Asunto(s)
Terapia Biológica/efectos adversos , Virus de la Hepatitis B/fisiología , Hepatitis B , Tuberculosis Latente , Tamizaje Masivo/métodos , Mycobacterium tuberculosis/fisiología , Terapia Biológica/métodos , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Prevalencia , Medición de Riesgo , Activación Viral/efectos de los fármacosRESUMEN
OBJECTIVE: To analyse the treatment outcome of patients with ankylosing spondylitis (AS) in the European AS infliximab cohort (EASIC) study after a total period of 8â years with specific focus on dosage and the duration of intervals between infliximab infusions. METHODS: EASIC included patients with AS who had received infliximab for 2â years as part of the ASSERT trial. After that period, rheumatologists were free to change the dose or the intervals of infliximab. Clinical data were status at baseline, end of ASSERT and for a total of 8â years of follow-up. RESULTS: Of the initially 71 patients with AS from EASIC, 55 patients (77.5%) had completed the 8th year of anti-tumour necrosis factor (TNF) treatment. Of those, 48 patients (87.3%) still continued on infliximab. The mean infusion interval increased slightly from 6 to 7.1±1.5â weeks, while 45.8% patients had increased the intervals up to a maximum of 12â weeks. The mean infliximab dose remained stable over time, with a minimum of 3.1â mg/kg and a maximum of 6.4â mg/kg. In patients receiving <5â mg/kg infliximab, the mean infusion interval increased to 7.0±1.2â weeks. In total, the mean cumulative dose per patient and per year decreased from 3566.30 to 2973.60â mg. CONCLUSIONS: We could observe that over a follow-up of 8â years of treatment with infliximab, >85% patients still remained on the same treatment, without any major safety events. Furthermore, both the infusion intervals and also the mean infliximab dose were modestly reduced in ≥70% of the patients without the loss of clinical efficiency.
RESUMEN
OBJECTIVES: To describe the distribution and evolution over time of bone marrow oedema (BME) on magnetic resonance imaging of the sacroiliac joint (MRI-SIJ) in patients with recent-onset inflammatory back pain (IBP) suspected for axial spondyloarthritis (axSpA). METHOD: A 2-year follow-up study with annual MRI-SIJ was conducted in patients with IBP of duration ≤ 2 years. Each SIJ was divided into quadrants and MRI scores were analysed on a per-patient and per-SIJ quadrant basis. The presence of BME in each SIJ quadrant was recorded. Fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) criteria for axSpA was assessed at baseline and at follow-up. RESULTS: At baseline, 68 patients (38% male; mean age 34.9 ± 10.3 years) were included. BME was visible at baseline in 24 (35%) patients, all fulfilling the ASAS axSpA criteria. Twenty-three of these 24 patients had a follow-up MRI. Not taking into account the baseline MRI, three (13%) of these 23 patients would no longer fulfil the ASAS criteria during follow-up because of subsiding BME. Forty-four (65%) patients had a negative baseline MRI, of whom 39 had a follow-up MRI available. New BME at follow-up meant that three (8%) of these 39 patients now fulfilled the ASAS criteria. At follow-up, baseline BME lesions subsided completely in 47% of SIJ quadrants (range 33-71%) whereas new BME lesions were detected in 8% of SIJ quadrants (range 2-11%). CONCLUSIONS: BME shows a fluctuating course in patients with early IBP suspected for axSpA. This may have an impact on diagnosis and the overall performance of the ASAS axSpA criteria.
Asunto(s)
Dolor de Espalda/patología , Enfermedades de la Médula Ósea/patología , Edema/patología , Articulación Sacroiliaca/patología , Adulto , Dolor de Espalda/diagnóstico , Enfermedades de la Médula Ósea/diagnóstico , Diagnóstico Diferencial , Progresión de la Enfermedad , Edema/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Espondiloartritis/diagnóstico , Espondiloartritis/patologíaRESUMEN
A 42-year-old man presented with fever, photosensitivity, headaches, myalgia, hyperhidrosis, muscle weakness, alopecia, nasal crustae, weight loss, painful nails, arthritis, oral ulcers, erythema, discoid cutaneous lesions, and painful subcutaneous nodes. We made a diagnosis of systemic lupus erythematosus (SLE), type II cryoglobulinemia, and nodular vasculitis. In the skin, different types of vasculitis may be observed. Typically, histology shows leukocytoclastic vasculitis of superficial vessels both in SLE and mixed cryoglobulinemia, which clinically results in palpable purpura. In our patient, however, histopathological examination of the subcutaneous nodes not only revealed leukocytoclastic vasculitis of the superficial vasculature but also showed even more extensive involvement of dermal and subdermal small and medium sized vessels, giving rise to a nodular vasculitis.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/etiología , Vasculitis/diagnóstico , Vasculitis/etiología , Adulto , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Piel/patologíaRESUMEN
OBJECTIVE: To compare the cost of illness of three musculoskeletal conditions in relation to general wellbeing. METHODS: Patients with fibromyalgia, chronic low back pain (CLBP), and ankylosing spondylitis who were referred to a specialist and participated in three randomised trials completed a cost diary for the duration of the study, comprising direct medical and non-medical resource utilisation and inability to perform paid and unpaid work. Patients rated perceived wellbeing (0-100) at baseline. Univariate differences in costs between the groups were estimated by bootstrapping. Regression analyses assessed which variables, in addition to the condition, contributed to costs and wellbeing. RESULTS: 70 patients with fibromyalgia, 110 with chronic low back pain, and 111 with ankylosing spondylitis provided data for the cost analyses. Average annual disease related total societal costs per patient were 7813 euro for fibromyalgia, 8533 euro for CLBP, and 3205 euro for ankylosing spondylitis. Total costs were higher for fibromyalgia and CLBP than for ankylosing spondylitis, mainly because of cost of formal and informal care, aids and adaptations, and work days lost. Wellbeing was lower in fibromyalgia (mean, 48) and low back pain (mean, 42) than in ankylosing spondylitis (mean, 67). No variables other than diagnostic group contributed to differences in costs or wellbeing. CONCLUSIONS: In patients under the care of a specialist, there were marked differences in costs and wellbeing between those with fibromyalgia or CLBP and those with ankylosing spondylitis. In particular, direct non-medical costs and productivity costs were higher in fibromyalgia and CLBP.