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SAT0078 Prospective Observational Study To Evaluate The Use of Musculoskeletal Ultrasonography To Improve Rheumatoid Arthritis Management: Canadian Experience (ECHO). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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FRI0172 Primary and Secondary Non-Response in RA Patients Treated with An anti-TNF: An Analysis from A Prospective, Observational Registry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0062 What is the Effect of TNF Inhibitors on Employment Status in Rheumatoid Arthritis Patients and what are the Predictors of Progression to Unemployment? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0204 What is the Correlation of Individual HAQ and Basdai Questions with Disease Activity Measures in Ankylosing Spondylitis? Implications for Instrument Reduction. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB1163 Prevalence of Smoking and Impact on Disease Parameters Among Ankylosing Spondylitis, Rheumatoid Arthritis and Psoriatic Arthritis Patients Treated with Infliximab or Golimumab. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0196 Is the Basdai Score Driven by Pain in Ankylosing Spondylitis Patients Treated with Anti-TNF? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0168 What is the Treatment Durability and Safety Profile of Rheumatoid Arthritis Patients Treated with Infliximab Plus Methotrexate and/or Leflunomide? An Analysis from a Real-World Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0090 Exploring The Das: What is the Level of Agreement in the Classification of Remission and Low Disease Activity Among the Various Versions of the Disease Activity Score (DAS) and Their Correlation? An Analysis from a Prospective, Observational Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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AB0304 What Proportion of Patients Fail to Achieve Das, Cdai, Sdai Remission Based on Patient Global assessment? An Analysis from a Prospective, Observational Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0557 Predictors of Response in Patients with Psoriatic Arthritis Treated with Anti-TNF in a Real-World Setting. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB1141-HPR Team Managed Care from A Patients Perspective: A Study of Biological Patients at A Canadian Centre. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0227 Two-Year Retention and Effectiveness of IV Abatacept Monotherapy and Combination in PTS with RA Previously Treated with at Least One Biologic Agent in A Real-Life Setting: Subgroup Analysis from the Action Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0241 Predictors of Acr/Eular Boolean and SDAI Remission in Patients with Established Rheumatoid Arthritis Treated with Anti-TNF: an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0760 Real-World Validation of the Minimal Disease Activity Index in Psoriatic Arthritis: an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0035 Impact of Corticosteroid Use on Remission Sustainability and Infection Rates among Rheumatoid Arthritis Patients in Remission While on Infliximab: Treatment Implications Based on A Real-World Population. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0363 Validation of the Ankylosing Spondylitis Disease Activity SCORE (ASDAS) and Effectiveness of Infliximab in the Treatment of Ankylosing Spondylitis over 4 Years. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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SAT0245 Decreased Use of Glucocorticoids in PTS with RA Who Initiated IV Abatacept and Previously Failed at Least One Biologic Agent: Results from the 2-Year Action Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0318 Two-Year Retention and Effectiveness of IV Abatacept in Real-Life Setting: Results from the Action Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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AB0761 Prevalence of Enthesitis and Dactylitis, Impact on Disease Severity and Evolution over 12 Months in PSA Patients Treated with Anti-TNF in A Real-World Setting. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0577-HPR A Study to Determine Patient Satisfaction with A Nurse Injection Clinic in Rheumatology. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0336 Change over Time in the Profile of Ankylosing Spondylitis Patients Treated with Infliximab in A REAL World Routine Care. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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THU0098 The Baseline Characteristics of A Canadian Ankylosing Spondylitis Cohort, the Canadian Humira Post Marketing Observational Epidemiological Study: Assessing Effectiviness in Ankylosing Spondylitis (COMPLETE- AS). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FRI0063 Comparison of disease characteristics of RA patients in remission according to the DAS criteria versus the new ACR/EULAR criteria in a real-world patient population. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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AB0421 Outcomes of infliximab treatment in canadian rheumatoid arthritis patients of different age groups. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0962 Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled international trial. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0551 What is the Real World Relationship between Patient-Reported Pain or Patient Global Assessment and Disease Activity Indices in Rheumatoid Arthritis? An Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0856 Real-life effectiveness of infliximab in the treatment of ankylosing spondylitis over 3 years: The canadian experience. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0260 Comparison of rheumatoid arthritis (RA) patient parameters at anti-TNF treatment initiation demonstrates wide variability over time in a large real-life cohort treated with infliximab. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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AB0541 Factors associated with selection of rituximab vs alternative TNF inhibitor (TNFI) following TNFI failure in patients with rheumatoid arthritis: Sub-analysis of switch-RA, a global, comparative effectiveness observational study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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AB0274 Correlation of CDAI and SDAI with das in a large real-life cohort of RA patients treated with infliximab:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Case Reports * 1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGF Receptor Mutations in Benign Joint Hypermobility. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Treatment with acetaminophen/paracetamol or ibuprofen alleviates post-dose symptoms related to intravenous infusion with zoledronic acid 5 mg. Osteoporos Int 2012; 23:503-12. [PMID: 21331467 DOI: 10.1007/s00198-011-1563-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/14/2011] [Indexed: 11/25/2022]
Abstract
SUMMARY Patients treated with intravenous zoledronic acid 5 mg for osteoporosis may experience post-dose influenza-like symptoms. Oral acetaminophen/paracetamol or ibuprofen administered 4 h post-infusion reduced the proportion of patients with increased oral temperature and worsening post-infusion symptom scores vs. placebo, thus providing an effective strategy for the treatment of such symptoms. INTRODUCTION Once-yearly intravenous zoledronic acid 5 mg is a safe and effective treatment for postmenopausal osteoporosis. This study assessed whether transient influenza-like post-dose symptoms associated with intravenous infusion of zoledronic acid can be reduced by post-dose administration of acetaminophen/paracetamol or ibuprofen. METHODS In an international, multicenter, randomized, double-blind, double-dummy parallel-group study, bisphosphonate-naïve postmenopausal women with osteopenia (n = 481) were randomized to receive zoledronic acid 5 mg + acetaminophen/paracetamol (n = 135), ibuprofen (n = 137) or placebo (n = 137), or placebo + placebo (n = 72). Acetaminophen/paracetamol and ibuprofen were administered every 6 h for 3 days beginning 4 h post-infusion. RESULTS The proportion of patients with increased oral temperature (≥1°C above 37.5°C) and with worsening post-infusion symptom scores over 3 days was significantly lower in patients receiving ibuprofen (36.8% and 48.5%) or acetaminophen/paracetamol (37.3% and 46.3%) vs. those receiving placebo (63.5% and 75.9%, respectively; all p < 0.0001) compared with background rates of 11.1% and 16.7%, respectively, in the absence of any active treatment. Overall incidence of adverse events was comparable for patients receiving acetaminophen/paracetamol or ibuprofen. CONCLUSION Oral acetaminophen/paracetamol or ibuprofen effectively managed the transient influenza-like symptoms associated with zoledronic acid 5 mg.
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Evaluation of easily measured risk factors in the prediction of osteoporotic fractures. BMC Musculoskelet Disord 2005; 6:47. [PMID: 16143046 PMCID: PMC1208898 DOI: 10.1186/1471-2474-6-47] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2004] [Accepted: 09/05/2005] [Indexed: 12/02/2022] Open
Abstract
Background Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. Methods Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (<65, 65–69, 70–74, 75–79, 80+ years), rising from a chair with arms (yes, no), weight (< 57, ≥ 57kg), maternal history of hip facture (yes, no), prior fracture after age 50 (yes, no), hip T-score (>-1, -1 to >-2.5, ≤-2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted. Results The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93) was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37), current smoking (1.95; 95% CI: 1.20, 3.18) and age between 75–79 years (1.96; 95% CI: 1.10, 3.51). New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90) and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22). Predictors of new rib fractures include a maternal history of a hip facture (2.89; 95% CI: 1.04, 8.08) and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87). Conclusion This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated into routine clinical practice.
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Efficacy and safety of valdecoxib in treating the signs and symptoms of rheumatoid arthritis: a randomized, controlled comparison with placebo and naproxen. Rheumatology (Oxford) 2002; 41:1008-16. [PMID: 12209034 DOI: 10.1093/rheumatology/41.9.1008] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare the efficacy of the COX-2 specific inhibitor valdecoxib with the conventional NSAID naproxen and placebo in treating rheumatoid arthritis (RA). METHODS This multi-centre, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of valdecoxib 10 mg (n=209), 20 mg (n=212) or 40 mg once daily (q.d.) (n=221) with naproxen 500 mg b.i.d. (n=226) or placebo (n=222), in treating the signs and symptoms of RA. Efficacy was assessed by the number of patients responding to treatment according to the American College of Rheumatology-Responder Index (ACR-20). RESULTS ACR-20 response was recorded for all randomized patients who received a single dose of study medication (above). Valdecoxib, at all administered doses, produced significant improvements in the ACR-20 Responder Index at weeks 2, 6 and 12 compared with placebo (P<or=0.01). Valdecoxib and naproxen did not differ in terms of ACR-20 response rate and the three doses of valdecoxib were similar to one another. All three doses of valdecoxib were well tolerated. CONCLUSIONS Single daily doses of valdecoxib 10, 20 and 40 mg demonstrated efficacy that was superior to placebo and similar to naproxen in treating the signs and symptoms of RA. All three doses provided similar levels of efficacy.
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Double blind randomized placebo control trial of controlled release codeine in the treatment of osteoarthritis of the hip or knee. J Rheumatol 2000; 27:764-71. [PMID: 10743822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Pain is the cardinal feature of osteoarthritis (OA), and with advancing disease there is loss of function and increasing pain even at times of joint rest. Few studies have evaluated the role of opioid analgesics in treating the pain of OA. METHODS This randomized, double blind, parallel group study compared the efficacy and safety of a 12 hourly controlled release codeine formulation (Codeine Contin) with placebo in patients with chronic pain due to OA of the hips and/or knees. The 4 week treatment period, following an analgesic washout phase of 2-7 days, included weekly clinic evaluations, at which the dose was escalated as appropriate, and daily patient diary completion. Pain (daily), stiffness, and physical function (weekly) were assessed using the multidimensional, self-administered WOMAC (visual analog scale version) questionnaire. RESULTS Sixty-six eligible patients completed the study. The mean initial and final daily doses of controlled release codeine were 50 mg every 12 h at baseline and 159 mg every 12 h at the final assessment. All variables in the efficacy analysis indicated superiority of controlled release codeine over placebo. The WOMAC pain scale showed an improvement of 44.8% over baseline in the controlled release codeine group compared with 12.3% taking placebo (p = 0.0004). For the WOMAC stiffness and physical function scales the improvements over baseline on controlled release codeine were 47.7% and 49.3%, respectively compared with 17.0% and 17.0%, respectively, with placebo (p = 0.003; p = 0.0007). Controlled release codeine was also significantly better than placebo on measures of sleep quality and requirement for supplemental acetaminophen. CONCLUSION Single entity controlled release codeine is an effective treatment for pain due to OA of the hip or knee.
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MESH Headings
- Acetaminophen/administration & dosage
- Acetaminophen/therapeutic use
- Aged
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Codeine/administration & dosage
- Codeine/therapeutic use
- Delayed-Action Preparations
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/drug therapy
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/physiopathology
- Placebos
- Pliability
- Sleep/drug effects
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Aim for remission or "personal best" using combination DMARD therapy with methotrexate and hydroxychloroquine. Clin Exp Rheumatol 1999; 17:S95-101. [PMID: 10589366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Combination disease-modifying antirheumatic drug therapy with methotrexate and hydroxychloroquine has changed the course of rheumatoid arthritis. Better management requires "front of the line" care, effective drug combinations, and a goal of "Personal Best." The Pincus phenomenon--the discrepancy between subjective satisfaction and objective progression--may be minimized in clinical practice by questionnaires and Snapshot.
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Newer, safer nonsteroidal anti-inflammatory drugs. Rational NSAID selection for arthritis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1998; 44:101-2, 105-7. [PMID: 9481468 PMCID: PMC2277567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To summarize current evidence that three new additions to nonsteroidal anti-inflammatory drugs (NSAIDs) offer comparable efficacy with fewer adverse effects than established NSAIDs. QUALITY OF EVIDENCE No large randomized controlled trials (RCTs) have compared all important NSAIDs. Several RCTs have shown that H2 antagonists do not protect against NSAID side effects, but some RCTs compared the protective effect of misoprostol (Cytotec) used with other NSAIDs; others have compared etodolac (Ultradol) or nabumetone (Relafen) with placebo and naproxen (eg, Naprosyn). Postmarketing surveys have been used to support claims that the new NSAIDs have few gastric or renal side effects. MAIN FINDINGS Using misoprostol in conjunction with traditional NSAIDs reduces gastric and renal adverse effects. Misoprostol can be taken at the same time as NSAIDs or in a combination tablet. Two new NSAIDS, etodolac and nabumetone, do not inhibit cyclooxygenase 1 prostaglandins, which occur in the stomach and kidneys, but more selectively block cyclooxygenase 2 prostaglandins, which cause arthritic inflammation. These two NSAIDs have efficacy profiles comparable to older NSAIDs but have markedly fewer side effects. CONCLUSIONS Safer treatment for arthritis can be achieved by combining misoprostol with traditional NSAIDs or by using one of two new agents, nabumetone or etodolac.
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Interaction between cyclosporin A and nonsteroidal antiinflammatory drugs. J Rheumatol 1997; 24:1122-5. [PMID: 9195520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although cyclosporin A (CyA) has been shown in a series of controlled trials to be of benefit to patients with rheumatoid arthritis (RA), the majority of patients continue to require nonsteroidal antiinflammatory drugs (NSAID) for relief of joint pain and stiffness. Our aim was to determine whether there is a clinically important difference in calculated creatinine clearance when CyA is given concurrently with NSAID with high cyclooxygenase activity (indomethacin and ketoprofen) compared with sulindac, which has been claimed to have fewer renal effects than other NSAID, and compared with a simple analgesic, paracetamol. METHODS Patients with RA started 2.5 mg/kg CyA/day and dosage was increased cautiously to 5 mg/kg/day or less if the serum creatinine rose by > or = 30% above baseline. The mean stabilized dose was 171.43 +/- 48.94 mg/day. Once CyA dose was stabilized, patients were allocated in random order to possible sequences of 4 week periods of acetaminophen, indomethacin, ketoprofen, and sulindac. Monitoring of cyclosporine levels, nephrotoxicity, and hepatoxicity, and adjustment of doses were by an "unblinded" clinician not in direct contact with study patients. All other assessments were made by a "blinded" clinician. Patients were instructed to take the identical appearing gelatin capsules qid. The multiple crossover design was analyzed using analysis of variance procedures for repeated measures. RESULTS 35 patients were enrolled, of whom 32 patients completed the acetaminophen and at least one course of NSAID. The calculated creatinine clearance was increased by 2.79 ml/min (3.5%) on average for acetaminophen versus all 3 NSAID (6% for indomethacin, 2.3% for ketoprofen, 2.6% for sulindac). The study had adequate power to detect a true difference of more than 10% in mean creatinine clearance for each major comparison. CONCLUSION NSAID studied did not produce a clinically important difference in the calculated creatinine clearance in these patients-the difference with acetaminophen was modest and not of clinical significance. There is no evidence that any of the 3 NSAID studied have an advantage or disadvantage. It seems reasonable to allow patients to continue an NSAID of their or their clinician's choice.
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Back to the future: the pyramids of rheumatoid arthritis. J Rheumatol Suppl 1997; 24:1023-7. [PMID: 9195503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The management treatment pyramid, treatment target and treatment pyramids provide a framework for RA management and treatment. This model brings back the traditional pyramid, which was widely accepted, and adapts it to our newer understanding of RA treatment. It provides a focus for care, as well as the flexibility to apply selective treatments to different temperaments of disease. We hope that these models will fill the void left by the abandonment of the traditional pyramid. We certainly need a model to refocus the patient and physician to the importance of RA and bring "order out of chaos". With our current knowledge, resources, and drugs, we could be making a far greater impact on this serious, expensive, and crippling disease. We must re-excite and re-educate the public, the patient, and the profession to the remarkable progress we have made with incurable but very treatable arthritis.
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Combination therapy of cyclosporine with methotrexate and gold in rheumatoid arthritis (2 pilot studies). J Rheumatol 1994; 21:2034-8. [PMID: 7869306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the efficacy and toxicity of cyclosporine A (CyA) in combination with gold and methotrexate (MTX) in patients with rheumatoid arthritis (RA). METHODS Twenty patients with RA with partial response to oral MTX and 20 patients with partial response to im gold had CyA added to their regimen for 6 months, withdrawn over 2 months and the patients monitored for 4 months. RESULTS There was a significant improvement in joint count, joint score, joint swelling, grip strength and joint pain in patients taking the combination with no significant increase in adverse reactions. CONCLUSION CyA in combination with gold or MTX may, over a 6 month period, increase efficacy in patients with refractory RA without significant increase in toxicity.
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Interrater reliability of the tender point criterion for fibromyalgia. J Rheumatol 1992; 19:1955-9. [PMID: 1294746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The diagnosis fibromyalgia (FS) requires the existence of tender points, routinely identified by clinical examination. We evaluated the interrater reliability of digital (thumb) examination for tender points by comparison with dolorimeter examination, a procedure considered to measure accurately muscle tenderness. Subjects were 15 patients with varying rheumatological diagnoses and anatomically widespread pain. In a physician blinded procedure, 2 rheumatologists determined the tender point count by digital examination at 18 points, and the tender point threshold by dolorimeter at 12 points. A pain threshold of 4 kg/1.77 cm2 or less defined the presence of tender points under both methods. Results indicate (1) classification as FS vs other diagnosis using pain complaint and digital examination for tender points, was moderately reliable (kappa = 0.74, p < 0.005); (2) interrater agreement about presence/absence of tenderness at individual points was not significantly lowered by digital examination (kappa = 0.51, p < 0.0001) relative to dolorimetry (kappa = 0.62, p < 0.0001); however, (3) analyses on the 12 anatomical points that were common to both methods indicated that digital examination resulted in significantly more anatomical points being considered tender relative to dolorimetry. Our findings indicate that digital and dolorimeter measures are equally reliable, but have poor concurrent validity for defining tender points in FS. Implications of these findings for the classification of fibromyalgia are discussed.
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Relationship of antiphospholipid antibodies to pregnancy loss in patients with systemic lupus erythematosus: a cross-sectional study. Blood 1992; 80:975-80. [PMID: 1498338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To determine whether an association exists between the presence of antiphospholipid antibodies and pregnancy loss, a cross-sectional study was performed. Consecutive women who were referred to three outpatient rheumatology clinics and who had systemic lupus erythematosus (SLE) and a history of one or more pregnancies were evaluated. Patients were interviewed to determine outcomes of all previous pregnancies. Blood was taken on two separate occasions at least 3 months apart to test for the presence of the lupus anticoagulant and anticardiolipin antibodies; on both occasions, five tests of the lupus anticoagulant, with well-defined normal ranges, and an enzyme-linked immunosorbent assay to measure IgG anticardiolipin antibodies were performed. Patients were considered to be positive for the lupus anticoagulant if one or more tests was abnormal on both occasions and positive for anticardiolipin antibodies if the test was abnormal on both occasions. Forty-two women were studied. Statistically significant associations were shown between lupus anticoagulant positivity and previous pregnancy loss (odds ratio [OR], 4.8; 95% confidence intervals [CI], 1.0 to 23.6; P = .05) and between anticardiolipin antibody positivity and previous pregnancy loss (OR, 20.0; 95% CI, 1.3 to 97.0; P = .01). All seven women with multiple episodes of pregnancy loss were lupus anticoagulant positive and four of these were also anticardiolipin antibody positive. If patients who are transiently positive for lupus anticoagulant and/or anticardiolipin antibodies are considered to be test positive, the associations with pregnancy loss are no longer statistically significant. Within the group of lupus anticoagulant-positive patients, we observed stronger associations between the presence of six or more positive tests and pregnancy loss than between the presence of two to five positive tests and pregnancy loss. No single test for the lupus anticoagulant provides a statistically significant association with pregnancy loss. The results of our study show that by performing multiple lupus anticoagulant tests and by repeating testing for lupus anticoagulant and anticardiolipin antibodies on more than one occasion, significant associations between the presence of antiphospholipid antibodies and previous pregnancy loss can be shown in patients with SLE.
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Current quality-of-life research challenges in arthritis relevant to the issue of clinical significance. CONTROLLED CLINICAL TRIALS 1991; 12:217S-225S. [PMID: 1663857 DOI: 10.1016/s0197-2456(05)80025-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Remodelling the pyramid: the therapeutic target of rheumatoid arthritis. J Rheumatol 1990; 17:987-9. [PMID: 2213793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Nephrotoxicity in patients with rheumatoid arthritis treated with cyclosporine. Transplant Proc 1988; 20:367-70. [PMID: 3381299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Serum lymphocytotoxic antibodies in neuropsychiatric lupus: a serial study. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1983; 28:243-51. [PMID: 6872362 DOI: 10.1016/0090-1229(83)90158-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The pathogenesis of neuropsychiatric (NP) SLE remains speculative. A relationship between circulating brain cross-reactive lymphocyte antibodies (LCA) and NP-SLE has been postulated but serial, prospective study of LCA in individual patients with SLE has rarely been performed. In the current study a group of 34 patients with SLE was analyzed using clinical, neurologic, psychiatric, and neuropsychological examinations, together with routine serological tests, to define NP-SLE. Previous history of alloimmunization was also recorded. LCA were measured by a two-stage microcytotoxicity assay against a panel of 25 normal donor B and T cells, at both 40 and 37 degrees C. LCA by this method were found in the serum of 20/34 (58%) SLE, 2/22 (9%) rheumatoid arthritis, and 3/24 (12%) antinuclear-antibody-positive chronic psychiatric patients (P less than 0.01). Analysis of LCA serially in individual SLE patients revealed: (1) No difference in B- or T-cell reactivity at either 4 or 37 degrees C, (2) no significant correlation between previous alloimmunization and the presence of LCA, (3) fluctuations in LCA associated with NP-SLE relapses or remissions, but not with therapy, in 10 patients prospectively studied. A significant positive association was found between the occurrence of single neuropsychiatric events and serial LCA determinations in 180 sera (P less than 0.000001). LCA as measured in this study appear more frequently in SLE than in controls and may indicate active NP-SLE in some patients. Further study of the pathogenic role and diagnostic value of LCA in NP-SLE, including their relationship to subtle neurocognitive changes, is proposed.
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Megaloblastic anemia in patients receiving total parenteral nutrition without folic acid or vitamin B12 supplementation. CANADIAN MEDICAL ASSOCIATION JOURNAL 1977; 117:144-6. [PMID: 406033 PMCID: PMC1879726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pancytopenia developed in four patients receiving postoperatively total parenteral nutrition (TPN). Symptoms and signs were related mainly to underlying bowel disease. Hematologic abnormalities, first noted from 4 to 7 weeks following institution of TPN, consisted of normocytic anemia (mean decrease in hemoglobin value, 2.2 g/dL), occasional macrocytes being noted, leukopenia (range of leukocyte counts, 1.2 to 3.6 X 10(9) L), some hypersegmented neutrophils being detected, and clinically significant thrombocytopenia (range of platelet counts, 25 to 52 X 10(9)/L). In all patients the bone marrow showed megaloblastic changes, with ring sideroblasts, although pyridoxine was included in the TPN regimens. Serum vitamin B12 values were normal in one patient and at the lower limit of normal in the other two patients in whom it was measured, while serum or erythrocyte folate values, or both, were reduced in three patients. Full hematologic response was observed in the four patients after folic acid replacement therapy; leukocytosis and thrombocytosis were noted in three. Thus, folic acid and possibly vitamin B12 should be added routinely to TPN regimens to prevent deficiency of either substance.
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Beitrag zur Kenntniss der Organveränderungen nach Schilddrüsen-Exstirpation bei Kaninchen. Virchows Arch 1902. [DOI: 10.1007/bf01929370] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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