment response. Frequency of extra-articular manifestations decreased. Improvements were observed in functional status and workability. No new safety signals were observed. CONCLUSION Adalimumab was effective and well tolerated during real-world use in central-eastern Europe.
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Affiliation(s)
- Sándor Szántó
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Poór
- National Institute of Rheumatology & Physiotherapy, Budapest, Hungary
| | | | | | - Leona Procházková
- Rheumatology Division, 2nd Department of Internal Medicine, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Reet Kuuse
- Tartu University Hospital, Tartu, Estonia
| | | | | | - Pál Géher
- Hospitaller Brothers of St John of God Hospital, Budapest, Hungary
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Géher P, Szántό S, Opriş D, Iaremenko O, Nagy O, Chernyshov V. SAT0409 Improved Clinical Outcomes and Workability in Spondyloarthritides during Real-Life Administration of Adalimumab in Central and Eastern Europe. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yoo DH, Park W, Brzosko M, Géher P, Andersone D, Jaworski J, Rekalov D, Oparanov B, Kausiene R, Pacheco-Tena C, Lee S. THU0159 Disease Activity Assessment Using the DAS28, CDAI and SDAI and Effect of Anti-Drug Antibody on Clinical Response in a Randomized, Double-Blind, Comparative Trial of CT-P13 and Innovator Infliximab: Planetra Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nagy O, Poόr G, Géher P, Killinger Z, Ter-Vartanyan S, Hojnik M. AB0384 Effectiveness and Adherence to Adalimumab Treatment in Patients with RA in Eastern Europe: Results of the Eviraeast Observational Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Szentesi M, Nagy Z, Géher P. THU0132 A Prospective Observational Study on Long-Term Results of 90Yttrium Radiosynoviorthesis of Chronic Knee Synovitis in Rheumatoid Arthritis and Osteoarthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Baji P, Péntek M, Szántó S, Géher P, Gulácsi L, Balogh O, Brodszky V. Comparative efficacy and safety of biosimilar infliximab and other biological treatments in ankylosing spondylitis: systematic literature review and meta-analysis. Eur J Health Econ 2014; 15 Suppl 1:S45-S52. [PMID: 24832835 PMCID: PMC4046080 DOI: 10.1007/s10198-014-0593-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare the efficacy and safety of infliximab-biosimilar with other biological drugs for the treatment of active ankylosing spondylitis (AS). METHODS Systematic literature review for randomized controlled trials (RCTs) with adalimumab, etanercept, golimumab, infliximab and infliximab-biosimilar in AS was performed and indirect meta-analysis (Bayesian mixed treatment comparison) was carried out. The proportion of patients reaching 20% improvement by the assessment of Spondyloarthritis International Society response criteria (ASAS20) at weeks 12 and 24 was used as efficacy endpoints, and the occurrence of serious adverse events at week 24 was applied to compare the safety of the biologicals. RESULTS Altogether, 13 RCTs, identified by the systematic literature search, were included in the analysis. Results on the ASAS20 efficacy endpoint were reported for week 12 in 12 RCTs involving 2,395 patients, and for week 24 in 5 RCTs comprising 1,337 patients. All the five biological agents proved to be significantly superior to placebo. Infliximab showed the highest odds ratio (OR) of 7.2 (95% CI 3.68-13.19) compared to placebo, followed by infliximab-biosimilar with OR 6.25 (95% CI 2.55-13.14), both assessed at week 24. No significant difference was found between infliximab-biosimilar and other biological treatments regarding their efficacy and safety. CONCLUSIONS This is the first study which includes a biosimilar drug in the meta-analysis of biological treatments in AS. The results have proven the similar efficacy and safety profile of infliximab-biosimilar treatment compared to other biologicals.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary,
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Péntek M, Rojkovich B, Czirják L, Géher P, Keszthelyi P, Kovács A, Kovács L, Szabó Z, Szekanecz Z, Tamási L, Tóth ÁE, Ujfalussy I, Hevér NV, Strbák B, Baji P, Brodszky V, Gulácsi L. Acceptability of less than perfect health states in rheumatoid arthritis: the patients' perspective. Eur J Health Econ 2014; 15 Suppl 1:S73-82. [PMID: 24832838 DOI: 10.1007/s10198-014-0596-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/31/2014] [Indexed: 05/15/2023]
Abstract
Some health problems are considered by many individuals as a 'normal' part of ageing. Our aim was to investigate whether patients with rheumatoid arthritis (RA) consider different types and levels of health losses as acceptable beyond a certain age. A multicenter cross-sectional survey was performed involving RA patients at the initiation of the first biological therapy. The EQ-5D and the Health Assessment Questionnaire Disability Index (HAQ-DI) questionnaires were used to describe domain-specific health states. Patients were asked to indicate for each domain from what age and onward (between ages 30 and 80 years in 10 year intervals) they considered moderate and severe problems acceptable or alternatively never acceptable. Seventy-seven RA patients (females 86%, mean age 50.3, disease duration 9.1 years) completed the questionnaire. Disease activity (DAS28), EQ-5D and HAQ-DI scores were mean 6.00 (SD 0.85), 0.35 (SD 0.36), 1.48 (SD 0.66), respectively. The majority of the patients considered age 70 and beyond as acceptable to have some health problems (EQ-5D: self-care 42%, pain/discomfort 34%, mobility 33%, usual activities 33%, anxiety/depression 27%), whilst at ages 30 and 40 as not acceptable. Severe health problems were mostly (57-69%) considered never acceptable, except the 'Usual activities' domain (acceptable from age 80 by 50.6%). The great majority of the patients (77-96%) were younger than what they indicated as the acceptability age limit. Similar results were found for the HAQ-DI. This small experimental study suggests that RA patients consider some health problems acceptable. This acceptability is age related and varies by health areas. Further larger studies are needed to explore explanatory variables and to compare with other diseases. Owing to the impact acceptability might have on RA patients' self-evaluation of current health state and decision-making, the topic deserves methodological improvement and further investigation.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary,
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Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. Int J Biometeorol 2014; 58:311-23. [PMID: 23677421 PMCID: PMC3955132 DOI: 10.1007/s00484-013-0667-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 03/21/2013] [Accepted: 03/31/2013] [Indexed: 05/21/2023]
Abstract
Balneotherapy is appreciated as a traditional treatment modality in medicine. Hungary is rich in thermal mineral waters. Balneotherapy has been in extensive use for centuries and its effects have been studied in detail. Here, we present a systematic review and meta-analysis of clinical trials conducted with Hungarian thermal mineral waters, the findings of which have been published by Hungarian authors in English. The 122 studies identified in different databases include 18 clinical trials. Five of these evaluated the effect of hydro- and balneotherapy on chronic low back pain, four on osteoarthritis of the knee, and two on osteoarthritis of the hand. One of the remaining seven trials evaluated balneotherapy in chronic inflammatory pelvic diseases, while six studies explored its effect on various laboratory parameters. Out of the 18 studies, 9 met the predefined criteria for meta-analysis. The results confirmed the beneficial effect of balneotherapy on pain with weight bearing and at rest in patients with degenerative joint and spinal diseases. A similar effect has been found in chronic pelvic inflammatory disease. The review also revealed that balneotherapy has some beneficial effects on antioxidant status, and on metabolic and inflammatory parameters. Based on the results, we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for lower back pain, as well as for knee and hand osteoarthritis.
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Affiliation(s)
- T Bender
- Polyclinic of the Hospitaller Brothers of St. John of God, Budapest, Hungary,
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Abstract
Physiotherapy lacks studies performed with the use of the modern research methodology and, therefore, its use based on empirical considerations. International practice guidelines do not recommend unequivocally the use of all kinds of physiotherapy with the exception of exercise therapy, but Hungarian guidelines support its use in the treatment of several different conditions. National health insurance in Hungary provides financial support for the use of physiotherapy in the fields of home care, out- and inpatient care and spa treatment. In 2011 national health insurance in Hungary supported spa treatments with 4 billion HUF, and the most frequently used treatment was thermal bath in about 2 million occasions. National health insurance in Hungary spent about 1 billion HUF for physiotherapy used in outpatient care; both ultrasound and interference treatments were financed in 2 million occasions in 2011.
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Affiliation(s)
- Pál Géher
- Semmelweis Egyetem, Általános Orvostudományi Kar, I. Kihelyezett Részleg (a Budai Irgalmasrendi Kórház I. Reumatológiai Osztályán) III. Belgyógyászati Klinika, Reumatológiai és Fizioterápiás Tanszéki Csoport Budapest Árpád fejedelem u. 7. 1023
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Pásztói M, Sódar B, Misják P, Pálóczi K, Kittel Á, Tóth K, Wellinger K, Géher P, Nagy G, Lakatos T, Falus A, Buzás EI. The recently identified hexosaminidase D enzyme substantially contributes to the elevated hexosaminidase activity in rheumatoid arthritis. Immunol Lett 2012; 149:71-6. [PMID: 23099419 DOI: 10.1016/j.imlet.2012.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/25/2012] [Accepted: 10/15/2012] [Indexed: 01/08/2023]
Abstract
Since the 1970s, numerous reports have described elevated hexosaminidase activities in rheumatoid arthritis. However, due to the overlapping substrate specificities of different hexosaminidases, identification of the exact enzyme(s) responsible for the elevated activity remains incomplete. In this work we tested if the recently described enzyme, hexosaminidase D was expressed in human arthritic joints, and could contribute to the elevated hexosaminidase activity in rheumatoid arthritis. Thermostable β-d-N-acetyl-galactosaminidase (hexosaminidase D) activities were determined in synovial fluid samples, synovial membranes, synovial fibroblast cell strains and synovial fibroblast-derived extracellular vesicles of patients with rheumatoid arthritis and osteoarthritis using chromogenic substrates. Expression of the HEXDC gene was detected both in steady state and in TGF-β treated synovial fibroblasts by real time PCR. Strikingly, hexosaminidase D accounted for approximately 50% of the total β-N-acetyl-galactosaminidase activity in synovial membranes and synovial fibroblasts, and it was responsible for the vast majority of the β-d-N-acetyl-galactosaminidase activity in synovial fluid samples. TGF-β downregulated the expression of hexosaminidase D in synovial fibroblasts dose-dependently. Of note, significant activity of hexosaminidase D was also found in association with extracellular vesicles released by synovial fibroblasts. This first study that describes the expression and disease relevance of the HEXDC gene in humans demonstrates the expression of this novel enzyme within the joints, and suggests that its activity may significantly contribute to the overall local exoglycosidase activity.
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Affiliation(s)
- Mária Pásztói
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary.
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Sieper J, Srinivasan S, Zamani O, Mielants H, Choquette D, Pavelka K, Loft AG, Géher P, Danda D, Reitblat T, Cantini F, Ancuta C, Erdes S, Raffayová H, Keat A, Gaston JSH, Praprotnik S, Vastesaeger N. Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study. Ann Rheum Dis 2012; 72:1621-7. [DOI: 10.1136/annrheumdis-2012-201777] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Khan NA, Spencer HJ, Abda EA, Alten R, Pohl C, Ancuta C, Cazzato M, Géher P, Gossec L, Henrohn D, Hetland ML, Inanc N, Jacobs JW, Kerzberg E, Majdan M, Oyoo O, Peredo-Wende RA, Selim ZI, Skopouli FN, Sulli A, Hørslev-Petersen K, Taylor PC, Sokka T. Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent? Ann Rheum Dis 2012; 71:1942-9. [PMID: 22532638 DOI: 10.1136/annrheumdis-2011-201142] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices. METHODS Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics. RESULTS Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices. CONCLUSIONS PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.
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Affiliation(s)
- Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 509, Little Rock, AR 72205, USA.
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Baka Z, György B, Géher P, Buzás EI, Falus A, Nagy G. Citrullination under physiological and pathological conditions. Joint Bone Spine 2012; 79:431-6. [PMID: 22366145 DOI: 10.1016/j.jbspin.2012.01.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 01/12/2012] [Indexed: 12/19/2022]
Abstract
Citrullination, one of the enzymatic posttranslational modifications has become a hot topic of recent research as it is involved in various physiological and pathological processes. Antibodies against citrullinated proteins called anti-citrullinated protein antibodies, are the hallmark (diagnostic and prognostic factors) of rheumatoid arthritis, and are specific for the disease. Citrullination has an important role in the normal function of the immune system, skin keratinization, the insulation of neurons and the plasticity of the central nervous system including its essential role in gene regulation. Abnormal citrullination has been proposed to play a role in multiple sclerosis and Alzheimer's disease, and recent research has drawn attention to its implication in tumorigenesis. Still, it is unclear whether citrullination is the cause or the consequence of these pathological alterations. Here, we discuss crucial aspects of citrullination during both physiological and pathological conditions.
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Affiliation(s)
- Zsuzsanna Baka
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
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Brodszky V, Bálint P, Géher P, Hodinka L, Horváth G, Koó É, Péntek M, Polgár A, Seszták M, Szántó S, Ujfalussy I, Gulácsi L. Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment. Rheumatol Int 2011; 30:199-205. [PMID: 19381635 DOI: 10.1007/s00296-009-0936-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 03/28/2009] [Indexed: 11/30/2022]
Abstract
The objectives of this study were to assess the costs of psoriatic arthritis (PsA) in Hungary and to identify key cost drivers among demographic and clinical variables and to compare cost-of-illness of PsA and rheumatoid arthritis (RA). Cross-sectional retrospective survey of 183 consecutive patients from eight rheumatology centres was conducted. Mean direct medical, direct non medical, indirect and total costs were 1,876, 794, 2,904 and 5,574 euros/patient/year, respectively. Total costs were in significant linear relationship with health assessment questionnaire score and psoriatic area severity index. Costs of RA were higher in all domains than of PsA. Our study was the first from the Eastern European region that provides cost-of-illness data on PsA. Our study revealed that functional status and severity of skin symptoms were the key cost drivers. The costs of PsA in Hungary were lower than in the high-income European countries.
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Affiliation(s)
- Valentin Brodszky
- Health Economics and Technology Assessment Research Centre, Corvinus University of Budapest, Fővám tér 8, 1093 Budapest, Hungary.
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Baka Z, Barta P, Losonczy G, Krenács T, Pápay J, Szarka E, Sármay G, Babos F, Magyar A, Géher P, Buzás EI, Nagy G. Specific expression of PAD4 and citrullinated proteins in lung cancer is not associated with anti-CCP antibody production. Int Immunol 2011; 23:405-14. [PMID: 21602177 DOI: 10.1093/intimm/dxr026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Anti-citrullinated protein antibodies (ACPAs), produced against citrullinated proteins, are diagnostic and prognostic markers of rheumatoid arthritis (RA). The underlying mechanism that explains the connection of smoking, citrullination [catalyzed by peptidyl arginine deiminases (PADs)] and ACPAs is still unclarified in RA. Thus, we searched for a non-arthritic model in which an increased cell death allows the formation of autoantibodies. Data supporting that lung cancer might be a good candidate are as follows: (i) smoking plays a role in its pathogenesis, (ii) the disease is frequently accompanied by paraneoplastic syndrome, (iii) smoking increases citrullination in the lung, (iv) various types of malignancies are associated with increased citrullination and (v) lung cancer tissue shows similarities with RA synovium. Serum PAD4, rheumatoid factor (RF) and ACPA levels were measured in 42 lung cancer patients; expression of cytokeratin 7 (CK7), PAD4 and citrullinated proteins was visualized in 113 lung cancer tissues. All parameters were analyzed in correlation with smoking history. None of the patients had polyarthritis or autoimmune disease. Significantly increased RF levels were associated with higher PAD4 levels in smoker lung cancer patients compared with non-smokers. Both PAD4 and citrullination immunostaining strongly correlated with that of CK7 in lung cancer, however, did not differ according to smoking history. Two of 30 smoker lung cancer patients had high anti-cyclic citrullinated peptide levels. In conclusion, PAD4 and citrullination may be helpful in distinguishing lung cancer from healthy tissue. Smoking, abnormal serum PAD4 and RF levels may not be sufficient for the production of ACPAs and development of autoimmunity.
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Affiliation(s)
- Zsuzsanna Baka
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
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Brodszky V, Péntek M, Bálint PV, Géher P, Hajdu O, Hodinka L, Horváth G, Koó E, Polgár A, Seszták M, Szántó S, Ujfalussy I, Gulácsi L. Comparison of the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire, the functional status (HAQ) and utility (EQ-5D) measures in psoriatic arthritis: results from a cross-sectional survey. Scand J Rheumatol 2010; 39:303-9. [PMID: 20166848 DOI: 10.3109/03009740903468982] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare the Psoriatic Arthritis Quality of Life (PsAQoL) instrument, the Health Assessment Questionnaire (HAQ) as a measure of functional status, and the generic health status (utility) measure the EuroQoL (EQ-5D) in terms of ability to assess disease severity in psoriatic arthritis (PsA). METHODS The differences between known groups and correlations of the PsAQoL, the HAQ and the EQ-5D with clinical measures were analysed in a sample of 183 PsA patients. RESULTS Different severities of PsA determined by known groups were distinguished well by all three questionnaires; more severe disease was associated with significantly worse values of the instruments. The correlations revealed a strong relationship between each of the measures, and with the patients' pain on the visual analogue scale (VAS), the patient global VAS, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and a weak relationship with the disease duration and the Psoriasis Area Severity Index (PASI). The PsAQoL also correlated strongly with the 28-joint Disease Activity Score (DAS28). CONCLUSIONS The PsAQoL, the HAQ, and the EQ-5D are able to distinguish well across levels of PsA severity.
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Affiliation(s)
- V Brodszky
- Health Economics and Technology Assessment Research Centre, Corvinus University of Budapest, Budapest, Fovám tér 8, Hungary.
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Pavelka K, Coste P, Géher P, Krejci G. Erratum to: Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee. Clin Rheumatol 2010. [DOI: 10.1007/s10067-010-1471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sokka T, Kautiainen H, Pincus T, Verstappen SMM, Aggarwal A, Alten R, Andersone D, Badsha H, Baecklund E, Belmonte M, Craig-Müller J, da Mota LMH, Dimic A, Fathi NA, Ferraccioli G, Fukuda W, Géher P, Gogus F, Hajjaj-Hassouni N, Hamoud H, Haugeberg G, Henrohn D, Horslev-Petersen K, Ionescu R, Karateew D, Kuuse R, Laurindo IMM, Lazovskis J, Luukkainen R, Mofti A, Murphy E, Nakajima A, Oyoo O, Pandya SC, Pohl C, Predeteanu D, Rexhepi M, Rexhepi S, Sharma B, Shono E, Sibilia J, Sierakowski S, Skopouli FN, Stropuviene S, Toloza S, Valter I, Woolf A, Yamanaka H. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 2010; 12:R42. [PMID: 20226018 PMCID: PMC2888189 DOI: 10.1186/ar2951] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/12/2010] [Accepted: 03/12/2010] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. METHODS The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. RESULTS At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. CONCLUSIONS Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Pavelka K, Coste P, Géher P, Krejci G. Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee. Clin Rheumatol 2010; 29:659-70. [PMID: 20179981 DOI: 10.1007/s10067-010-1384-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 10/15/2009] [Accepted: 01/06/2010] [Indexed: 12/21/2022]
Abstract
To investigate that a 6-month treatment with avocado soybean unsaponifiable (Piascledine 300 mg) once daily is as effective as with chondroitin sulfate 400 mg three times daily in femorotibial gonarthrosis, and also the carry-over effect for two more months is comparable. Patients were randomized (1:1) to the treatment groups. They received for 6 months 3 capsules chondroitin sulfate per day or one capsule of avocado soybean unsaponifiable (ASU) in a double-dummy technique. A 2-month post-treatment period followed to determine the carry-over effect. Primary efficacy criterion was the change of the WOMAC-index from study begin to end of treatment. Secondary criteria were the changes in Lequesne-index, pain on active movement and at rest, global assessment of efficacy. Three hundred sixty-four patients have been taken up into the trial. Three hundred sixty one patients were eligible for evaluation. One hundred eighty three received ASU 300 mg once daily, one hundred seventy eight chondroitin sulfate three times daily. The WOMAC-index decreased in both groups for approx. 50% to the end of therapy. During the post-treatment observation there was a further slight improvement. There was no statistical significant difference between the treatment groups during the entire observation. All other observed parameters showed the same pattern. The daily intake of rescue medication was reduced continuously. Overall efficacy has been rated excellent and good in more than 80% of the patients in both groups. Both drugs were safe and well tolerated. The first direct comparison between avocado soybean unsaponifiable 300 mg once daily and chondroitin sulfate three times daily reveiled no difference in efficacy or safety aspects between 1 capsule ASU 300 mg per day and 3 capsules chondroitin sulfate per day. It can be assumed that the once daily intake of ASU will lead to a better compliance in routine therapy.
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Affiliation(s)
- Karel Pavelka
- Institute of Rheumatology, Charles University Prague, Prague, Czech Republic
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Pásztói M, Nagy G, Géher P, Lakatos T, Tóth K, Wellinger K, Pócza P, György B, Holub MC, Kittel A, Pálóczy K, Mazán M, Nyirkos P, Falus A, Buzas EI. Gene expression and activity of cartilage degrading glycosidases in human rheumatoid arthritis and osteoarthritis synovial fibroblasts. Arthritis Res Ther 2009; 11:R68. [PMID: 19442276 PMCID: PMC2714114 DOI: 10.1186/ar2697] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 03/09/2009] [Accepted: 05/14/2009] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Similar to matrix metalloproteinases, glycosidases also play a major role in cartilage degradation. Carbohydrate cleavage products, generated by these latter enzymes, are released from degrading cartilage during arthritis. Some of the cleavage products (such as hyaluronate oligosaccharides) have been shown to bind to Toll-like receptors and provide endogenous danger signals, while others (like N-acetyl glucosamine) are reported to have chondroprotective functions. In the current study for the first time we systematically investigated the expression of glycosidases within the joints. METHODS Expressions of beta-D-hexosaminidase, beta-D-glucuronidase, hyaluronidase, sperm adhesion molecule 1 and klotho genes were measured in synovial fibroblasts and synovial membrane samples of patients with rheumatoid arthritis and osteoarthritis by real-time PCR. beta-D-Glucuronidase, beta-D-glucosaminidase and beta-D-galactosaminidase activities were characterized using chromogenic or fluorogenic substrates. Synovial fibroblast-derived microvesicles were also tested for glycosidase activity. RESULTS According to our data, beta-D-hexosaminidase, beta-D-glucuronidase, hyaluronidase, and klotho are expressed in the synovial membrane. Hexosaminidase is the major glycosidase expressed within the joints, and it is primarily produced by synovial fibroblasts. HexA subunit gene, one of the two genes encoding for the alpha or the beta chains of hexosaminidase, was characterized by the strongest gene expression. It was followed by the expression of HexB subunit gene and the beta-D-glucuronidase gene, while the expression of hyaluronidase-1 gene and the klotho gene was rather low in both synovial fibroblasts and synovial membrane samples. Tumor growth factor-beta1 profoundly downregulated glycosidase expression in both rheumatoid arthritis and osteoarthritis derived synovial fibroblasts. In addition, expression of cartilage-degrading glycosidases was moderately downregulated by proinflammatory cytokines including TNFalpha, IL-1beta and IL-17. CONCLUSIONS According to our present data, glycosidases expressed by synovial membranes and synovial fibroblasts are under negative regulation by some locally expressed cytokines both in rheumatoid arthritis and osteoarthritis. This does not exclude the possibility that these enzymes may contribute significantly to cartilage degradation in both joint diseases if acting in collaboration with the differentially upregulated proteases to deplete cartilage in glycosaminoglycans.
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Affiliation(s)
- Mária Pásztói
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4, Budapest H-1089, Hungary.
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Ebner W, Palotai T, Codreanu C, Géher P, Pahor A, Pavelka K, Smolen J, Szechiński J, Zlnay M. [Ankylosing spondylitis in Central and Eastern Europe. Cross-sectional study on treatment modalities, disease activity and quality of life]. Z Rheumatol 2009; 67:503-10. [PMID: 18712402 DOI: 10.1007/s00393-008-0316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To obtain information on the profile of patients with ankylosing spondylitis (AS), disease activity, previous and current treatments, and the proportion and profile of patients treated with conventional medications but considered eligible for anti-tumour necrosis factor (TNF) therapy. METHODS Participants were rheumatologists from seven Central and Eastern European countries who were considered experts in the treatment of AS and were to include 3-5 patients who had never received anti-TNF therapy. Rheumatologists were asked to decide whether they considered their patients candidates for anti-TNF therapy. RESULTS A total of 1506 patients were analysed. Overall, 61% of AS patients who had never received anti-TNF therapy until the time of the survey were considered candidates for anti-TNF therapy based on the clinical judgement of their rheumatologists. This proportion ranged from 40% in Slovakia to 84% in Romania. Candidates had higher levels of disease activity and functional impairment, and they were more likely to report a lower quality of life. Only 38% of candidates fulfilled the Assessment in Ankylosing Spondylitis (ASAS) recommendations with respect to a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4 combined with previous use of at least two non-steroidal anti-inflammatory drugs, ranging from 18% in Poland to 57% in Hungary. CONCLUSION More than half of AS patients currently treated with other medications may be eligible for anti-TNF therapy. Also, rheumatologists regarded disease activity as the determining factor for starting anti-TNF drugs, but their decision did not always fully comply with the ASAS recommendations, confirming the need for continued exchange among the medical community to increase awareness of the ASAS recommendations.
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Affiliation(s)
- W Ebner
- Medical Department II, Rheumatology, Hietzing Hospital, Wolkersbergenstr. 1, 1130, Wien, Osterreich.
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Sokka T, Toloza S, Cutolo M, Kautiainen H, Makinen H, Gogus F, Skakic V, Badsha H, Peets T, Baranauskaite A, Géher P, Ujfalussy I, Skopouli FN, Mavrommati M, Alten R, Pohl C, Sibilia J, Stancati A, Salaffi F, Romanowski W, Zarowny-Wierzbinska D, Henrohn D, Bresnihan B, Minnock P, Knudsen LS, Jacobs JW, Calvo-Alen J, Lazovskis J, Pinheiro GDRC, Karateev D, Andersone D, Rexhepi S, Yazici Y, Pincus T. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther 2009; 11:R7. [PMID: 19144159 PMCID: PMC2688237 DOI: 10.1186/ar2591] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 10/28/2008] [Accepted: 01/14/2009] [Indexed: 11/23/2022] Open
Abstract
Introduction Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA). Methods The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents. Results Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies. Conclusions In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Aänekoski, Finland.
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38
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György B, Tóthfalusi L, Nagy G, Pásztói M, Géher P, Lörinc Z, Polgár A, Rojkovich B, Ujfalussy I, Poór G, Pócza P, Wiener Z, Misják P, Koncz A, Falus A, Buzás EI. Natural autoantibodies reactive with glycosaminoglycans in rheumatoid arthritis. Arthritis Res Ther 2008; 10:R110. [PMID: 18789149 PMCID: PMC2592792 DOI: 10.1186/ar2507] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 08/27/2008] [Accepted: 09/12/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Although natural autoantibodies make up the majority of circulating immunoglobulins and are also present in high numbers in therapeutically used intravenous immunoglobulin preparations, they have received little attention and their precise role remains largely unknown. An increasing awareness of the importance of posttranslational autoantigen modifications and glycobiology led us to explore carbohydrate-reactive natural autoantibodies in patients with rheumatoid arthritis. This study examined systematic antibodies reactive to glycosaminoglycans (GAGs), the carbohydrate components of proteoglycans that are released in large amounts from degrading cartilage. Methods To measure antibodies reactive to six different types of GAGs, a specialised ELISA was used in which the carbohydrates were covalently linked to the plastic surface through a 2 nm spacer. Sera from rheumatoid arthritis patients (n = 66), umbilical cord serum samples (n = 11) and adult controls (n = 54) were studied. In order to explore cross-reactivity with microbial antigens, bacterial peptidoglycans and fungal polysaccharides were used. Sera and synovial fluid samples were also tested using a GlycoChip carbohydrate array to characterise individual carbohydrate recognition patterns. We followed a multistep statistical screening strategy for screening GAG-reactive antibodies as predictive disease markers. Results While anti-GAG antibodies were absent in the umbilical cord sera, they were readily detectable in adult controls and were significantly elevated in patients with rheumatoid arthritis (p < 0.001). Anti-GAG antibodies showed significant cross-reactivity among different types of GAGs. They also reacted with bacterial peptidoglycans and fungal polysaccharides. Interestingly, anti-chondroitin sulphate C IgM antibody levels showed inverse correlation both with the Disease Activity Score (DAS) 28 scores and C-reactive protein (CRP) levels in rheumatoid arthritis. Conclusion The highly abundant and cross-reactive, GAG-specific natural autoantibodies in serum may serve as novel disease-state markers in patients with rheumatoid arthritis.
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Affiliation(s)
- Bence György
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvarad ter 4, H-1089, Budapest, Hungary.
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Gáti T, Pajor A, Géher P, Nagy G. [Systemic lupus erythematosus and pregnancy]. Orv Hetil 2008; 149:723-31. [PMID: 18426719 DOI: 10.1556/oh.2008.28295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Systemic Lupus Erythematosus (SLE) is a disease primarily targeting fertile women. The odds of spontaneous miscarriage, preeclampsia, intrauterine growth restriction is higher in pregnant women with SLE as well as there are increased risks of preterm delivery and perinatal fetal death. The occurrence of spontaneous abortion is closely related to the presence of antiphospholipid antibodies. The disease on its own is not a contraindication of pregnancy but at least a six-month remission is suggested prior conception. The physiological changes in the course of pregnancy might have close resemblance to the symptoms of lupus, therefore these changes should be differentiated from symptoms caused by lupus. For mothers suffering from SLE, regular visits not only to their obstetricians but also to a rheumatologist are also recommended in order to allow at proper time recognition of potential complications and their appropriate treatment. Thorough check of the maternal disease is of high importance not only during but also prior to and following pregnancy. An overview is given of the opportunities of recent diagnosis and opportunities of therapeutic approaches including biological as well as stem cell treatments. The antithrombotics treatment increases the chance of survival and healthy child birth in the case of pregnant women suffering from antiphospholipid syndrome. Although occurring rarely, neonatal SLE has significantly higher morbidity and mortality compared to healthy births. Recent studies show positive results in the case of prophylactic treatment of neonatal lupus. Prenatal care is recommended to be conducted at an institute where the obstetrician is experienced in the possible complications of lupus and where consultation with a rheumatologist, and the treatment of neonates with low birth weight are ensured.
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Affiliation(s)
- Tamás Gáti
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Budai Irgalmasrendi Kórház, III. Belgyógyászati Klinika, Reumatológiai és Fizioterápiás Tanszéki Csoport, Budapest.
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40
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Pásztói M, Nagy G, Géher P, Lakatos T, Tóth K, Pócza P, Mercedesz M, Falus A, Buzas E. Synovial glycosidases in joint diseases. Joint Bone Spine 2008. [DOI: 10.1016/j.jbspin.2008.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Brodszky V, Czirják L, Géher P, Hodinka L, Kárpáti K, Péntek M, Poór G, Szekanecz Z, Gulácsi L. Rituximab in patients with rheumatoid arthritis: systematic review. Orv Hetil 2007; 148:1883-93. [PMID: 17905683 DOI: 10.1556/oh.2007.28080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A rheumatoid arthritis terápiájában legújabban alkalmazott gyógyszerek a biológiai szerek. Legutóbb a B-lymphocyta-gátló rituximabot törzskönyvezték rheumatoid arthritis indikációjában. A rituximabot eddig a non-Hodgkin-lymphoma kezelésében alkalmazták. Európai és a magyar reumatológusok ajánlása szerint a rituximab rheumatoid arthritisben azoknak a betegeknek javasolható, akiknél a kórtörténetben eredménytelenség vagy toxicitás miatt sikertelen TNF-α-gátló kezelés szerepel.
Célkitűzés:
A rituximabkezelés klinikai hatásosságáról rheumatoid arthritisben rendelkezésre álló szakirodalom áttekintése. A rituximabkezelés hatásosságának és biztonságának értékelése.
Módszer:
A szerzők a MEDLINE- és Cochrane-adatbázisokban megkeresték az összes randomizált, kontrollált rituximabvizsgálatot rheumatoid arthritisben. Elvégezték az adatok metaanalízisét.
Eredmények:
Az irodalomkeresés során 3 randomizált kontrollált klinikai vizsgálatot azonosítottak a szerzők, amelyekben összesen 1145 beteget követtek. A TNF-α-gátló kezelésre nem reagáló, súlyos gyulladásos tüneteket mutató betegeknél rituximabkezelés mellett 33%-kal több betegnek (95%; KI: 25–41%) javulnak a tünetei az American College of Rheumatology 20 kritérium szerint, mint ha nem kezelnék őket. Majdnem 5-ször nagyobb (relatív kockázat = 4,77; 95%; KI, 3,12–7,31) esélyük van a javulásra, mint kezelés nélkül. A funkcionális állapotot jelző Health Assessment Questionnaire pontszám is szignifikánsan nagyobb mértékben (
p
< 0,001) javult a rituximabcsoportban (–0,4 pont), mint a kontrollcsoportban (–0,1 pont). Rituximabkezelés hatására a mérsékelt vagy jó választ adó betegek aránya 38%-kal nagyobb (95% KI, 32–44%) a rituximabkezelési ágon, mint a kontrollcsoportban, a különbség szignifikáns (
p
< 0,00001). A rituximab a radiológiai progressziót is javítja a TNF-α-gátló kezelésre nem reagáló betegek között.
Következtetések:
A rituximab új, hatásos terápiás lehetőség a rheumatoid arthritis terápiájában. A TNF-α-gátló kezelésre nem reagáló vagy azt nem toleráló betegeknél is javulás érhető el.
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Affiliation(s)
- Valentin Brodszky
- Budapesti Corvinus Egyetem, Közszolgálati Tanszék, Egészségügyi Gazdaságtani és Technológiaelemzési Kutatóközpont, Budapest.
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Abstract
Beta-endorphin (betaE) is an important reliever of pain. Various stressors and certain modalities of physiotherapy are potent inducers of the release of endogenous betaE to the blood stream. Most forms of exercise also increase blood betaE level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level. Age, gender, and mental activity during exercise also may influence betaE levels. Publications on the potential stimulating effect of manual therapy and massage on betaE release are controversial. Sauna, mud bath, and thermal water increase betaE levels through conveying heat to the tissues. The majority of the techniques for electrical stimulation have a similar effect, which is exerted both centrally and--to a lesser extent--peripherally. However, the parameters of electrotherapy have not yet been standardised. The efficacy of analgesia and the improvement of general well-being do not necessarily correlate with betaE level. Although in addition to blood, increased brain and cerebrospinal fluid betaE levels are also associated with pain, the majority of studies have concerned blood betaE levels. In general, various modalities of physical therapy might influence endorphin levels in the serum or in the cerebrospinal fluid--this is usually manifested by elevation with potential mitigation of pain. However, a causal relationship between the elevation of blood, cerebrospinal fluid or brain betaE levels and the onset of the analgesic action cannot be demonstrated with certainty.
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Affiliation(s)
- Tamás Bender
- Polyclinic of Hospitaller Brothers of St. John of God, Budapest, Hungary.
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Géher P, Nagy MB, Péntek M, Tóth E, Brodszky V, Gulácsi L. [The role of biologic agents in the therapy of ankylosing spondylitis]. Orv Hetil 2006; 147:1203-13. [PMID: 16898082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Ankylosing spondylitis is a chronic, inflammatory rheumatic disease which etiology and pathogenesis are not yet fully understood. The inflammation involves the spine and also the peripheral joints might be affected in some cases resulting in a progressive ankylosis, restricted mobility, significant disability, loss of productivity and decreased quality of life. Gene technology based new drugs of the past decade, the biologic agents, offer an alternative opportunity for the treatment of ankylosing spondylitis in comparison with the previous drugs with doubtful efficiency. In Hungary infliximab and etanercept has been registered for ankylosing spondylitis. The aim of this study was to evaluate the efficacy of infliximab and etanercept by the available randomised controlled trials. A systematic search of the literature was performed from 01. 01. 2000 to 08. 31. 2005. and the relevant publications were analysed following the concepts of evidence based medicine. 7 double blind, randomised, placebo controlled trials were identified, three for infliximab (n = 389) and four for etanercept (n = 431). Although the inclusion criteria, the duration of the trials and the primary endpoints were different, the results confirm that both drugs significantly decrease symptoms and disease activity, and this effect is sustained during the therapy, nevertheless half of the patients did not achieve the standardised criteria of 50% decrease in disease activity. Both agents are well tolerated by patients. The outcomes of long-term therapy are reassuring by open extension studies of three years. Guidelines for biologic therapy has been developed in Hungary determining the target patient group, the conditions of the therapy and also an arthritis centre network has been established. Though individual admission is feasible, biologic drugs are not under reimbursement in Hungary. High drug costs makes the implementation of this new therapeutic opportunity difficult in the daily medical practice.
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Affiliation(s)
- Pál Géher
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Ill. Belgyógyászati Klinika, Reumatológiai es Fizioterápiás Tanszéki Csoport, Budai Irgalmasrendi Kórház, I. Reumatológiai Osztály, Budapest
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Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2005; 65:442-52. [PMID: 16126791 PMCID: PMC1798102 DOI: 10.1136/ard.2005.041137] [Citation(s) in RCA: 414] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence based recommendations for the management of ankylosing spondylitis (AS) as a combined effort of the 'ASsessment in AS' international working group and the European League Against Rheumatism. METHODS Each of the 22 participants was asked to contribute up to 15 propositions describing key clinical aspects of AS management. A Delphi process was used to select 10 final propositions. A systematic literature search was then performed to obtain scientific evidence for each proposition. Outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, relative risk, number needed to treat, and incremental cost effectiveness ratio were calculated. On the basis of the search results, 10 major recommendations for the management of AS were constructed. The strength of recommendation was assessed based on the strength of the literature evidence, risk-benefit trade-off, and clinical expertise. RESULTS The final recommendations considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, non-pharmacological treatment (including education, exercise, and physiotherapy), and surgical interventions. Three general recommendations were also included. Research evidence (categories I-IV) supported 11 interventions in the treatment of AS. Strength of recommendation varied, depending on the category of evidence and expert opinion. CONCLUSION Ten key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus. Regular updating will be carried out to keep abreast of new developments in the management of AS.
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Affiliation(s)
- J Zochling
- Rheumazentrum-Ruhrgebiet, St Josefs-Krankenhaus, Landgrafenstr 15, 44652 Herne, Germany
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Nagy G, Géher P, Koncz A, Perl A. [Signal transduction abnormalities in systemic lupus erythematosus]. Orv Hetil 2005; 146:1625-30. [PMID: 16158611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Engagement of T cell receptors by antigen-presenting cells or stimulation by cytokines determine whether the cell will become activated, anergic or die via apoptosis or necrosis. Ca2+ is a key second messenger that delivers signal from the cell surface, reactive oxygen intermediates and nitric oxide are recently recognized as important mediators of T cell activation. Nitric oxide is a multifunctional intracellular and intercellular messenger induces mitochondrial biogenesis in many cell types, such as lymphocytes. Mitochondria produce reactive oxygen intermediates and store and release Ca2+ in response to activation and death signals. Rapid Ca2+ fluxing is increased while sustained Ca2+ signaling is decreased in lupus T cells. Lupus T cells contain increased numbers and mass of mitochondria. Serum nitric oxide levels and production of nitric oxide by monocytes is increased in patients with systemic lupus erythematosus. Lupus T cells exhibit mitochondrial hyperpolarization and increased mitochondrial mass, which confer predisposition to necrosis rather than apoptosis in response to repetitive activation and death signals. Exposure of normal T cells to nitric oxide dose-dependently increase the mitochondrial mass and mimic rapid and sustained Ca2+ signal abnormalities observed in lupus T cells. Thus increased mitochondrial biogenesis may account for altered Ca2+ handling and represents novel targets for pharmacological intervention in SLE.
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Affiliation(s)
- György Nagy
- Semmelweis Egyetem, Altalános Orvostudományi Kar, 111. Belgyógyászati Klinika Reumatológiai es Fizioterápiás Tanszéki Csoport, I. Részleg, Budai Irgalmasrendi Kórház, Budapest
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Abstract
OBJECTIVES The aim of this study was to examine the effects of plasmapheresis on serum beta-endorphin (BE) levels. METHOD The serum BE levels of 12 patients with various autoimmune or hematological disorders were monitored during plasmapheresis therapy. RESULTS BE levels increased after the initial session in 8 of 12 patients; in the remaining 4 patients no change (n = 2) or a decline (n = 2) in BE levels was found. However, no further changes were observed during subsequent therapy. During the last session, an elevation in the BE level was detected in 5 patients, with no change in 1 and a decrease in BE level in another 5 patients. CONCLUSION Our findings suggest that although plasmapheresis results in an elevation in serum BE levels initially, this change does not persist during subsequent sessions.
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Affiliation(s)
- Tamás Bender
- Polyclinic, Hospitaller Brothers of St. John of God, Budapest, Hungary.
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Ortutay Z, Polgár A, Gömör B, Géher P, Lakatos T, Glant TT, Gay RE, Gay S, Pállinger E, Farkas C, Farkas E, Tóthfalusi L, Kocsis K, Falus A, Buzás EI. Synovial fluid exoglycosidases are predictors of rheumatoid arthritis and are effective in cartilage glycosaminoglycan depletion. Arthritis Rheum 2003; 48:2163-72. [PMID: 12905469 DOI: 10.1002/art.11093] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze enzymes involved in joint damage by simultaneous investigation of glycosidases and matrix metalloproteinases (MMPs) in patients with various joint diseases. METHODS Activities of glycosidases (beta-D-glucuronidase, beta-D-N-acetyl-glucosaminidase, beta-D-N-acetyl-galactosaminidase, beta-D-galactosidase, and alpha-D-mannosidase) were tested at an acidic pH as well as at the original pH of the synovial fluid (SF) samples in parallel with activities of MMP-1 and MMP-9. RESULTS Patients with rheumatoid arthritis (RA) were characterized by significantly elevated activities of beta-D-glucuronidase and beta-D-N-acetyl-glucosaminidase in SF compared with patients with osteoarthritis, seronegative spondylarthritis, or acute sports injury. To select the best predictor for distinguishing among patient groups, a stepwise logistic regression analysis was performed; the strongest association was found to be between RA and beta-D-glucuronidase/beta-D-N-acetyl-glucosaminidase activities (measured at the pH of the SF). Further, a significant correlation was observed between the activity of SF beta-D-N-acetyl-glucosaminidase and the level of rheumatoid factor. In vitro digestion of human hyaline cartilage samples revealed that the dominant glycosidases, alone or in combination with MMPs, proved to be effective in depleting glycosaminoglycans (GAGs) from cartilage. CONCLUSION These results suggest that exoglycosidases, which are present in the SF of RA patients, may contribute to the depletion of GAGs from cartilage and thereby facilitate the invasion of synovial cells and their attachment to cartilage in RA.
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Affiliation(s)
- Zsuzsanna Ortutay
- Department of Genetics, Cell and Immunobiology, Semmelweis University, 4 Nagyvárad tér, H-1089 Budapest, Hungary
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Lovas K, Géher P, Whalley D, McKenna S, Meads D, Kaló Z. [Hungarian adaptation of a disease-specific quality-of-life questionnaire in patients with ankylosing spondylitis]. Orv Hetil 2002; 143:1893-7. [PMID: 12221995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Measuring quality of life has growing importance in the field of health technology assessment. It is especially true for chronic diseases, like ankylosing spondylitis, which results in significant impact on patients' quality of life through the intensity and duration of the disease. OBJECTIVES To measure the reliability and validity of the Hungarian version of Ankylosing Spondylitis Quality of Life instrument with the intention of its use in clinical and health economic trials and burden of disease studies in Hungary via the introduction of a certain validation process. METHODS One of the most important criteria for the validity of quality of life instruments is the standard method used for adapting the questionnaire to foreign languages. The dual method was applied for the Hungarian adaptation of the Ankylosing Spondylitis Quality of Life questionnaire, which was followed by psychometric testing. RESULTS High test-retest correlation (0.85) indicated an acceptable degree of reliability with no evidence of excessive random measurement error. The internal consistency of the measure was confirmed (Cronbach's alpha coefficients were 0.87 and 0.91 at Time 1 and Time 2 respectively), with strong evidence that all items were adequately inter-related. The correlations with the NHP at both time points were at the expected levels, providing evidence of convergent and divergent validity. CONCLUSION On the basis of results shown above, it is concluded that the Hungarian Ankylosing Spondylitis Quality of Life questionnaire is a reliable and valid measure of quality of life.
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Affiliation(s)
- Kornélia Lovas
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Egyetemi Gyógyszertár és Gyógyszerügyi Intézet, Budapest
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49
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Géher P, Bender T, Ratkó I, Gömör B. Die Wirbelsäulenbeweglichkeit der Patienten mit
ankylosierender Spondylitis. AKTUEL RHEUMATOL 2002. [DOI: 10.1055/s-2002-20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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