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1.
J Korean Med Sci ; 36(12): e95, 2021 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-33783147

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has caused more than 100 million infections and 2 million deaths worldwide. In up to 20% of cases, COVID-19 infection can take a severe, life-threatening course. Therefore, preventive measures such as mask-wearing, hand hygiene, and social distancing are important. COVID-19 vaccines that use novel vaccine technology can prevent up to 95% of infections. However, the uncertainty regarding the efficacy and safety of vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), who are immunocompromised due to underlying immune dysfunction and concomitant immunosuppressive treatment, warrants clear guidance. A task force of the Korean College of Rheumatology formulated a set of vaccination guidance based on the currently available data and expert consensus. The currently available COVID-19 vaccines are considered to be safe and effective. Every patient with AIIRD should receive one of the available COVID-19 vaccines unless contraindicated for medical reasons such as prior allergy/anaphylaxis to the COVID-19 vaccine or its components. Patients should continue immunosuppressive treatment for their underlying AIIRD, including biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, methotrexate can be withheld for 1-2 weeks after each vaccination, and the timing of rituximab and abatacept infusion should be adjusted if clinically acceptable. Rheumatologists should play a leading role in educating and vaccinating patients with AIIRD.


Asunto(s)
Enfermedades Autoinmunes/tratamiento farmacológico , /prevención & control , Guías de Práctica Clínica como Asunto , Enfermedades Reumáticas/tratamiento farmacológico , Vacunación , Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/inmunología , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Reumáticas/inmunología
3.
Ann Agric Environ Med ; 28(1): 122-126, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33775077

RESUMEN

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic causes vital concerns due to the lack of proved, effective, and safe therapy. Chloroquine and hydroxychloroquine seem to be useful, but recently serious concerns regarding their adverse events have risen. The aim of the study was to broaden the general perspective of chloroquine and hydroxychloroquine use in COVID-19 treatment, based on an analysis of their current safety profile among patients with rheumatic diseases. MATERIAL AND METHODS: The study was based on a group of 152 patients with rheumatic diseases, aged 20-78 years, treated either with chloroquine or hydroxychloroquine. Analyzed data included age, gender, comorbidities, type of drug, dosage, treatment duration, and reported adverse events. Cases of drug withdrawal related to adverse events were also recorded. RESULTS: The dosage was consistent in both groups: 250 mg of chloroquine or 200 mg of hydroxychloroquine daily. 77.6% of patients did not experience any adverse reactions to the treatment. Hydroxychloroquine showed better safety profile, with 10.9% of patients reporting side-ffects, compared to 28.9% in patients treated with chloroquine. The overall incidence of ophthalmic complications was 6.6%. For both drugs, no statistically significant correlation between adverse events and age, chronic heart or liver disease, or hypertension was found. CONCLUSIONS: Chloroquine and hydroxychloroquine at lower doses, as used in rheumatic diseases, prove to be relatively safe. Data from the literature show that high dosage as recommended in COVID-19 treatment may pose a risk of toxicity and require precise management, but prophylactic, long-term use of lower, safe doses might be a promising solution.


Asunto(s)
Antirreumáticos/efectos adversos , Cloroquina/efectos adversos , Hidroxicloroquina/efectos adversos , Enfermedades Reumáticas/tratamiento farmacológico , Adulto , Anciano , Antirreumáticos/administración & dosificación , Antirreumáticos/uso terapéutico , Cloroquina/administración & dosificación , Cloroquina/uso terapéutico , Ojo/efectos de los fármacos , Femenino , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/uso terapéutico , Masculino , Persona de Mediana Edad
4.
Z Rheumatol ; 80(3): 243-250, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33635407

RESUMEN

OBJECTIVE: To investigate the prescription frequency of analgesics in persons diagnosed with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) in 2019 using claims data. METHODS: Persons ≥ 18 years insured in 2019 with a diagnosis of RA (M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. Analgesics were identified by the anatomic therapeutic classification (ATC) system. Reported is the percentage of individuals with ≥ 1 analgesics prescription for the respective rheumatic diagnosis in 2019 and for opioids age-standardized in each of the years 2005-2019. In addition, the proportion of long-term opioid use (prescriptions in ≥ 3 consecutive quarter years) in 2006 and 2019 is compared. RESULTS: Metamizole (29-33%) was the most commonly prescribed analgesic. Nonsteroidal anti-inflammatory drugs (NSAID)/coxibs were prescribed from 35% (SLE) to 50% (axSpA). Of the patients 11-13% were prescribed weak and 6-8% strong opioids. From 2005 to 2019, the proportion of persons with an opioid prescription remained stable, with similar or slightly decreasing proportions of weak opioids and more frequent prescriptions of strong opioids. The proportion of long-term opioid prescriptions increased from 2006 to 2019 from 8.9% to 11.0% (RA), from 6.9% to 9.1% (axSPA), from 7.8% to 9.5% (PsA), and from 7.5% to 8.8% (SLE), corresponding to a 17-24% increase. CONCLUSION: The prescription of opioids for persons with inflammatory rheumatic diagnoses is not as high in Germany as in other countries; however, the proportion of long-term prescriptions has considerably increased. The frequent prescription of metamizole is conspicuous.


Asunto(s)
Análisis de Datos , Enfermedades Reumáticas , Analgésicos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Alemania/epidemiología , Humanos , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/epidemiología
5.
Best Pract Res Clin Rheumatol ; 35(1): 101659, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33526326

RESUMEN

Several immunosuppressive therapies have been investigated as potential treatments for patients with severe and critical coronavirus disease 2019 (COVID-19). Notable examples include corticosteroids, interleukin 6 (IL-6), interleukin 1 (IL-1), Janus kinase (JAK), and tumor necrosis factor alpha (TNF-α) inhibitors. The aim of this narrative review is to analyze the mechanistic rationale and available evidence for these selected anti-rheumatic drugs for the treatment of COVID-19. Currently, only corticosteroids have consistently proven to be effective in decreasing mortality and are recommended in clinical guidelines for the treatment of severe and critical COVID-19. Multiple randomized controlled trials (RCTs) are ongoing to determine the role of other immunosuppressants.


Asunto(s)
Antirreumáticos , Enfermedades Reumáticas , Antirreumáticos/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico
6.
Zhonghua Er Ke Za Zhi ; 59(2): 107-112, 2021 Feb 02.
Artículo en Chino | MEDLINE | ID: mdl-33548956

RESUMEN

Objective: To analyze the disease spectrum among children who were using hydroxychloroquine (HCQ), and evaluate the drug's safety and compliance. Methods: From January 2008 to December 2019, children from Children's Hospital of Fudan University who used HCQ were selected as subjects, the disease spectrum of HCQ was analyzed, and the drug safety and compliance were evaluated for the patients who were followed up for more than 6 months. Demographic information, diagnosis, initial dose, time of continuous use, cumulative dosage and related adverse reactions report, project and the results of eye test were collected. Results: A total of 528 cases used HCQ during the 12 years, with 156 male cases and 372 female cases, and age at initial medication was (10.5±3.2) years. Among them, 514 cases (97.3%) had rheumatic disease, 5 had pulmonary interstitial lesions and 9 had other system diseases. The top three of the rheumatic diseases were systemic lupus erythematosus (SLE) in 316 cases (316/514,61.5%), juvenile idiopathic arthritis in 69 cases (69/514,13.4%), and juvenile dermatomyositis in 56 cases (56/514,10.9%). During the same period, 397 cases were diagnosed with SLE, and the utilization rate was 79.6% (316/397), which was the highest compared with other diseases and increased year by year. Pulmonary interstitial lesions included 4 cases with SFTPC gene defect related interstitial lung disease. Of the 528 ceses who were treated with HCQ, 397 cases were included for evaluating HCQ's safety and compliance, the initial dose was (4.2±1.0) mg/kg, duration was 29.6 (14.9, 48.8) months, the longest usage time was 127 months, the largest cumulative dosage was 566.8 g. The continuous usage duration (Z=-3.191, P=0.001) of SLE was significantly higher than those of other diseases, as well as cumulative dosage (Z=-5.355, P=0.001). All cases received comprehensive eye exams before medication, 354 cases (354/397, 89.2%) were followed up in the ophthalmological department, and 65.5% (232/354) of them could be reviewed regularly at least 1 time per year. One case suffered from severe skin adverse reactions when the drug was used for 32.7 months, and no other serious adverse reactions were reported. HCQ related retinopathy was not seen during the follow-up period. There were 5 cases stopped HCQ on their own. Conclusions: HCQ was widely used in rheumatic disease in children, especially in those with SLE. It was safe for long-time usage in children, and the medication compliance and the ophthalmic follow-up was good.


Asunto(s)
Antirreumáticos , Lupus Eritematoso Sistémico , Enfermedades Reumáticas , Adolescente , Antirreumáticos/efectos adversos , Niño , Enfermedad Crónica , Femenino , Humanos , Hidroxicloroquina/efectos adversos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Enfermedades Reumáticas/tratamiento farmacológico
7.
Med Clin North Am ; 105(2): 213-225, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33589098

RESUMEN

Patients with rheumatic diseases are susceptible to infections due to their underlying disease states as well as from immunosuppressive medications, highlighting the importance of vaccination, these same factors also pose challenges to vaccine efficacy, safety, and uptake. This article reviews the impact of immunosuppressive therapies and rheumatic disease on vaccine efficacy in this vulnerable patient population as well as discusses best practices.


Asunto(s)
Antirreumáticos/farmacología , Productos Biológicos/farmacología , Inmunogenicidad Vacunal , Inmunosupresores/farmacología , Enfermedades Reumáticas , Vacunación/métodos , Vacunas , Susceptibilidad a Enfermedades , Humanos , Inmunogenicidad Vacunal/efectos de los fármacos , Inmunogenicidad Vacunal/inmunología , Control de Infecciones/métodos , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/inmunología , Vacunas/clasificación , Vacunas/farmacología
8.
Med Clin North Am ; 105(2): 273-284, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33589102

RESUMEN

Patients with rheumatic disease, including those with systemic lupus erythematous, rheumatoid arthritis, and spondyloarthritis, use total hip and knee arthroplasties at high rates. They represent a particularly vulnerable population in the perioperative setting because of their diseases and the immunosuppressant therapies used to treat them. Careful planning among internists, medical specialists, and the surgical team must therefore occur preoperatively to minimize risks in the postoperative period, particularly infection. Management of immunosuppressant medications, such as conventional synthetic disease-modifying antirheumatic drugs and targeted therapies including biologics, is one avenue by which this infectious risk can be mitigated.


Asunto(s)
Artroplastia , Administración del Tratamiento Farmacológico , Periodo Perioperatorio/métodos , Enfermedades Reumáticas , Artroplastia/efectos adversos , Artroplastia/métodos , Humanos , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/cirugía , Ajuste de Riesgo/métodos
10.
Arch Osteoporos ; 16(1): 39, 2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33624165

RESUMEN

This study evaluates the clinical efficacy of denosumab for glucocorticoid-induced osteoporosis (GIOP) refractory to previous osteoporosis treatment. Our results show that denosumab significantly increased BMD of the lumbar spine and bilateral hip over the 24-month study period. Denosumab demonstrates potential as a treatment for GIOP refractory to previous therapy. INTRODUCTION: The aim of this study was to evaluate the clinical efficacy and safety of denosumab in patients with rheumatic diseases and glucocorticoid-induced osteoporosis (GIOP) refractory to previous osteoporosis treatment. METHODS: All patients were treated with 60 mg of denosumab subcutaneously every 6 months for 2 years after administration of bisphosphonates or rhPTH was stopped. We assessed bone mineral density (BMD) of the lumbar spine and bilateral hip at baseline, and at 6, 12, 18, and 24 months. We measured serum levels of bone alkaline acid phosphatase (BAP) and tartrate-resistant acid phosphatase (TRACP)-5b at baseline, and at 3, 6, 12, 18, and 24 months. RESULTS: Fifty-five patients with rheumatic diseases and GIOP were enrolled in this study. All patients were treated with bisphosphonates (n=40), recombinant human parathyroid hormone (n=4), or active vitamin D3 (n=11). Over the 24-month study period, denosumab significantly increased the mean BMD of the lumbar spine and bilateral hip (5.8 ± 0.7%, and 1.3 ± 0.4%, respectively). Additionally, denosumab also significantly reduced the serum levels of TRACP-5b and BAP over this same period (by -38.8 ± 3.5% and -16.3 ± 3.1%, respectively), although these changes in bone turnover markers were not predictive factors of an improvement in BMD values. While three patients developed fragility fractures during the study period, all three had several risk factors for fragility fractures in GIOP. CONCLUSIONS: In conclusion, denosumab is a potential treatment for GIOP in rheumatic diseases, especially in patients refractory to previous therapy, including bisphosphonate therapy.


Asunto(s)
Conservadores de la Densidad Ósea , Osteoporosis , Enfermedades Reumáticas , Densidad Ósea , Conservadores de la Densidad Ósea/efectos adversos , Denosumab/efectos adversos , Glucocorticoides/efectos adversos , Humanos , Osteoporosis/inducido químicamente , Osteoporosis/tratamiento farmacológico , Estudios Prospectivos , Enfermedades Reumáticas/tratamiento farmacológico
11.
RMD Open ; 7(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33402443

RESUMEN

AIMS: In Danish patients with inflammatory rheumatic diseases to explore self-protection strategies and health behaviour including adherence to disease-modifying antirheumatic treatment (DMARD) during the initial phase of the COVID-19 pandemic and again after the reopening of the society started. Furthermore, to identify characteristics of patients with high levels of anxiety and self-isolation. METHODS: Patients in routine care followed prospectively in the nationwide DANBIO registry were invited to answer an online questionnaire regarding disease activity and COVID-19 infection, behaviour in March and June 2020. Responses were linked to patient data in DANBIO. Characteristics potentially associated with anxiety, self-isolation and medication adherence (gender/age/diagnosis/education/work status/comorbidity/DMARD/smoking/EQ-5D/disease activity) were explored with multivariable logistic regression analyses. RESULTS: We included 12 789 patients (8168 rheumatoid arthritis/2068 psoriatic arthritis/1758 axial spondyloarthritis/795 other) of whom 65% were women and 36% treated with biological DMARD. Self-reported COVID-19 prevalence was 0.3%. Patients reported that they were worried to get COVID-19 infection (March/June: 70%/45%) and self-isolated more than others of the same age (48%/38%). The fraction of patients who changed medication due to fear of COVID-19 were 4.1%/0.6%. Female gender, comorbidities, not working, lower education, biological treatment and poor European Quality of life, 5 dimensions were associated with both anxiety and self-isolation. CONCLUSION: In >12 000 patients with inflammatory arthritis, we found widespread anxiety and self-isolation, but high medication adherence, in the initial phase of the COVID-19 pandemic. This persisted during the gradual opening of society during the following months. Attention to patients' anxiety and self-isolation is important during this and potential future epidemics.


Asunto(s)
/epidemiología , Conductas Relacionadas con la Salud , Pandemias , Enfermedades Reumáticas/psicología , Adulto , Anciano , Anciano de 80 o más Años , Antirreumáticos/uso terapéutico , Ansiedad/epidemiología , Artritis Psoriásica/tratamiento farmacológico , Artritis Psoriásica/epidemiología , Artritis Psoriásica/psicología , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Artritis Reumatoide/psicología , /psicología , Dinamarca/epidemiología , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Cuarentena/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/epidemiología , Espondiloartropatías/tratamiento farmacológico , Espondiloartropatías/epidemiología , Espondiloartropatías/psicología
12.
Z Rheumatol ; 80(3): 214-225, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33443608

RESUMEN

Persistent pain despite adequate inflammation control poses a big challenge in many rheumatic diseases for patients as well as physicians. The focus of drug development over the past years was on anti-inflammatory therapies. Enormous progress has been made and several treatment options have been added. It has been observed that pain triggered by inflammation can be effectively treated by inflammation control; however, the chronic pain component remains a problem, is little studied and specific treatment options are missing. Pain is influenced by inflammatory mediators, such as cytokines, which act on peripheral nociceptors and lead to peripheral sensitization. If inflammation continues, this can potentially lead to central sensitization and chronification of pain via immigration of immune cells and/or local activation of e.g. microglia. This leads to increasing autonomization and uncoupling of pain from the actual inflammatory process. The present review deals with the question if bDMARD or tsDMARD also show benefits concerning pain processes in addition to the profound inhibitory effects on inflammation. There are preclinical data that show an influence on sensitization following the use of cytokine inhibitors. On the other hand, so far clinical data show that bDMARDs as well as tsDMARDs consistently rapidly and reliably reduce nociceptive inflammatory pain across disease entities. An effect especially on the process of central sensitization and therefore on chronification of pain cannot be finally evaluated based on the currently available data.


Asunto(s)
Productos Biológicos , Inhibidores de las Cinasas Janus , Enfermedades Reumáticas , Factores Biológicos , Productos Biológicos/efectos adversos , Humanos , Nociceptores , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico
14.
Best Pract Res Clin Rheumatol ; 35(1): 101657, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33468418

RESUMEN

There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.


Asunto(s)
Enfermedades Reumáticas , Humanos , Inmunosupresores , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/epidemiología , Factores de Riesgo
15.
Rheumatol Int ; 41(2): 257-273, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33386447

RESUMEN

Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.


Asunto(s)
Antirreumáticos/efectos adversos , Muerte Súbita Cardíaca/etiología , Hidroxicloroquina/efectos adversos , Antirreumáticos/administración & dosificación , Humanos , Hidroxicloroquina/administración & dosificación , Pandemias , Enfermedades Reumáticas/tratamiento farmacológico , Medición de Riesgo
16.
RMD Open ; 7(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33479021

RESUMEN

INTRODUCTION: Whether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation. METHODS: Patients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19. RESULTS: Data from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91). CONCLUSION: Age was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.


Asunto(s)
/diagnóstico , Glucocorticoides/efectos adversos , Enfermedades Musculoesqueléticas/complicaciones , Enfermedades Reumáticas/complicaciones , /genética , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , /terapia , Estudios de Casos y Controles , Comorbilidad , Femenino , Alemania/epidemiología , Glucocorticoides/uso terapéutico , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Sistema de Registros , Respiración Artificial/métodos , Estudios Retrospectivos , Enfermedades Reumáticas/tratamiento farmacológico , Factores de Riesgo
17.
RMD Open ; 7(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33455920

RESUMEN

BACKGROUND: The recent outbreak of COVID-19 has raised concerns in the rheumatology community about the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It is not clear whether the use of biological agents may suppose a risk or protection against SARS-CoV-2 infection; however, it has been suggested that severe respiratory forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. This prompted the use of interleukin 6 (IL-6) (tocilizumab and sarilumab) and IL-1 inhibitors (anakinra) in severe COVID-19 disease and more recently JAK1/2 inhibitor (baricitinib). Therefore, patients with rheumatic diseases provide a great opportunity to learn about the use of biological agents as protective drugs against SARS-CoV-2. OBJECTIVES: To estimate COVID-19 infection rate in patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) for inflammatory rheumatic diseases (RMD), determine the influence of biological agents treatment as risk or protective factors and study the prognosis of patients with rheumatic diseases receiving biological agents compared to the general population in a third-level hospital setting in León, Spain. METHODS: We performed a retrospective observational study including patients seen at our rheumatology department who received bDMARDs for rheumatic diseases between December 1st 2019 and December 1st 2020, and analysed COVID-19 infection rate. All patients who attended our rheumatology outpatient clinic with diagnosis of inflammatory rheumatic disease receiving treatment with biological agents were included. Main variable was the hospital admission related to COVID-19. The covariates were age, sex, comorbidities, biological agent, duration of treatment, mean dose of glucocorticoids and need for intensive care unit . We performed an univariate and multivariate logistic regression models to assess risk factors of COVID-19 infection. RESULTS: There were a total of 4464 patients with COVID-19 requiring hospitalisation. 40 patients out of a total of 820 patients with rheumatic diseases (4.8%) receiving bDMARDs contracted COVID-19 and 4 required hospital care. Crude incidence rate of COVID-19 requiring hospital care among the general population was 3.6%, and it was 0.89% among the group with underlying rheumatic diseases. 90% of patients receiving bDMARDS with COVID-19 did not require hospitalisation. Out of the 4464 patients, 869 patients died, 2 of which received treatment with biological agents. Patients with rheumatic diseases who tested positive for COVID-19 were older (female: median age 60.8 IQR 46-74; male: median age 61.9 IQR 52-70.3) than those who were negative for COVID-19 (female: median age 58.3 IQR 48-69; male: median age 56.2 IQR 47-66), more likely to have hypertension (45% vs 26%, OR 2.25 (CI 1.18-4.27),p 0.02), cardiovascular disease (23 % vs 9.6%, OR 2.73 (1.25-5.95), p 0.02), be smokers (13% vs 4.6%, OR 2.95 (CI 1.09-7.98), p 0.04), receiving treatment with rituximab (20% vs 8%, 2.28 (CI 1.24-6.32), p 0.02) and a higher dose of glucocorticoids (OR 2.5 (1.3-10.33, p 0.02) and were less likely to be receiving treatment with IL-6 inhibitors (2.5% vs 14%, OR 0.16, (CI 0.10-0.97, p 0.03). When exploring the effect of the rest of the therapies between groups (affected patients vs unaffected), we found no significant differences in bDMARD proportions. IL-1 inhibitors, IL-6 inhibitors, JAK inhibitors and belimumab-treated patients showed the lowest incidence of COVID-19 among adult patients with rheumatic diseases. We found no differences in sex or rheumatological disease between patients who tested positive for COVID-19 and patients who tested negative. CONCLUSIONS: Overall, the use of biological disease-modifying antirheumatic drugs (bDMARDs) does not associate with severe manifestations of COVID-19. Patients with rheumatic disease diagnosed with COVID-19 were more likely to be receiving a higher dose of glucocorticoids and treatment with rituximab. IL-6 inhibitors may have a protective effect.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Factores Biológicos/uso terapéutico , Brotes de Enfermedades , Glucocorticoides/uso terapéutico , Sustancias Protectoras/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , Rituximab/uso terapéutico , /aislamiento & purificación , Anciano , Anticuerpos Monoclonales Humanizados/farmacología , Femenino , Humanos , Interleucina-6/antagonistas & inhibidores , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , /inmunología , España/epidemiología , Resultado del Tratamiento
18.
Z Rheumatol ; 80(3): 226-233, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33355701

RESUMEN

Pain is a leading symptom in inflammatory rheumatic diseases. For a long time it has been assumed that this pain is of nociceptive origin; however, in about one fifth of all patients the pain remains despite successful anti-inflammatory treatment and is not typically described as nociceptive by those affected. Recent studies indicate that some patients with rheumatoid arthritis (RA) experience pain with a neuropathic pain component. The treatment of neuropathic pain with damage to the somatosensory system differs markedly from the treatment of nociceptive pain in which the pain processing system is intact. Thus, the recognition and, above all, the more precise differentiation of the pain symptoms of affected patients make a decisive contribution to a successful treatment. With the help of a few points in the history and a physical examination, the assumption of the diagnosis neuropathic pain can often be rejected or substantiated. Pain with a neuropathic component does not adequately respond to typical analgesics. Instead, the high efficacy of co-analgesics, such as anticonvulsants and antidepressants, has been repeatedly proven.


Asunto(s)
Neuralgia , Enfermedades Reumáticas , Analgésicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Humanos , Neuralgia/diagnóstico , Neuralgia/tratamiento farmacológico , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico
19.
Nat Rev Rheumatol ; 17(2): 81-97, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33318665

RESUMEN

Biologic agents have become a core component of therapeutic strategies for many inflammatory rheumatic diseases. However, perhaps reflecting the specificity and generally high affinity of biologic agents, these therapeutics have been used by rheumatologists with less consideration of their pharmacokinetics than that of conventional synthetic DMARDs. Immunogenicity was recognized as a potential limitation to the use of biologic agents at an early stage in their development, although regulatory guidance was relatively limited and assays to measure immunogenicity were less sophisticated than today. The advent of biosimilars has sparked a renewed interest in immunogenicity that has resulted in the development of increasingly sensitive assays, an enhanced appreciation of the pharmacokinetic consequences of immunogenicity and the development of comprehensive and specific guidance from regulatory authorities. As a result, rheumatologists have a greatly improved understanding of the field in general, including the factors responsible for immunogenicity, its potential clinical consequences and the implications for everyday treatment. In some specialties, immunogenicity testing is becoming a part of routine clinical management, but definitive evidence of its cost-effectiveness in rheumatology is awaited.


Asunto(s)
Inmunidad Adaptativa/efectos de los fármacos , Factores Biológicos/farmacocinética , Enfermedades Reumáticas/tratamiento farmacológico , Reumatología/normas , Inmunidad Adaptativa/inmunología , Antirreumáticos/administración & dosificación , Antirreumáticos/uso terapéutico , Factores Biológicos/inmunología , Factores Biológicos/uso terapéutico , Biosimilares Farmacéuticos/farmacocinética , Biosimilares Farmacéuticos/uso terapéutico , Análisis Costo-Beneficio , Humanos , Enfermedades Reumáticas/inmunología , Reumatólogos/estadística & datos numéricos , Reumatología/economía
20.
Autoimmun Rev ; 20(2): 102742, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33333235

RESUMEN

Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.


Asunto(s)
Antirreumáticos , Enfermedades Autoinmunes , Enfermedades Pulmonares Intersticiales , Enfermedades Reumáticas , Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/tratamiento farmacológico
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