RESUMEN
OBJECTIVE: To investigate the effects of both the Fc fragment in tumor necrosis factor (TNF) inhibitors and rheumatoid factor (RF) titers on treatment survival, disease activity, and laboratory parameters in patients with rheumatoid arthritis (RA). METHODS: In this retrospective cohort study, patients with RA who had started any anti-TNF therapy between January 2017 and March 2020 and who had stayed on this treatment for at least six months were included. The data of the patients were compared separately according to continuation or discontinuation of treatment and the presence or absence of Fc portion in the structure of anti-TNFs. Patients who were taking certolizumab pegol (CZP) without the Fc fragment were placed in the "without Fc group" (wo/Fc), while patients who were taking other drugs (adalimumab, etanercept, golimumab, and infliximab) were placed in the "with Fc group" (w/Fc). RESULTS: Among the 221 RA patients whose data were available, 52 patients met the inclusion criteria and were included in the study. There was a significant difference in the DAS28-CRP score between wo/Fc group and w/Fc group in the third month of treatment (p=0.012). However, this difference did not persist at the sixth month of treatment (p=0.384). According to the cox-regression results, RF titers were determined to have a significant impact on the drug survival of anti-TNF agents when adjustments were made for the effects of other candidate predictors (Hazard ratio: 1.007 (1.002-1.012), p=0.009). CONCLUSION: Our results suggest that compared to the Fc fragment, RF titers were the more important risk factor in survival of anti-TNF drugs.
RESUMEN
BACKGROUND: Distal suprascapular nerve blocks (SSNB) can be performed at the level of the suprascapular notch (the preferred site) or at the level of the spinoglenoid notch. OBJECTIVES: To compare the efficacy and safety of spinoglenoid versus suprascapular notch approaches for ultrasound (US)-guided distal SSNB in patients with chronic shoulder pain. STUDY DESIGN: Prospective randomized controlled trial. SETTING: Outpatient physical medicine and rehabilitation outpatient clinic of a tertiary center. METHODS: Eighty patients with chronic unilateral shoulder pain were included in this study. Patients were randomized into 2 groups: group 1 (SSNB at the level of the spinoglenoid notch) and group 2 (SSNB at the level of the suprascapular notch). The patients were evaluated for pain according to the Shoulder Pain and Disability Index (SPADI) and a secondary visual analog scale (VAS), as well as for the outcome measures of range of motion (ROM) and pain pressure threshold (PPT) at baseline and at one, 4, and 12 weeks after the injection. RESULTS: Statistically significant improvement was observed in the SPADI and VAS scores and ROM measurements, and the PPT measurements were similar at all post-injection follow-ups in both groups. Changes in outcome measures were similar between the groups, except for some ROM measurements at the post-injection follow-ups. LIMITATIONS: Heterogeneity of shoulder pain etiologies. CONCLUSION: Both distal SSNB approaches significantly improved pain and disability scores in patients with chronic shoulder pain, with no observable differences in the short-to-medium term. SSNB performed at the level of the spinoglenoid notch is therefore not inferior in efficacy and safety to SSNB performed at the level of the suprascapular notch.