Satisfaction and discontent of Polish patients with biological therapy of rheumatic diseases: results of a multi-center questionnaire study.

OBJECTIVES: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. MATERIAL AND METHODS: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. RESULTS: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients.In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. CONCLUSIONS: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers).

Assessment of diabetes control in insulin pump therapy in late adolescentsand young adults with type 1 diabetes.

OBJECTIVES: The aim of the study was to evaluate metabolic control in insulin pump therapy (IPT) in late adolescents and young adults with type 1 diabetes mellitus. MATERIAL AND METHODS: The study was conducted in 86 subjects with type 1 diabetes, and included 45 patients aged 16-19 years (mean 17.6±1.2) treated in a pediatric outpatient clinic and 41 subjects aged 19-26 years (mean 22.8±2.2) treated in an adult outpatient clinic of the same university hospital, who received the same refund of IPT. RESULTS: Late adolescents had a lower BMI (22.7±2.9 kg/m2 vs. 24.2±3.2 kg/m2; P<0.05), higher HbA1c (69.4±15.1 mmol/mol vs. 58.5±11.8 mmol/mol; P<0.001) and mean blood glucose levels (10.4±2.6 mmol/l vs. 9.2±1.4 mmol/l, P<0.05), and received higher insulin doses per day (0.85±0.23 IU/kg vs. 0.65±0.13 IU/kg; P<0.001). The mean diabetes and IPT duration, number of visits, basal/bolus insulin ratio, number of insulin boluses, blood glucose tests and the episodes of hypoglycemia were similar. CONCLUSIONS: Metabolic control in late adolescents with type 1 diabetes on IPT is significantly worse than in young adults, despite higher doses of insulin and very similar way of treatment and self-control. This may be related to the patients age or the less rigorous approach to therapeutic recommendations resulting from pediatric diabetes care.

Non-steroidal anti-inflammatory drugs and the risk of cardiovascular diseases: are we going to see the revival of cyclooxygenase-2 selective inhibitors?

The use of non-steroidal anti-inflammatory drugs (NSAID) is associated with a number of gastrointestinal and other adverse effects. Introduction of selective cyclooxygenase-2 (COX-2) inhibitors at the end of the 20th century raised hopes for a substantial reduction in the rate of serious events such as upper gastrointestinal ulcers, bleeding and perforations. In 2004 and 2005, predictions of some pharmacologists were confirmed when the Adenomatous Polyp Prevention on VIOXX trial (APPROVE) and other randomized, double-blind, placebo-controlled trials with COX-2 inhibitors showed an increased rate of thrombotic vascular events, including myocardial infarction, in patients treated with coxibs. So far, only limited long-term data on cardiovascular risk associated with non-selective NSAID have been available; however, some studies have suggested that both selective COX-2 inhibitors and traditional NSAID increase the risk of cardiovascular events. For patients at high cardiovascular risk, contradictory warnings and recommendations have been published recently by the American Heart Association, Food and Drug Administration, and by independent experts. The current paper reviews these recommendations and discusses the therapeutic challenge to minimize the risk of serious adverse events associated with the use of NSAID.

[Statins--are they potentially useful in rheumatology?]. / Statyny--czy okaza sie przydatne w reumatologii?

For more than 30 years statins have been successfully used in patients with hypercholesterolemia and cardiovascular diseases. Recently, there is a growing body of evidence, that statins exert effects by much exceeding the effect of cholesterol level decrease. Inhibition of earlier stages of cholesterol biosynthesis pathway (not influencing the very cholesterol level) results in blocking the intermediate metabolite synthesis; isoprenoids (farnesyl phosphate and geranyl phosphate), which play a regulatory function in cells. Statins have antiatherosclerotic, antiinflammatory, antioxidant, immunomodulatory and antithrombotic effects. It applies equally to diseases of chronic inflammation type, as to those, where bone metabolism is disturbed. It is well known that statins decrease bone fracture risk; through bone formation intensification, and inhibition of bone tissue resorption. Slowing down the atherosclerosis progression is a very important effect, considering that in rheumatoid arthritis (RA) and in systemic lupus erythematosus (SLE) we are dealing with premature and rapid progression of atherosclerotic lesions. In this paper statins pathways of action in rheumatic diseases (including pleiotropic effects), and their potential use in rheumatology have been discussed. Though there is lack of reliable data enabling statins introduction to standard complementary therapy in rheumatic diseases, the results however of completed studies allow concluding of their utility. The statins that were most frequently evaluated in clinical studies were simvastatin and atorvastatin. Studies on statins have been performed in RA, SLE, osteoporosis and systemic vasculotos.