Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 80
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-33472796

RESUMO

INTRODUCTION: Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied. RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model. RESULTS: After propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference. CONCLUSIONS: SGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.

2.
Calcif Tissue Int ; 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32978683

RESUMO

Paget's disease of bone (PDB) is characterized by focal or multifocal increase in bone turnover. One of the most well-established candidate genes for susceptibility to PDB is Sequestosome 1 (SQSTM1). Mutations in SQSTM1 have been documented among Western-European, British and American patients with PDB. However, there is no information on SQSTM1 mutation status in PDB patients from the Central- and Eastern-European regions. In this study, we conducted a mutation screening for SQSTM1 gene variants in 82 PDB patients and 100 control participants in Hungary. Mutations of SQSTM1 were detected in 18 PDB patients (21.95%); associations between genotype and clinical characteristics were also analyzed. Altogether, six different exonic alterations, including two types of UTR variants in the SQSTM1 gene, were observed in our PDB patients. Similarly, to previous genetic studies on Paget's disease, our most commonly detected variant was the c.1175C > T (p.Pro392Leu) in nine cases (four in monostotic and five in polyostotic form). We have surveyed the germline SQSTM1 variant distribution among Hungarian patients with PDB. We also highlighted that the pattern of the analyzed disease-associated pathophysiological parameters could partially discriminate PDB patients with normal or mutant SQSTM1 genotype. However, our findings also underline and strengthen that not solely SQSTM1 stands in the background of the complex PDB etiology.

3.
Orv Hetil ; 161(33): 1373-1381, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32749234

RESUMO

INTRODUCTION: Osteoarthritis (OA) as the most common joint disease is a major public health concern. AIM: To investigate the effect of multimorbidity on functional and quality of life outcomes in women with generalized osteoathritis (hand and knee arthritis, GOA). METHOD: In this cross-sectional study, patients according to the American College of Rheumatology (ACR) criteria for OA were invited. The control group consisted of subjects without any musculoskeletal symptoms, osteoarthritis or inflammatory rheumatic disease. Comorbidity count was calculated from the investigated comorbidities. In the GOA group, the function was assessed by Western Ontario and McMaster Universities Arthritis Index (WOMAC), Cochin Hand Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Health Assessment Questionnaire (HAQ), while quality of life was measured in both groups with the EuroQol-5D Scale. Interaction between summarized comorbidity count, age, body mass index (BMI) and scores were analysed. Descriptive statistics, two-sample t-test and Pearson's correlation test were used for data analysis. RESULTS: The study groups included 200-200 participants with a similar age spread. Significant correlation was demonstrated in both study groups between higher comorbidity count and older age (0.37, p<0.001, and 0.24, p<0.001 in the GOA and the control group, respectively) and higher BMI (0.18, p: 0.01, and 0.45, p<0.001 in the GOA and the control group, respectively). In GOA, the increasing comorbidity number had a negative effect on the measured outcomes. CONCLUSIONS: Age and BMI showed strong correlation with multimorbidity in both groups. The lower correlation between BMI and comorbidity count in the GOA group requires further investigation and may suggest different interactions. Orv Hetil. 2020; 161(32): 1332-1340.


Assuntos
Atividades Cotidianas , Osteoartrite do Joelho/psicologia , Qualidade de Vida , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Humanos , Multimorbidade , Dor/epidemiologia
4.
Ann Rheum Dis ; 79(6): 685-699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31969328

RESUMO

OBJECTIVES: To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field. METHODS: An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items. RESULTS: The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high. CONCLUSIONS: These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Sociedades Médicas , Medicamentos Sintéticos/uso terapêutico , Antirreumáticos/economia , Produtos Biológicos/economia , Consenso , Quimioterapia Combinada , Europa (Continente) , Humanos , Inibidores de Janus Quinases/uso terapêutico , Medicamentos Sintéticos/economia , Revisões Sistemáticas como Assunto , Fator de Necrose Tumoral alfa/antagonistas & inibidores
5.
Clin Exp Rheumatol ; 38(5): 858-863, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31820730

RESUMO

OBJECTIVES: Until now, glucocorticoids (GCs) with their anti-inflammatory and immune suppressive effects are one of the most effective agents in therapy of several autoimmune disorders including rheumatoid arthritis (RA). Glucocorticoid receptor (GR) polymorphisms may result in variable sensitivity to glucocorticoids playing an important role in the development and control of symptoms in RA. We aimed to test whether the functional polymorphisms of the GR encoding gene (NR3C1) are associated with susceptibility to RA and with various clinical signs and symptoms. METHODS: 146 patients were enrolled at the National Institute of Reumatology. Clinical diagnosis was based on the criteria of the American College of Rheumatism (ACR) 2010. Complex clinical, routine laboratory and immunlaboratory evaluations were performed. For genotyping of the GR polymorphisms N363S (rs6195), BclI (rs41423247) and 9ß (rs6198) peripheral blood DNA was used, extracted with commercially available reagents. Genotyping was performed with routine molecular biological methods. Genetic data were compared to those obtained in a healthy control group (n=160) using Chi square or Fisher tests. Associations between GR genotypes and clinical and immunological parameters were determined with ANOVA. RESULTS: The main finding of the present study is the lower frequency of the BclI in RA patients. Furthermore, regarding the laboratory and immunoserological parameters, the level of anti-DNA antibody was significantly higher in homozygous BclI carriers compared to heterozygous carriers, irrespective of the anti-TNF-alpha therapy. CONCLUSIONS: Our results reveal that although GR polymorphisms are not key players in development or clinical course of RA, they might affect glucocorticoid action and, together with other endogenous and exogenous factors, interfere with the pathomechanism of RA. Our results reveal some possible factors (including BclI polymorphism), and therefore contribute to elucidate the implication of the combination of GR functional variants.


Assuntos
Artrite Reumatoide , Receptores de Glucocorticoides , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/genética , Genótipo , Glucocorticoides/uso terapêutico , Humanos , Polimorfismo Genético , Receptores de Glucocorticoides/genética , Fator de Necrose Tumoral alfa
7.
Clin Rheumatol ; 38(7): 1979-1984, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30850964

RESUMO

BACKGROUND: SLE is a systemic autoimmune disorder with multiple organ manifestations. Despite of the innovations glucocorticoids (GC) have still remained the first-line therapy in SLE. Besides HSD11B enzymes, intracellular glucocorticoid receptors (GR) affect tissue-specific cortisol effect and the consequent signalisation pathway. SNPs of the glucocorticoid receptor gene (NR3C1) modulate individual sensitivity to glucocorticoids. Our aim was to determine the allele frequency of the three, clinically most important SNPs in a SLE patient population in comparison to healthy volunteers and to find association with particular manifestations of SLE. METHODS: We analysed results of 104 SLE patients compared to 160 healthy subjects. All patients were genotyped for the functional GR polymorphisms BclI, N363S, and A3669G. The GR gene polymorphisms were determined using allele-specific PCR and Taqman allelic discrimination assays. RESULTS: The BclI allele frequency was lower in the SLE group compared to the healthy control group. The central nervous system and especially psychiatric symptoms developed more frequently in the BclI carriers compared to none carriers. The prevalence of theA3669G polymorphism was the same in both groups, but showed a negative association with the psychiatric symptoms. CONCLUSION: The increased and decreased sensitivity associated with GR BclI and A3669G polymorphisms could have a pathogenic significance in SLE especial with the central nervous system and psychiatric symptoms. Improving our knowledge on the importance of GR polymorphisms may reveal their pathophysiologic and therapeutic consequences.


Assuntos
Lúpus Eritematoso Sistêmico/genética , Polimorfismo de Nucleotídeo Único , Receptores de Glucocorticoides/genética , Adulto , Idoso , Autoanticorpos/sangue , Estudos de Casos e Controles , Feminino , Frequência do Gene , Predisposição Genética para Doença , Heterozigoto , Humanos , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade
8.
J Rehabil Med ; 50(6): 542-547, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-29767227

RESUMO

OBJECTIVE: To investigate the effect of a 12-month complex balance-training programme on static and dynamic postural balance, aerobic capacity and frequency of falls in women with established osteoporosis. DESIGN: Randomized controlled trial in which the intervention group was assigned a 12-month exercise programme (3 times a week for 30 min) and the control group had no intervention. SUBJECTS: A total of 100 osteoporotic women with at least one previous fracture. METHODS: Performance-based Timed Up and Go (TUG), Berg Balance Scale (BBS) and stabilometric platform tests were used to evaluate balance. Aerobic capacity was measured by bicycle ergometry. Frequency of falls was assessed using a falls diary. RESULTS: After 1 year, there was a statistically significant difference between the improvement achieved in the intervention and control groups on the performance-based TUG, BBS and stabilometric platform tests (p < 0.05). Mean metabolic equivalent (MET) value decreased in the intervention group, from 4.91 to 3.82 (a significant difference from the change achieved in the control group; p = 0.05). Relative risk of falls was 0.534 at 1 year (p = 0.17). CONCLUSION: The 12-month balance-training programme significantly improved postural balance and increased aerobic capacity in women with established osteoporosis.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Osteoporose/complicações , Osteoporose/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Equilíbrio Postural/fisiologia , Idoso , Feminino , Humanos , Osteoporose/patologia
9.
Sci Rep ; 8(1): 7487, 2018 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-29749379

RESUMO

The ABCG2 membrane protein is a key xeno- and endobiotic transporter, modulating the absorption and metabolism of pharmacological agents and causing multidrug resistance in cancer. ABCG2 is also involved in uric acid elimination and its impaired function is causative in gout. Analysis of ABCG2 expression in the erythrocyte membranes of healthy volunteers and gout patients showed an enrichment of lower expression levels in the patients. By genetic screening based on protein expression, we found a relatively frequent, novel ABCG2 mutation (ABCG2-M71V), which, according to cellular expression studies, causes reduced protein expression, although with preserved transporter capability. Molecular dynamics simulations indicated a stumbled dynamics of the mutant protein, while ABCG2-M71V expression in vitro could be corrected by therapeutically relevant small molecules. These results suggest that personalized medicine should consider this newly discovered ABCG2 mutation, and genetic analysis linked to protein expression provides a new tool to uncover clinically important mutations in membrane proteins.


Assuntos
Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/metabolismo , Membrana Eritrocítica/metabolismo , Proteínas Mutantes/metabolismo , Mutação , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/química , Substituição de Aminoácidos , Animais , Estudos de Casos e Controles , Cães , Testes Genéticos , Gota/sangue , Gota/genética , Células HEK293 , Células HeLa , Humanos , Hiperuricemia/sangue , Hiperuricemia/genética , Células Madin Darby de Rim Canino , Modelos Moleculares , Proteínas Mutantes/genética , Proteínas de Neoplasias/química , Polimorfismo de Nucleotídeo Único , Células Sf9 , Spodoptera
10.
Rheumatol Int ; 38(Suppl 1): 243-250, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29637341

RESUMO

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Hungarian language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 206 JIA patients (3.9% systemic, 41.3% oligoarticular, 28.2% RF-negative polyarthritis, 26.6% other categories) and 90 healthy children, were enrolled in two centres. The JAMAR components discriminated healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Hungarian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.


Assuntos
Artrite Juvenil/diagnóstico , Avaliação da Deficiência , Medidas de Resultados Relatados pelo Paciente , Reumatologia/métodos , Adolescente , Idade de Início , Artrite Juvenil/fisiopatologia , Artrite Juvenil/psicologia , Artrite Juvenil/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Características Culturais , Feminino , Nível de Saúde , Humanos , Hungria , Masculino , Pais/psicologia , Pacientes/psicologia , Valor Preditivo dos Testes , Prognóstico , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Tradução
11.
Rheumatology (Oxford) ; 56(7): 1189-1199, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28398504

RESUMO

Objectives: To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time. Methods: In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature. Results: Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD. Conclusion: KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Osteocondrose/diagnóstico por imagem , Osteocondrose/epidemiologia , Osteoporose/diagnóstico por imagem , Distribuição por Idade , Idoso , Densidade Óssea , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Radiografia/métodos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Distribuição por Sexo
12.
Orv Hetil ; 158(17): 662-667, 2017 Apr.
Artigo em Húngaro | MEDLINE | ID: mdl-28434244

RESUMO

INTRODUCTION: An important task of our institute is to support social reintegration: including occupational rehabilitation of patients suffering from chronic musculoskeletal diseases with decreased working ability. AIM: The aim of the authors was to provide informations of their daily practice, how they perform patient education, giving information for their patients about their disease, the rehabilitation possibilities, how they support the patients with decreased working ability to take part in their own rehabilitation. METHOD: Patients taking part in in-patient rehabilitation received teaching and education about their disease and rehabilitation options in groups. Patients interested in part-time jobs were individually interviewed by a 30-120 minutes talk about their educational level and training, social conditions and about the available part time jobs. The part time jobs were available with the help of the Motivation Foundation of the National Association of the Societies of Motion Disabled, and the Alfa Rehabilitation Nonprofit Rt. The data of patients receiving in-patient rehabilitation betwen the 1st of January 2009 and 31st of December 2014 were analyzed. RESULTS: Out of the 230 patients seeking our help for part time job, our social service could organise jobs for 180 disabled persons, all town-inhabitants, but was unsuccesful in getting jobs for patients living in villages and separated farms. CONCLUSION: Part time jobs can be organized for musculoskeletal disabled living in cities and towns. For village-dwellers there are no suitable jobs and working places. It is necessary to organize rehabilitation working possibitities for musculoskeletal disabled patients living in villages. Orv Hetil. 2017; 158(17): 662-667.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Doenças Musculoesqueléticas/reabilitação , Doenças Profissionais/reabilitação , Avaliação da Deficiência , Feminino , Humanos , Hungria , Masculino , Avaliação de Resultados em Cuidados de Saúde , Reabilitação Vocacional/estatística & dados numéricos , Local de Trabalho
13.
Ann Rheum Dis ; 76(6): 960-977, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28264816

RESUMO

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Substituição de Medicamentos , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Humanos , Janus Quinases/antagonistas & inibidores , Metotrexato/uso terapêutico , Participação do Paciente , Fatores de Tempo
14.
Clin Rehabil ; 31(2): 217-224, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26825109

RESUMO

OBJECTIVE: To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis. DESIGN: Randomized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment. SUBJECTS: A total of 100 osteoporotic women - at least with one osteoporotic fracture - aged 65 years old and above. MAIN MEASURES: Balance was assessed in static and dynamic posture both with performance-based measures of balance, such as the Berg Balance Scale and the Timed Up and Go Test, and with a stabilometric computerized platform. INTERVENTIONS: Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting, guided by physical therapists, three times a week, for 30 minutes. RESULTS: The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005, respectively). Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme. As a consequence, the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group. CONCLUSION: The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Osteoporose Pós-Menopausa/diagnóstico , Fraturas por Osteoporose/prevenção & controle , Equilíbrio Postural/fisiologia , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/fisiologia , Feminino , Humanos , Hungria , Osteoporose Pós-Menopausa/complicações , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
15.
J Immunol Res ; 2016: 5758192, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27981054

RESUMO

Complement receptors (CRs) play an integral role in innate immunity and also function to initiate and shape the adaptive immune response. Our earlier results showed that complement receptor type 1 (CR1, CD35) is a potent inhibitor of the B cell receptor- (BCR-) induced functions of human B lymphocytes. Here we show that this inhibition occurs already at the initial steps of B cell activation since ligation of CR1 reduces the BCR-induced phosphorylation of key signaling molecules such as Syk and mitogen activated protein kinases (MAPKs). Furthermore, our data give evidence that although B lymphocytes of active systemic lupus erythematosus (SLE) patients express lower level of CR1, the inhibitory capacity of this complement receptor is still maintained and its ligand-induced clustering results in significant inhibition of the main B cell functions, similar to that found in the case of healthy individuals. Since we have found that reduced CR1 expression of SLE patients does not affect the inhibitory capacity of the receptor, our results further support the therapeutical potential of CD35 targeting the decrease of B cell activation and autoantibody production in autoimmune patients.


Assuntos
Linfócitos B/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Receptores de Complemento 3b/imunologia , Receptores de Complemento 3b/metabolismo , Adulto , Autoanticorpos/imunologia , Linfócitos B/fisiologia , Proliferação de Células , Células Cultivadas , Feminino , Citometria de Fluxo , Humanos , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Fosforilação , Receptores de Antígenos de Linfócitos B/imunologia , Quinase Syk/metabolismo
16.
J Comp Eff Res ; 5(5): 475-85, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27417564

RESUMO

AIM: Adalimumab effectiveness on clinical, functional and work-related outcomes was evaluated in patients with active ankylosing spondylitis or psoriatic arthritis treated in routine clinical practice in central-eastern Europe. METHODS: Patients (n = 555) were followed for 12 months. Primary end point was percentage of patients with a treatment response (≥50% decrease from baseline in Bath Ankylosing Spondylitis Disease Activity Index or ≥1.2 point decrease from baseline in Disease Activity Index-28 joint for axial or peripheral symptoms, respectively). Functional status was evaluated by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire Disability Index. Working ability was evaluated by the Work Productivity and Activity Impairment Questionnaire - Specific Health Problem. RESULTS: 76.1% of patients with axial symptoms and 83.5% with peripheral symptoms achieved a treatment response. Frequency of extra-articular manifestations decreased. Improvements were observed in functional status and workability. No new safety signals were observed. CONCLUSION: Adalimumab was effective and well tolerated during real-world use in central-eastern Europe.


Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Espondilite Anquilosante/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Europa (Continente) , Europa Oriental , Seguimentos , Humanos , Resultado do Tratamento
17.
Arthritis Res Ther ; 18: 63, 2016 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-26970742

RESUMO

BACKGROUND: Our aim was to investigate the role of nicotinic acetylcholine receptors (nAChRs) in in-vitro osteoclastogenesis and in in-vivo bone homeostasis. METHODS: The presence of nAChR subunits as well as the in-vitro effects of nAChR agonists were investigated by ex vivo osteoclastogenesis assays, real-time polymerase chain reaction, Western blot and flow cytometry in murine bone marrow-derived macrophages differentiated in the presence of recombinant receptor activator of nuclear factor kappa B ligand (RANKL) and macrophage colony-stimulating factor (M-CSF). The bone phenotype of mice lacking various nAChR subunits was investigated by peripheral quantitative computed tomography and histomorphometric analysis. Oscillations in the intracellular calcium concentration were detected by measuring the Fura-2 fluorescence intensity. RESULTS: We could demonstrate the presence of several nAChR subunits in bone marrow-derived macrophages stimulated with RANKL and M-CSF, and showed that they are capable of producing acetylcholine. nAChR ligands reduced the number of osteoclasts as well as the number of tartrate-resistant acidic phosphatase-positive mononuclear cells in a dose-dependent manner. In vitro RANKL-mediated osteoclastogenesis was reduced in mice lacking α7 homomeric nAChR or ß2-containing heteromeric nAChRs, while bone histomorphometry revealed increased bone volume as well as impaired osteoclastogenesis in male mice lacking the α7 nAChR. nAChR ligands inhibited RANKL-induced calcium oscillation, a well-established phenomenon of osteoclastogenesis. This inhibitory effect on Ca(2+) oscillation subsequently led to the inhibition of RANKL-induced NFATc1 and c-fos expression after long-term treatment with nicotine. CONCLUSIONS: We have shown that the activity of nAChRs conveys a marked effect on osteoclastogenesis in mice. Agonists of these receptors inhibited calcium oscillations in osteoclasts and blocked the RANKL-induced activation of c-fos and NFATc1. RANKL-mediated in-vitro osteoclastogenesis was reduced in α7 knockout mice, which was paralleled by increased tibial bone volume in male mice in vivo.


Assuntos
Remodelação Óssea/fisiologia , Osso e Ossos/fisiologia , Osteoclastos/metabolismo , Receptores Nicotínicos/metabolismo , Animais , Western Blotting , Citometria de Fluxo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Reação em Cadeia da Polimerase em Tempo Real
19.
Orv Hetil ; 157(1): 2-12, 2016 Jan 03.
Artigo em Húngaro | MEDLINE | ID: mdl-26708681

RESUMO

Polymyalgia rheumatica is an inflammatory musculoskeletal disorder of people aged 50 years or over, characterised by pain, aching and morning stiffness in the shoulder girdle and often hip girdle and neck. Marked systemic inflammation and rapid response to corticosteroid therapy are characteristic features. Giant cell arteritis is a well-known association of polymyalgia rheumatica. Recent clinical evidence and scientific results in the field have provided new challenges for rheumatologists. Besides the aspecific - although characteristic - proximal syndrome, less well recognizable and more variable distal musculoskeletal manifestations were observed. Magnetic resonance and ultrasound studies showed mild, remitting and non-erosive synovitis, with dominating inflammation of the extraarticular synovial structures. As no pathognostic sign is known, the diagnosis of polymyalgia rheumatica is based on its differential diagnosis, differentiation from the polymyalgia mimics; particularly from elderly onset inflammatory arthritides, such as elderly onset rheumatoid arthritis and late onset seronegative spondylarthritis. In 2012 the international polymyalgia rheumatica work group under the guidance of the American College of Rheumatology and European League Against Rheumatism elaborated new classification criteria, the scoring algorythm of which is based on clinical symptoms, with ultrasonography increasing the specificity. Corticosteroids remain the cornerstone of the therapy of polymyalgia rheumatica. No effective steroid-sparing drug has been found to date. Corticosteroids are generally needed for 1-1.5 years, though some patients have a chronic-relapsing course and require corticosteroids for several years. Well known corticosteroid-related side effects (diabetes, hypertension, hyperlipidaemia and osteoporosis) cause significant morbidity and economic burden on the society. Novel therapeautic approaches are on trial. Early recognition of the disease, early start of corticosteroids and a well-defined course, prevention and management of side effects are everyday tasks for rheumatologists and family doctors. Knowledge of polymyalgia rheumatica is essential for all medical specialties.


Assuntos
Polimialgia Reumática , Corticosteroides/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Bursite/tratamento farmacológico , Diagnóstico Diferencial , Cronoterapia Farmacológica , Arterite de Células Gigantes/diagnóstico , História do Século XV , História do Século XIX , História do Século XX , Humanos , Polimialgia Reumática/classificação , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Polimialgia Reumática/epidemiologia , Polimialgia Reumática/etiologia , Polimialgia Reumática/história , Espondilartrite/tratamento farmacológico
20.
Orv Hetil ; 156(41): 1653-60, 2015 Oct 11.
Artigo em Húngaro | MEDLINE | ID: mdl-26551168

RESUMO

The authors review the nomenclature of vasculitides and the classification of antineutrophil cytoplasm antibody associated vasculitides and present the method of measuring disease activity (Five-factor Score, Birmingham Vasculitis Activity Score) and its role in defining therapeutical needs. They discuss the treatment algorithm of antineutrophil cytoplasm antibody associated vasculitides, present the sometimes equipotential medications used during the induction therapy followed by a maintenance regimen, and outline their usage and possible side-effects that may require medical attention. They point out the importance of plasmapheresis as an adjunctive treatment in some cases, as well as indications and possible outcome of kidney transplantation in therapy-resistant cases. Finally, they review several ongoing clinical studies, as their outcome will probably influence therapeutical opportunities of antineutrophil cytoplasm antibody associated vasculitides in the next few years.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Imunossupressores/uso terapêutico , Algoritmos , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/classificação , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Azatioprina/uso terapêutico , Ensaios Clínicos como Assunto , Granulomatose com Poliangiite/terapia , Humanos , Transplante de Rim , Metotrexato/uso terapêutico , Poliangiite Microscópica/terapia , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Plasmaferese , Prognóstico , Rituximab/uso terapêutico , Índice de Gravidade de Doença , Terminologia como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...