RESUMEN
BACKGROUND: Chronic fatigue is common among patients with rheumatoid arthritis (RA), affecting quality of life. Osteoporosis is a prevalent co-morbidity in RA patients. OBJECTIVES: To assess the effect of long-term treatment with tocilizumab on fatigue and bone mineral density (BMD) in RA patients with inadequate response to synthetic or biologic disease-modifying anti-rheumatic drugs. METHODS: In this multicenter, open-label, non-controlled, single-arm study, patients ≥ 18 years of age received intravenous tocilizumab 8 mg/kg every 4 weeks for 96 weeks. The primary outcome was the change in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score from baseline to weeks 24, 48, 72, and 96. BMD was assessed before and 96 weeks after treatment. RESULTS: The study comprised 145 patients (mean age 53.4 ± 13.4 years, 83.4% women). Of these, 88 (60.7%) completed the 2 year treatment period. The mean FACIT-Fatigue score improved consistently starting from week 4 and showed a statistically significant increase of 5.0 ± 9.7, 6.8 ± 10.5, 7.3 ± 10.9, and 7.3 ± 10.4 from baseline to weeks 24, 48, 72, and 96, respectively (P < 0.0001). Mean BMD of femoral neck and total spine remained stable. Disease activity, acute phase reactants, and composite efficacy measures decreased during the study, while hemoglobin levels increased. Adverse events and serious adverse events were as expected for the known and previously described data. CONCLUSIONS: Tocilizumab therapy for 2 years significantly and clinically decreased fatigue. BMD remained stable and no new safety issue was reported.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Densidad Ósea/efectos de los fármacos , Fatiga/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/efectos adversos , Artritis Reumatoide/fisiopatología , Enfermedad Crónica , Fatiga/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Granulomatosis con Poliangitis/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Enfermedades Orbitales , Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales de Origen Murino , Progresión de la Enfermedad , Granulomatosis con Poliangitis/diagnóstico por imagen , Granulomatosis con Poliangitis/inmunología , Humanos , Factores Inmunológicos/administración & dosificación , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/tratamiento farmacológico , Inducción de Remisión , Rituximab , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Enfermedad Mixta del Tejido Conjuntivo/tratamiento farmacológico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Comorbilidad , Progresión de la Enfermedad , Quimioterapia Combinada , Resultado Fatal , Glucocorticoides/administración & dosificación , Humanos , Inmunosupresores/administración & dosificación , Infliximab , Linfoma de Células B Grandes Difuso/inducido químicamente , Linfoma de Células B Grandes Difuso/epidemiología , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/epidemiología , Yoduro de Potasio/administración & dosificación , Yoduro de Potasio/uso terapéutico , Prednisona/administración & dosificación , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Vasculitis/etiologíaRESUMEN
A cohort of patients with recently diagnosed axial spondyloarthritis (SpA) was characterized with emphasis on gender differences and factors leading to delay in diagnosis. Clinical, laboratory, and imaging data of 151 consecutive patients diagnosed with ankylosing spondylitis or undifferentiated SpA in 2004-2009 and satisfying the new ASAS classification criteria for axial SpA, was collected and analyzed. Seventy-nine men and 72 women were enrolled. Both groups (men and women) had similar age of onset of disease-related symptoms, as well as similar delay time to diagnosis, follow-up duration and frequency of anti-TNF treatment. Inflammatory back pain, as a first symptom related to SpA, was reported more often by men, while women had more pelvic, heel, and widespread pain (WP) during the course of the disease. At the time of diagnosis, men were more limited in chest expansion and showed increased occiput-to-wall distance compared to women. Elevated erythrocyte sedimentation rate and/or C-reactive protein were detected in a similar proportion of men and women. Presence of WP in women almost doubled the delay in the diagnosis of SpA. No other differences in disease presentation or burden were demonstrated to correlate with delay in diagnosis.
Asunto(s)
Columna Vertebral/patología , Espondilitis Anquilosante/diagnóstico , Adulto , Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Dolor de Espalda/diagnóstico , Dolor de Espalda/etiología , Dolor de Espalda/fisiopatología , Estudios de Cohortes , Diagnóstico Tardío , Femenino , Humanos , Masculino , Dolor/diagnóstico , Dolor/etiología , Dolor/fisiopatología , Factores Sexuales , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/fisiopatologíaRESUMEN
Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of the celiac trunk which occurred in a 49 year old male with a previously undiagnosed bicuspid aortic valve (BAV). We also describe the classical appearance in different imaging modalities with a particular emphasis on multidetector computed tomography, and discuss the clinical manifestation and its relationship to BAV.
Asunto(s)
Disección Aórtica/etiología , Válvula Aórtica/anomalías , Arteria Celíaca , Cardiopatías Congénitas/complicaciones , Dolor Abdominal/etiología , Disección Aórtica/diagnóstico , Disección Aórtica/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Válvula Aórtica/diagnóstico por imagen , Arteria Celíaca/diagnóstico por imagen , Ecocardiografía Transesofágica , Enoxaparina/uso terapéutico , Cardiopatías Congénitas/diagnóstico , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Esteroides/uso terapéutico , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Degenerative lumbar spinal stenosis, manifesting as chronic low back pain and neurogenic claudication, is an increasing chronic problem in an aging population, with limited effective conservative treatment options. Based on previous reports on the utility of subcutaneous calcitonin and two anectodal cases, we launched an open therapeutic trial of IV monthly pamidronate infusions, over a course of 3-6 months in this condition. Of 24 patients, 75% reported pain improvement, with the mean VAS score improved by 40%; while composite functional improvement in walking time, activities of daily living, and sense of well being was reported by 66%, with a mean improvement of 50%. The results of this pilot trial suggest the usefulness of this modality and warrant examination in a controlled clinical trial.
Asunto(s)
Antiinflamatorios/uso terapéutico , Difosfonatos/uso terapéutico , Vértebras Lumbares , Estenosis Espinal/tratamiento farmacológico , Actividades Cotidianas/psicología , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios/administración & dosificación , Difosfonatos/administración & dosificación , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Pamidronato , Proyectos Piloto , Estenosis Espinal/fisiopatología , Estenosis Espinal/psicología , Resultado del Tratamiento , Caminata/fisiología , Caminata/psicologíaRESUMEN
Isolated hypoglossal nerve (HN) palsy has been reported in a variety of disorders involving the cervical spine and/or skull base, however, unilateral HN palsy caused by rheumatoid arthritis (RA) has rarely been reported. We report herein an uncommon case of isolated HN palsy secondary to RA cervical spine involvement: pannus formation at the C1-C2 articulation, atlanto-axial subluxation, as well as, erosion of the right occipital condyle, lateral mass and anterior arch of C1. Pulse therapy with methylprednisolone followed by maintenance therapy with prednisone resulted in dramatic improvement. We also present the variety of diagnostic modalities helpful for the diagnosis and follow-up.