Asunto(s)
Dermatomiositis , Enfermedades Pulmonares Intersticiales , Humanos , Dermatomiositis/tratamiento farmacológico , Autoanticuerpos , Anticuerpos Monoclonales/uso terapéutico , Progresión de la Enfermedad , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Helicasa Inducida por Interferón IFIH1 , Estudios RetrospectivosAsunto(s)
Anemia Macrocítica/diagnóstico , Enfermedades Autoinflamatorias Hereditarias/diagnóstico , Linfadenitis Necrotizante Histiocítica/diagnóstico , Policondritis Recurrente/diagnóstico , Tromboembolia Venosa/diagnóstico , Anciano , Anemia Macrocítica/tratamiento farmacológico , Diagnóstico Diferencial , Enfermedades Autoinflamatorias Hereditarias/tratamiento farmacológico , Linfadenitis Necrotizante Histiocítica/tratamiento farmacológico , Humanos , Masculino , Policondritis Recurrente/tratamiento farmacológico , Tromboembolia Venosa/tratamiento farmacológicoRESUMEN
AIMS: To describe inflammatory arthritis (IA) patients initiating biologic disease-modifying anti-rheumatic drugs (bDMARDs) who use complementary and alternative medicine (CAM), and determine the impact of CAM on predicting modified Health Assessment Questionnaire (mHAQ) at 6 months. METHODS: This was a prospective inception cohort study of patients ≥21 years old initiating a bDMARD for IA after July 2016. Data were obtained via questionnaires and abstraction from medical records. Baseline characteristics between ever-CAM and CAM non-users were compared. CAM as a predictor of mHAQ ≥1 at 6 months after bDMARD initiation was analyzed using multivariate logistic regression, adjusting for other baseline characteristics. RESULTS: We recruited 299 patients (36.2% male, mean age 49.0 years). There were 45.8% who had rheumatoid arthritis, 54.2% had a spondyloarthropathy, median disease duration of 1.1 years and median mHAQ of 0.4. Compared to CAM non-users, ever-CAM users had a lower mean body mass index, were less likely to speak English, and more likely to smoke and drink alcohol. There was no association of CAM use with high mHAQ and no interaction with smoking. Smoking (odds ratio [OR] 938.9; 95% CI 3.20-275 884.1), baseline mHAQ (OR 252.2; 95% CI 5.34-11 899.2) and Charlson's Comorbidity Index score ≥4 (OR 237.4; 95% CI 1.22-46 184.4) independently predicted high mHAQ at 6 months. CONCLUSIONS: CAM use was not associated with high mHAQ at 6 months. Smoking was an independent predictor of residual functional disability at 6 months, even after adjusting for age, comorbidity and baseline mHAQ. Greater emphasis on smoking cessation may improve long-term functional outcomes in IA patients on bDMARDs.
Asunto(s)
Antirreumáticos , Artritis Reumatoide , Productos Biológicos , Terapias Complementarias , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Adulto , Femenino , Singapur , Estudios Prospectivos , Estudios de Cohortes , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Productos Biológicos/uso terapéutico , FumarRESUMEN
We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
Asunto(s)
Glucocorticoides/uso terapéutico , Sarcoidosis/diagnóstico , Sarcoidosis/tratamiento farmacológico , Dolor Abdominal/etiología , Enfermedades Óseas/etiología , Diagnóstico Diferencial , Oftalmopatías/etiología , Femenino , Granuloma/etiología , Humanos , Hepatopatías/etiología , Persona de Mediana Edad , Sistema Mononuclear Fagocítico/fisiopatología , Sarcoidosis/complicacionesRESUMEN
AIM: This study was undertaken to determine the incidence and patterns of malignancies in rheumatoid arthritis (RA) patients in our cohort. METHODS: Between 2001 and 2013, we analyzed 1117 patients in the prospective Tan Tock Seng Hospital (TTSH) RA Registry. Patients who developed malignancies after the onset of RA were identified from this registry. Age- and sex-adjusted standardized incidence ratios (SIRs) were calculated to compare observed to expected numbers of malignancies based on data from the Singapore Cancer Registry. RESULTS: Out of 19 839 person-years of follow-up, 132 incident malignancies were diagnosed during the observation period. There were 114 (86.4%) solid-organ tumors and 18 (13.6%) hematological malignancies. The SIR (95% confidence interval) for all malignancies combined was 1.28 (0.88-1.87) for males and 1.21 (1.00-1.46) for females. Compared to the general population, we found a 4- to 5-fold increase in lymphoma among our RA patients compared to the general population (SIR 5.05 [1.90-13.46] for males and 3.75 [1.95-7.20] for females). The SIR of lung malignancy in male RA patients is 2.36 (1.23-4.53) and SIR of cervical malignancy in female RA patients is 3.72 (2.20-6.23). CONCLUSION: There is a trend toward an overall increased malignancy risk in our RA patients compared to the general population. Specifically, there is an increased risk of lymphomas in all RA patients, lung malignancy in male patients, and cervical malignancy in female patients, compared to the general population.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Neoplasias/etnología , Adulto , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/etnología , Artritis Reumatoide/mortalidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/mortalidad , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Singapur/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
The seronegative spondyloarthropathies are a heterogenous groups of inflammatory diseases which may present with sacroilitis, inflammatory arthritis, spondylitis and enthesitis, as well as extra-articular manifestations of inflammation most commonly involving the eye, skin and gastrointestinal tract. There is a familial preponderance to these conditions, and an association with the HLA-B27 gene. The new ASAS classification system for these conditions aims to classify patients into 2 broad categories based on the predominant site of their symptoms. The diagnosis of early spondyloarthropathy relies on a detailed history and physical examination as radiographic changes occur late, and blood work-up may be normal. Management of these chronic diseases requires a holistic multidisciplinary approach with both pharmacological and non-pharmacological interventions in recent years, many newer therapies, especially biologic agents have become available for treatment of these conditions.