Effects of Tocilizumab, an Anti-Interleukin-6 Receptor Antibody, on Serum Lipid and Adipokine Levels in Patients with Rheumatoid Arthritis.

Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Dyslipidemia is a known adverse effect of tocilizumab (TCZ), an anti-interleukin-6 receptor antibody used in RA treatment. We aimed to assess the effect of TCZ on lipid profile and adipokine levels in RA patients. Height, weight, disease activity scores, lipid profile and atherogenic indices (AI), leptin, adiponectin, resistin, interleukin-6, and high-sensitivity C-reactive protein (CRP) were measured before and four months after initiation of TCZ in 40 RA patients and 40 healthy controls. Following TCZ treatment, total cholesterol, high density lipoprotein (HDL), and triglycerides were significantly elevated, but no significant changes in weight, body mass index (BMI), low density lipoprotein (LDL), and AI were observed. Compared with controls, significantly higher adiponectin levels were measured in the RA group at baseline. Following TCZ treatment, resistin levels and the leptin-to-adiponectin ratio increased, adiponectin levels decreased, and leptin levels remained unchanged. No correlation was found between the change in adipokine serum levels and changes in the disease activity indices, nor the lipid profile. In conclusion, the changes observed suggest a protective role for TCZ on the metabolic and cardiovascular burden associated with RA, but does not provide a mechanistic explanation for this phenomenon.

Rehabilitation of elderly patients in the community following surgery for hip fracture - utilization of personal and health care services.

PURPOSE: To assess the change in utilization of personal and health care services following surgery for hip fracture in elderly patients rehabilitated in the community. METHODS: A descriptive study of patients hospitalized in the orthopedic surgery ward for traumatic hip fracture. The first interview took place after surgery and included functional and medical data, and details on utilization of personal and health care services in the month prior to surgery. The second interview took place at home three months after discharge from the hospital and documented corresponding data for the last month. RESULTS: The study included 91 elderly patients. The mean number of contacts with health care providers increased from 4.6/month before HF to 6.4/month during rehabilitation; in particular an increase in home visits by primary care nurses and physicians from 0.4 to 1.0 visit/month (p < 0.001). Personal care showed a greater increase from 32.5 to 95.0 weekly hours (p < 0.001). Multivariate analyses showed that the increase in primary care visits was associated with chronic co-morbidity and being single, while the increase in personal care was associated with medium dependence level and an ambulatory rehabilitation setting. CONCLUSIONS: During the rehabilitation period in the community there was an increase in non-rehabilitative services-medical and personal. Morbidity and functional data could predict the increase in use at time of discharge from hospital.

The effect of low back pain on work absenteeism among soldiers on active service.

STUDY DESIGN: A prospective longitudinal study. OBJECTIVE: To identify factors that influence absenteeism among soldiers with acute low back pain (ALBP). SUMMARY OF BACKGROUND DATA: Recommendations for the treatment of low back pain include continuing physical activity. Ninety-seven percent of patients return to work within 1 month. METHODS: This was a prospective longitudinal study using a questionnaire to assess morbidity from ALBP and the job being carried out by the soldier at the time of referral to the army clinic and 6 weeks later. Potential associations were investigated between prolonged absenteeism and variables including disease indexes, use of healthcare services, the soldier's army job, and their satisfaction with it. RESULTS.: The study population consisted of 160 soldiers with uncomplicated ALBP. Eighty-six percent of the participants returned to their job within 6 weeks. The rates of improvement in pain, the mental functioning under pain, satisfaction with jobs, and having combat status were higher among soldiers who returned to their jobs as compared with those who did not. Those who did not return to their jobs had higher rates of utilization of healthcare services. CONCLUSION: Nondisease factors are associated with the duration of absenteeism among soldiers with ALBP. Absenteeism is directly related to use of healthcare services.