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1.
Curr Opin Rheumatol ; 35(6): 414-422, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37339523

RESUMO

PURPOSE OF REVIEW: Psoriatic arthritis (PsA) is a common form of inflammatory arthritis that affects people with psoriasis. Both psoriasis and PsA are associated with metabolic diseases including obesity, hypertension, hyperlipidaemia, diabetes mellitus, fatty liver disease, and cardiovascular disease including myocardial infarction. Dietary interventions for psoriatic disease have been of great interest, particularly among patients with PsA. RECENT FINDINGS: Herein, we review the evidence for dietary intervention in psoriatic arthritis. To date, weight loss among patients who are obese has the greatest evidence for benefit. We also examine the evidence for fasting, nutrient supplementation, and specific diets as adjunct therapeutic strategies. SUMMARY: While the data do not clearly support a single dietary intervention across the disease, weight loss among those who are obese results in improved PsA disease activity and physical function. Additional studies are needed to better understand the impact of diet on psoriatic arthritis.


Assuntos
Artrite Psoriásica , Doenças Cardiovasculares , Psoríase , Humanos , Obesidade/complicações , Redução de Peso
2.
Rheumatol Int ; 41(11): 1941-1947, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34427760

RESUMO

Management of ANCA-associated vasculitis (AAV) during the COVID-19 pandemic poses unique therapeutic challenges. An online survey was conducted to understand physician's choices for treating AAV during the COVID-19 pandemic. Web-based survey featuring nineteen questions was circulated amongst physicians across various specialties. The responses regarding immunosuppressive therapy for remission induction and maintenance, COVID-19 testing, and preventive measures were recorded. A total of 304 responses were recorded. Most of the respondents were from India (83.9%) and comprised rheumatologists (66%) in practice for ≥ 5 years (71%). Though a majority preferred Rituximab or intravenous cyclophosphamide (CYC) as a remission induction agent, a significant proportion opted for oral CYC and mycophenolate mofetil (MMF) also. Only one-third wanted to test for COVID-19 before initiating immunosuppressive therapy in patients with organ/life-threatening manifestations. Rituximab was the most favored maintenance therapy (47%), followed by azathioprine, MMF, and methotrexate. The results of this focused survey of managing AAV patients depict the real-world dilemmas and physicians' choices in this setting.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Terapia de Imunossupressão/métodos , Padrões de Prática Médica , Reumatologia/métodos , Adulto , COVID-19/epidemiologia , Teste para COVID-19 , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pandemias , Indução de Remissão/métodos , SARS-CoV-2 , Inquéritos e Questionários
3.
BMC Med Genet ; 19(1): 48, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587639

RESUMO

BACKGROUND: Psoriasis and psoriatic arthritis (PsA) are inflammatory associated autoimmune disorders. MicroRNA (miR)-146a plays a crucial role in regulating inflammation. A single nucleotide polymorphism in the miR-146a gene (rs2910164), aberrantly alters its gene expression and linked with the pathogenesis of several disorders, including psoriasis and PsA. In South Africa, psoriasis and PsA are extremely rare in the indigenous African population and most common in both the Indian and Caucasian population. The aim of this study was to investigate whether the miR-146a rs2910164 contributes towards psoriasis and PsA development in South African Indian and Caucasian patients. METHODS: South African Indian (n = 84) and Caucasian (n = 32) PsA patients (total n = 116) and healthy control subjects (Indian: n = 62 and Caucasian: n = 38; total n = 100) were recruited in the study. DNA was extracted from whole blood taken from all subjects, and genotyped for the miR-146a rs2910164 using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Data for laboratory parameters were obtained from pathology reports. The consulting rheumatologist collected all other clinical data. RESULTS: Unstratified data (Caucasians + Indians): A significant decrease in C-reactive protein (CRP) levels in PsA patients was observed (CRP monitored at inclusion vs. after 6 months of treatment) (18.95 ± 2.81 mg/L vs. 9.68 ± 1.32 mg/L, p = 0.0011). The miR-146a rs2910164 variant C-allele frequency in PsA patients was significantly higher vs. healthy controls (35.78% vs. 26% respectively, p = 0.0295, OR = 1.59 95% CI 1.05-2.40). Stratified data (Indians): The variant C-allele frequency in Indian PsA patients was significantly higher vs. healthy Indian controls (35.71% vs. 22.58%, p = 0.0200, OR = 1.91 95% CI 1.13-3.22). Stratified data (Caucasians): The variant C-allele frequency distribution between Caucasian PsA patients and healthy Caucasian controls was similar. CONCLUSION: The rs2910164 variant C-allele may play a role in the progression of PsA in the South African Indian population. The main limitation in this study was the small sample size in the case-control cohorts, with a low overall statistical power (post-hoc power analysis = 19%).


Assuntos
Artrite Psoriásica/genética , População Negra/genética , MicroRNAs/genética , Polimorfismo de Nucleotídeo Único , População Branca/genética , Glicemia/metabolismo , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Colesterol/sangue , Feminino , Frequência do Gene , Predisposição Genética para Doença , Técnicas de Genotipagem , Hemoglobinas Glicadas/metabolismo , Humanos , Imunoglobulina M/sangue , Índia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Fragmento de Restrição , Tamanho da Amostra , África do Sul , Inquéritos e Questionários , Vitamina D/sangue
4.
Ann Rheum Dis ; 74(10): 1799-807, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26359488

RESUMO

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.


Assuntos
Polimialgia Reumática/tratamento farmacológico , Algoritmos , Antirreumáticos/uso terapêutico , Pesquisa Biomédica/métodos , Gerenciamento Clínico , Esquema de Medicação , Medicina Baseada em Evidências/métodos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Cooperação Internacional , Fitoterapia/métodos , Polimialgia Reumática/diagnóstico
5.
Semin Arthritis Rheum ; 65: 152381, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38306813

RESUMO

OBJECTIVE: To gain consensus on the definitions and descriptions of the domains of the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials evaluating shared decision making (SDM) interventions. METHODS: Following the OMERACT Handbook methods, our Working Group (WG), comprised of 90 members, including 17 patient research partners (PRPs) and 73 clinicians and researchers, had six virtual meetings in addition to email exchanges to develop draft definitions and descriptions. The WG then conducted an international survey of its members to gain consensus on the definitions and descriptions. Finally, the WG members had virtual meetings and e-mail exchanges to review survey results and finalize names, definitions and descriptions of the domains. RESULTS: WG members contributed to developing the definitions. Fifty-two members representing four continents and 13 countries completed the survey, including 15 PRPs, 33 clinicians and 37 researchers. PRPs and clinicians/researchers agreed with all definitions and descriptions with agreements ranging from 87% to 100%. Respondents suggested wording changes to the names, definitions and descriptions to better reflect the domains. Discussions led to further simplification and clarification to address common questions/concerns about the domains. CONCLUSION: Our WG reached consensus on the definitions and descriptions of the domains of the core domain set for rheumatology trials of SDM interventions. This step is crucial to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE: The current study provides consensus-based definitions and descriptions for the domains of the OMERACT core domain set for shared decision making interventions from patients/caregivers, clinicians and researchers. This is a crucial step to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set for trials of SDM interventions.


Assuntos
Reumatologia , Humanos , Consenso , Tomada de Decisão Compartilhada , Avaliação de Resultados em Cuidados de Saúde
6.
J Rheumatol ; 50(3): 426-432, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36319003

RESUMO

OBJECTIVE: The 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations provide an evidence-based guide for selecting therapy based on the individual's disease features. Beyond the disease features and associated conditions (eg, uveitis and inflammatory bowel disease), comorbidities play an important role in selecting therapy for an individual patient. METHODS: We performed a systematic literature review. We examined the available evidence to inform treatment selection based on the presence or absence of comorbidities in psoriatic arthritis (PsA). RESULTS: Common comorbidities in PsA that may affect treatment selection include presence of baseline cardiovascular disease (CVD) or high risk for CVD, obesity and metabolic syndrome, liver disease, mood disorders, including depression in particular, chronic infections, malignancies, osteoporosis, and fibromyalgia and/or central sensitization. CONCLUSION: Comorbidities may influence both the effectiveness of a given therapy but also the potential for adverse events. It is important to assess for the presence of comorbidities prior to therapy selection.


Assuntos
Artrite Psoriásica , Doenças Cardiovasculares , Psoríase , Humanos , Artrite Psoriásica/epidemiologia , Comorbidade , Obesidade/epidemiologia , Doenças Cardiovasculares/epidemiologia
7.
Best Pract Res Clin Rheumatol ; 36(1): 101739, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34998696

RESUMO

The relationship between rheumatoid arthritis (RA) and human immunodeficiency virus (HIV)-associated arthritis is a complex one that was first described more than three decades ago. There are many similarities and some differences in the clinical presentations of both diseases. In addition, treatment options and long-term monitoring can be challenging in the presence of both disorders, as HIV causes an immunocompromised state and medications used to treat RA are immunosuppressive. In this chapter, we discuss the clinical presentation and the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) in the management of these conditions.


Assuntos
Antirreumáticos , Artrite Reumatoide , Infecções por HIV , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Numismática
8.
Clin Rheumatol ; 40(9): 3411-3418, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34180027

RESUMO

Psoriatic arthritis is a chronic immune-mediated inflammatory arthritis associated with the skin condition psoriasis. Although there is a large body of evidence regarding epidemiology, outcomes, and response to therapy from the Western world, there is a dearth of published literature from the African continent. There are many challenges responsible for this. Lack of resources, both human and financial, an enormous disease burden, and a focus on communicable diseases leave an unmet need for this important disease. This review explores and identifies these challenges and proposes ways to improve and overcome these deficiencies. We discuss the epidemiology of psoriatic arthritis in Africa, postulating the role of genetic and environmental factors, looking at the role of HLA-B 23, HLA-B 17, and HLA-B 8. Dietary intake as a contributing factor to the low prevalence of psoriatic arthritis and psoriasis is also discussed. Challenges on the African continent regarding limited access to specialised units/specialists, delay in diagnosis, limited attention by healthcare authorities to non-communicable diseases, and the difficulties in implementing international recommendations on the African continent are discussed. We also discuss a relative lack of data from the African continent, the cost of specialised medication in resource-poor countries, and comorbidities of psoriatic arthritis. The lack of validated questionnaires relevant to the African continent is also important and discussed. Finally, we discuss a proposed research agenda that will improve care, quality of life, and outcomes for patients with psoriatic arthritis on the African continent.


Assuntos
Artrite Psoriásica , Psoríase , África/epidemiologia , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Humanos , Qualidade de Vida , Inquéritos e Questionários
9.
Semin Arthritis Rheum ; 51(3): 593-600, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33892937

RESUMO

OBJECTIVE: To gain consensus on the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials of shared decision making (SDM) interventions. METHODS: The process followed the OMERACT Filter 2.1 methodology, and used consensus-building methods, with patients involved since the inception. After developing the draft core domain set in previous research, we conducted five steps: (i) improving the draft core domain set; (ii) developing and disseminating white-board videos to promote its understanding; (iii) conducting an electronic survey to gather feedback on the draft core domain set; (iv) finalizing the core domain set and developing summaries, a plenary session video and discussion boards to promote its understanding; and (v) conducting virtual workshops with voting to endorse the core domain set. RESULTS: A total of 167 participants from 28 countries answered the survey (62% were patients/caregivers). Most participants rated domains as relevant (81%-95%) and clear (82%-93%). A total of 149 participants (n = 48 patients/caregivers, 101 clinicians/researchers) participated in virtual workshops and voted on the proposed core domain set which received endorsement by 95%. Endorsed domains are: 1- Knowledge of options, their potential benefits and harms; 2- Chosen option aligned with each patient's values and preferences; 3- Confidence in the chosen option; 4- Satisfaction with the decision-making process; 5- Adherence to the chosen option and 6- Potential negative consequences of the SDM intervention. CONCLUSION: We achieved consensus among an international group of stakeholders on the OMERACT core domain set for rheumatology trials of SDM interventions. Future research will develop the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE: Prior to this study, there had been no consensus on the OMERACT core domain set for SDM interventions. The current study shows that the OMERACT core domain set achieved a high level of endorsement by key stakeholders, including patients/caregivers, clinicians and researchers.


Assuntos
Reumatologia , Consenso , Tomada de Decisão Compartilhada , Humanos , Avaliação de Resultados em Cuidados de Saúde
10.
BMC Rheumatol ; 4: 42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32550295

RESUMO

BACKGROUND: It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. METHODS: Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. RESULTS: Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. CONCLUSIONS: Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.

11.
Expert Rev Clin Immunol ; 13(4): 319-331, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27826996

RESUMO

INTRODUCTION: Recent advances in the therapeutics of psoriatic arthritis (PsA) have provided more options to clinicians managing PsA. The purpose of this review is to update the reader on treatment options for PsA using conventional synthetic disease modifying agents (csDMARDs) and novel therapies including tumour necrosis factor alpha inhibitors, interleukin 12/23 inhibitor (ustekinumab), the interleukin 17 antagonists including secukinumab, brodalumab, ixekizumab, and the phosphodiesterase-4 inhibitor, apremilast. Areas covered: We reviewed published articles on the treatment of PsA. Our main sources of data included treatment recommendations, registry studies, systematic literature reviews, major randomised controlled trials for more recently approved drugs, and abstracts from the American College of Rheumatology and EULAR meetings. Expert commentary: An overview of the evidence for the use of various pharmacotherapeutic agents for treatment of this heterogeneous disease was compiled. Treatment options for the various domains of PsA are also discussed.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/terapia , Imunoterapia/tendências , Inibidores da Fosfodiesterase 4/uso terapêutico , Animais , Artrite Psoriásica/imunologia , Humanos , Imunoterapia/métodos , Interleucina-12/antagonistas & inibidores , Interleucina-23/antagonistas & inibidores , Talidomida/análogos & derivados , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Ustekinumab
13.
Expert Rev Clin Immunol ; 12(5): 573-82, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26807494

RESUMO

The management of psoriatic arthritis (PsA) and psoriasis has undergone major advancements over the last decade. This has been made possible, in part, due to the introduction of new therapies for their management, as well as global collaboration in the development of outcome measures and "treat- to- target" paradigms. In this review article, we discuss how disease activity is measured and the outcome measures that have been recently developed for the management of PsA. The importance of assessing the individual domains as well as global assessments both from the physician and patient perspective, and the development of composite measures are discussed. The newer PsA specific measures are expected to be more commonly used in clinical trials as well as clinical practice.


Assuntos
Artrite Psoriásica/diagnóstico , Artrite Psoriásica/terapia , Psoríase/diagnóstico , Psoríase/terapia , Gerenciamento Clínico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença
14.
S Afr Med J ; 106(5): 469, 2016 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-27138678

RESUMO

We report on an interesting patient who presented with acute renal failure from rhabdomyolysis and was found to have McArdle's disease on further investigation.

15.
S Afr Med J ; 106(6)2016 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-27245733

RESUMO

BACKGROUND: Although psoriatic arthritis (PsA) is a well-documented clinical entity, epidemiological, clinical and radiological studies of South African (SA) patients are scarce. OBJECTIVES: To assess clinical, biochemical and radiological features in a single-centre SA cohort. METHODS: We conducted a prospective assessment of the clinical, biochemical and radiological features of 384 consecutive patients with PsA seen at the rheumatology clinic at Prince Mshiyeni Memorial Hospital, Durban, SA, between January 2007 and December 2013. Patients were assessed at enrolment and 6 months after enrolment. They were classified into five groups as described by Moll and Wright, being entered into the group that best described the clinical manifestations. Clinicopathological characteristics recorded at enrolment were age at the time of examination, racial background, personal and family medical history, age and symptoms at the onset of PsA, pattern of joint involvement, joint pain, and the relationship between joint pain and the onset of PsA. RESULTS: Of the patients, 59.1% had a polyarticular presentation indistinguishable from rheumatoid arthritis, 19.0% had distal interphalangeal involvement, 9.1% had spondyloarthropathy, 11.9% had oligoarthritis and 0.9% had arthritis mutilans. The epidemiological trends (male/female ratio 1.45:1, mean age at onset of arthritis 50.2 (standard deviation 11.8) years, female preponderance in the polyarticular group and male preponderance in the spondyloarthropathy and oligoarticular groups) were similar to trends published elsewhere. A notable characteristic of our cohort was the complete absence of black South Africans with PsA. CONCLUSIONS: The complete absence of black South Africans with PsA is interesting. We anticipate that our findings will prompt genetic studies to isolate both protective and susceptibility genes for further elucidating PsA.

17.
J Rheumatol ; 42(6): 960-2, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25877500

RESUMO

OBJECTIVE: To evaluate the sensitivity and specificity of the classification criteria for psoriatic arthritis (PsA) in a South African cohort. METHODS: Data from consecutive patients with PsA and other chronic inflammatory arthritides were collected prospectively. Subjects were classified according to the classification criteria. The sensitivity and specificity in each group of patients were compared with a clinical diagnosis made by a rheumatologist. RESULTS: The European Spondylarthropathy Study Group criteria exhibited the lowest sensitivity followed by the Moll and Wright criteria. The sensitivity and specificity of the ClASsification for Psoriatic ARthritis (CASPAR) criteria were 98.4% and 99.7%, respectively. CONCLUSION: The CASPAR criteria were evaluated in our cohort and they performed well.


Assuntos
Artrite Psoriásica/classificação , Artrite Reumatoide/classificação , Espondilite Anquilosante/classificação , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/fisiopatologia , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/fisiopatologia , Estudos de Casos e Controles , Países em Desenvolvimento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Distribuição por Sexo , África do Sul/epidemiologia , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/fisiopatologia , Adulto Jovem
18.
Arthritis Rheumatol ; 67(10): 2569-80, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26352874

RESUMO

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.


Assuntos
Polimialgia Reumática/tratamento farmacológico , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Europa (Continente) , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Estados Unidos
19.
J Rheumatol ; 41(11): 2315-22, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25362717

RESUMO

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that can lead to decreased health-related quality of life and permanent joint damage leading to functional decline. In addition to joint and skin manifestations, both psoriasis and PsA are associated with numerous comorbidities and extraarticular/cutaneous manifestations, which may influence the physician's choice of therapy. The objectives of this review are (1) to identify comorbidities in patients with PsA based on the available evidence; (2) to examine the effects of these comorbidities or extraarticular/cutaneous manifestation on the management of patients with PsA as well as the selection of therapy; and (3) to highlight research needs around comorbidities and treatment paradigms. This review is part of a treatment recommendations update initiated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).


Assuntos
Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Assistência Integral à Saúde/métodos , Guias de Prática Clínica como Assunto , Artrite Psoriásica/diagnóstico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Medicina Baseada em Evidências , Feminino , Humanos , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/terapia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Resultado do Tratamento
20.
Clin Rheumatol ; 32(2): 151-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23274756

RESUMO

Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.


Assuntos
Artrite Reumatoide/epidemiologia , Artrite Reumatoide/terapia , Países em Desenvolvimento , Guias de Prática Clínica como Assunto , Reumatologia/normas , África , Artrite Reumatoide/diagnóstico , Humanos , Oriente Médio , Prevalência
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