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1.
Bone Joint J ; 102-B(4): 426-433, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228087

RESUMO

AIMS: To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps. METHODS: In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees posterior stabilized (PS) TKAs with patellar resurfacing in combination with adequate soft tissue balancing were used. RESULTS: Overall mean ROM in stiff knees increased preoperatively from 67° (0° to 80°) to 114° postoperatively (65° to 135°) (p < 0.001). Mean knee flexion improved from 82° (0° to 110°) to 115° (65° to 135°) and mean flexion contracture decreased from 14° (0° to 50°) to 1° (0° to 10°) (p < 0.001). The mean Knee Society Score (KSS) improved from 34 (0 to 71) to 88 (38 to 100) (p < 0.001) and the KSS Functional Score from 43 (0 to 70) to 86 (0 to 100). Seven knees (7%) required manipulations under anaesthesia (MUA) and none of the knees had flexion instability. The mean overall ROM in the control group improved from 117° (100° to 140°) to 123° (100° to 130°) (p < 0.001). Mean knee flexion improved from 119° (100° to 140°) to 123° (100° to 130°) (p < 0.001) and mean flexion contracture decreased from 2° (0° to 15°) to 0° (0° to 5°) (p < 0.001). None of the knees in the control group had flexion instability or required MUA. The mean KSS Knee Score improved from 48 (0 to 80) to 94 (79 to 100) (p < 0.001) and the KSS Functional Score from 52 (5 to 100) to 95 (60 to 100) (p < 0.001). Mean improvement in ROM (p < 0.001) and KSS Knee Score (p = 0.017) were greater in knees with preoperative stiffness compared with the control group, but the KSS Functional Score improvement was comparable (p = 0.885). CONCLUSION: TKA with a 2 mm increased flexion gap provided a significant improvement of ROM in knees with preoperative stiffness. While the improvement in ROM was greater, the absolute postoperative ROM was less than in matched non-stiff knees. PS TKA with patellar resurfacing and a 2 mm increased flexion gap, in combination with adequate soft tissue balancing, provides excellent ROM and knee function when stiffness of the knee had been present preoperatively. Cite this article: Bone Joint J 2020;102-B(4):426-433.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/cirurgia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Patela/cirurgia , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Int. j. morphol ; 38(1): 43-47, Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056395

RESUMO

Rheumatoid arthritis (RA) is a disease triggered by environmental and genetic factors. Research suggests that physical exercise has benefits such as delaying functional disability. In vivo studies using experimental models of arthritis can provide useful information about these benefits. to analyze the effects that different intensities of aquatic physical exercise have on the proprieties of the bones in induced arthritis in knees of Wistar rats. Male Wistar adults rats (n=20) were divided into 5 groups: Group Control Arthritis (GCA) n=4, Group control Placebo (GCP) n=4, Group Low Physical Activity (GB) n=4, Group Moderate Physical Activity (GM) n=4 and Group Intense Physical Activity (GI) n=4. The physical activity groups got an intra-articular injection of Zymosam on the right knee; the GCA received saline solution in the right knee; the GCP was submitted to the stress of the needle. The animals were submitted to aquatic activity for 30 minutes, 4 times a week for 5 weeks, and the intensity of the exercise was determined by a weight placed on their back: GB=1 %, GM=5 %, GI=15 % of their body weight. It was observed that the group GB, and the groups that did not exercise GCA and GCP, gained more weight compared to the group GM. In relation to the bone mineral content of the tibia, there was a decrease in the GM group when compared to the GCP group, whereas in the tibial bone mineral density there was a decrease in the GM group compared to the GCP, GCA, GB. As for the area of the femur, the GI group presented an increase of it compared to the GB and GM groups. It is concluded that the high intensity exercises promote better results in bone properties.


La investigación sugiere que el ejercicio físico tiene beneficios como retrasar la discapacidad funcional de la artritis reumatoide. Los estudios in vivo que utilizan modelos experimentales de artritis pueden proporcionar información útil sobre estos beneficios. Se analizaron los efectos de las intensidades del ejercicio físico acuático sobre las propiedades de los huesos, en la artritis inducida en las rodillas de ratas Wistar. Las ratas Wistar macho adultas (n = 20) se dividieron en 5 grupos: grupo de control artritis (ACG) n = 4, grupo control placebo (CGP) n = 4, grupo de actividad física baja (GB) n = 4, grupo de actividad física moderada (GM) n = 4 y grupo de actividad física intensa (GI) n = 4. Los grupos de actividad física recibieron una inyección intraarticular de Zymosam en la rodilla derecha; el GCA recibió solución salina en la rodilla derecha; el CGP fue sometido a la tensión de una aguja. Los animales fueron sometidos a actividad acuática durante 30 minutos, 4 veces a la semana durante 5 semanas, y la intensidad del ejercicio se determinó mediante un peso colocado sobre su espalda: GB = 1 %, GM = 5 %, GI = 15 % de su peso corporal. Se observó que el grupo GB, y los grupos que no ejercitaron GCA y CGP, ganaron más peso en comparación con el grupo GM. En relación con el contenido mineral óseo de la tibia, hubo una disminución en el grupo GM en comparación con el grupo GCP, mientras que en la densidad mineral del hueso tibial hubo una disminución en el grupo GM en comparación con el GCP, GCA, GB. En cuanto al área del fémur, el grupo GI presentó un aumento en comparación con los grupos GB y GM. En conclusión el ejercicio de alta intensidad promueve mejores resultados en las propiedades óseas.


Assuntos
Animais , Masculino , Ratos , Artrite Reumatoide/patologia , Natação/fisiologia , Tíbia/patologia , Fêmur/patologia , Artrite Reumatoide/fisiopatologia , Tíbia/fisiopatologia , Peso Corporal , Exercício Físico/fisiologia , Ratos Wistar , Modelos Animais de Doenças , Fêmur/fisiopatologia
3.
Ann Rheum Dis ; 79(4): 445-452, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32024651

RESUMO

OBJECTIVES: This study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA). METHODS: We used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0-10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored. RESULTS: Data from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions. CONCLUSION: Increasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.


Assuntos
Artrite Reumatoide/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Adalimumab/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Humanos , Infliximab/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Índice de Gravidade de Doença , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Escala Visual Analógica
4.
Ann Rheum Dis ; 79(4): 460-463, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32033935

RESUMO

BACKGROUND: In rheumatoid arthritis (RA) trials, inclusion of patients on background treatment with glucocorticoids (GCs) might impact efficacy and safety outcomes. OBJECTIVES: To determine if inclusion of patients on background GC use influenced efficacy and safety outcomes of RA randomised clinical trials on initiation of tocilizumab (TCZ) or adalimumab (ADA) or methotrexate (MTX) monotherapy. METHODS: Data of four double-blind RA randomised controlled trials (AMBITION, ACT-RAY, ADACTA and FUNCTION) with in total four TCZ, one ADA and two MTX monotherapy arms were analysed. Analyses of covariance of changes from baseline to week 24 in efficacy endpoints and radiographic progression up to week 104 were performed, correcting for relevant covariates. Incidence rates of serious adverse events (SAEs) were assessed. RESULTS: No statistically significant differences were found in efficacy parameters between background GC users and non-GC users, except for less radiographic progression associated with GC usage in one MTX arm. SAE rates were not statistically significantly different between GC users and non-GC users in the treatment arms. CONCLUSION: No effect of including patients on background GC treatment on efficacy and safety trial outcomes was found, with the exception of reduced radiological joint damage in one MTX arm.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Glucocorticoides/uso terapêutico , Adalimumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/fisiopatologia , Quimioterapia Combinada , Humanos , Infecções/induzido quimicamente , Metotrexato/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Radiol Med ; 125(5): 481-490, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020529

RESUMO

OBJECTIVES: To systematically review the current literature concerning the role of superb microvascular imaging (SMI), a novel Doppler technique that enables detection of fine vessels and slow blood flow, in the evaluation of musculoskeletal disorders. METHODS: An online search of the literature was conducted for the period 2013 to April 2019 and included original articles written in English language. A data analysis was performed at the end of the literature search. RESULTS: Eight original articles with prospective design and one with retrospective design were included in this review: 4 studies focused on rheumatoid arthritis, 2 on rheumatoid and other arthritides, 1 on lateral epicondylosis and 2 on carpal tunnel syndrome. Sample size ranged from 26 to 83 patients. Despite some methodological differences, all studies compared the performance of SMI with that of a conventional Doppler technique such as power and color Doppler and found an improvement in vascularity detection with SMI. The main variations were in sample size, evaluated parameters and vascularity interpretation methods. Inter-observer agreement for SMI ranged from moderate to excellent. CONCLUSIONS: SMI is a promising tool for the diagnosis and treatment planning of different musculoskeletal disorders. Future investigations should include larger samples of patients with long-term follow-up.


Assuntos
Microvasos/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Velocidade do Fluxo Sanguíneo , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Microvasos/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Cotovelo de Tenista/diagnóstico por imagem , Cotovelo de Tenista/fisiopatologia , Ultrassonografia Doppler em Cores/métodos
6.
Ann Rheum Dis ; 79(4): 453-459, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32094157

RESUMO

OBJECTIVES: To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target. METHODS: RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models. RESULTS: In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52). CONCLUSION: In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Planejamento de Assistência ao Paciente , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Idoso , Artrite Reumatoide/imunologia , Artrite Reumatoide/fisiopatologia , Sedimentação Sanguínea , Proteína C-Reativa/imunologia , Tomada de Decisão Clínica , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Fator Reumatoide/imunologia
7.
Ann Rheum Dis ; 79(4): 464-471, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31996367

RESUMO

OBJECTIVES: We sought to confirm in very early rheumatoid arthritis (ERA) a much greater superiority (30%) of first-line etanercept+methotrexate (ETN+MTX) over treat-to-target MTX (MTX-TT) than previously reported in ERA (14%); and explore whether ETN following initial MTX secures a comparable response to first-line ETN+MTX. METHODS: Pragmatic, open-label, randomised controlled trial of treatment-naïve ERA (≤12 months symptom), Disease Activity Score 28 joint (DAS28)-erythrocyte sedimentation rate (ESR) ≥3.2, rheumatoid factor (RF)+/-anticitrullinated peptide antibody (ACPA) positive or ultrasound power Doppler (PD) if RF and ACPA negative. Subjects were randomised 1:1 to ETN+MTX; or MTX-TT, escalated to ETN if week 24 DAS28-ESR ≥2.6 and intramuscular corticosteroid at protocolised time points. Primary endpoint of week 48 DAS28ESR remission with clinical and imaging secondary endpoints. RESULTS: We randomised 120 patients, 60 to each arm (71% female, 73% RF/84% ACPA positive, median (IQR) symptom duration 20.3 (13.1, 30.8) weeks; mean (SD) DAS28 5.1 (1.1)). Remission rates with ETN+MTX and MTX-TT, respectively, were 38% vs 33% at week 24; 52% vs 38% at week 48 (ORs 1.6, 95% CI 0.8 to 3.5, p=0.211). Greater, sustained DAS28-ESR remission observed with ETN+MTX versus MTX-TT (42% and 27%, respectively; p=0.035). PD was fully suppressed by week 48 in over 90% in each arm. Planned exploratory analysis revealed OR 2.84, 95% CI 0.8 to 9.6) of achieving remission after 24 weeks of ETN administered first line compared with administered post-MTX. CONCLUSIONS: Compared with remission rates typically reported with first-line tumour necrosis factor inhabitor+MTX versus MTX-TT, we did not demonstrate a larger effect in very ERA. Neither strategy conferred remission in the majority of patients although ultrasound confirmed local inflammation suppression. Poorer ETN response following failure of MTX-TT is also suggested. Trial registration number NCT02433184.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Etanercepte/uso terapêutico , Metotrexato/uso terapêutico , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Artrite Reumatoide/fisiopatologia , Quimioterapia Combinada , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
8.
Rev Med Chil ; 147(6): 762-775, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859830

RESUMO

Rheumatoid arthritis (RA) and chronic periodontitis (CP) may be related due to a bidirectional etiology. The evidence shows that CP could alter the clinical course of RA. We performed a systematic search to determine if CP alters the morbidity of RA, analyzing its clinical and molecular aspects. Of 552 initial articles found, 16 were selected for a thorough review. There is a greater prevalence of CP in patients with RA. Patients with RA have significantly higher values of periodontal clinical parameters than healthy controls. Arthritis activity is significantly greater in patients who suffer from CP and decreases with nonsurgical periodontal treatment. There is a significant relationship between the severity of CP and RA activity.


Assuntos
Artrite Reumatoide/complicações , Periodontite Crônica/complicações , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/terapia , Biomarcadores , Estudos de Casos e Controles , Periodontite Crônica/fisiopatologia , Periodontite Crônica/terapia , Feminino , Humanos , Masculino , Fatores de Risco
9.
Rev. esp. patol. torac ; 31(4): 267-269, dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187188

RESUMO

El pseudoquilotórax ha sido relacionado clásicamente con un defecto en la reabsorción de líquido en el contexto de un engrosamiento pleural que aparece tras largo tiempo de evolución de la etiología subyacente. Sin embargo, durante los últimos años se han reportado en diversos países, aunque muy pocos, casos de pacientes con este tipo de derrame en los que no existía una causa de larga evolución ni engrosamiento o calcificaciones pleurales. A nivel mundial, se han comunicado menos de 10 casos de estas características. En este manuscrito presentamos el caso de una mujer de 40 años con artritis reumatoide de corta evolución que desarrolló un pseudoquilotórax sin engrosamiento pleural


Pseudochylothorax has conventionally been associated with a deficit in the reabsorption of liquid in the context of pleural thickening, which appears over a long period of underlying etiology. However, in recent years, there have been reports in different countries, though very few, of patients with this type of effusion in which there is no long-standing cause nor plural thickening or calcification. Worldwide, fewer than 10 cases with these characteristics have been reported. In this study, we present the case of a 40-yearold woman with short-duration rheumatoid arthritis who developed a pseudochylothorax without pleural thickening


Assuntos
Humanos , Feminino , Adulto , Artrite Reumatoide/fisiopatologia , Derrame Pleural/complicações , Quilotórax/etiologia , Quilotórax/patologia , Radiografia Torácica , Metotrexato/administração & dosagem , Leflunomida/administração & dosagem , Corticosteroides/administração & dosagem , Progressão da Doença
10.
Rev Med Chil ; 147(5): 612-617, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31859893

RESUMO

BACKGROUND: The Health Assessment Questionnaire Disability Index (HAQDI) is one of the main instruments used to evaluate functional status in rheumatoid arthritis (RA). AIM: To assess the reliability and validity of the Spanish version of HAQDI in Chilean RA population. MATERIALS AND METHODS: The questionnaire was applied to 98 patients with RA aged 44 ± 12 years (90% women). Reliability was assessed using Cronbach's alpha statistic for internal consistency. Construct validity was assessed by comparing total HAQDI value and eight HAQDI domains with multiple parameters of disease activity. Discriminant validity was evaluated by classifying disease activity in low, medium or high and evaluating HAQDI value in each category. Floor and ceiling effects were evaluated. To assess construct validity, principal components analysis was performed using varimax rotation. RESULTS: There were no issues in the comprehensibility of the questionnaire. Mean HAQDI score was 1.57 ± 0.66. Standardized Cronbach's Alpha was 0.883. Correlations between Chilean HAQ domains had a p value less than 0.001, and values ranged from 0.317 to 0.597. Activity parameters, DAS 28 and CDAI were significantly correlated with HAQDI domains. Mean HAQDI values were 0.98 ± 0.59,1.45 ± 0.57, and 1.90 ± 0.56 for mild, moderate and severe disease activity. A principal components analysis identified two factors that accounted for 70.0% of total variability. CONCLUSIONS: This study shows that the Spanish version of HAQDI is reliable and valid and can be used in Chilean patients with RA.


Assuntos
Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Inquéritos e Questionários/normas , Adulto , Chile , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas
11.
PLoS One ; 14(12): e0226255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851711

RESUMO

BACKGROUND: Confounding by disease severity is an issue in pharmacoepidemiology studies of rheumatoid arthritis (RA), due to channeling of sicker patients to certain therapies. To address the issue of limited clinical data for confounder adjustment, a patient-level prediction model to differentiate between patients prescribed and not prescribed advanced therapies was developed as a surrogate for disease severity, using all available data from a US claims database. METHODS: Data from adult RA patients were used to build regularized logistic regression models to predict current and future disease severity using a biologic or tofacitinib prescription claim as a surrogate for moderate-to-severe disease. Model discrimination was assessed using the area under the receiver (AUC) operating characteristic curve, tested and trained in Optum Clinformatics® Extended DataMart (Optum) and additionally validated in three external IBM MarketScan® databases. The model was further validated in the Optum database across a range of patient cohorts. RESULTS: In the Optum database (n = 68,608), the AUC for discriminating RA patients with a prescription claim for a biologic or tofacitinib versus those without in the 90 days following index diagnosis was 0.80. Model AUCs were 0.77 in IBM CCAE (n = 75,579) and IBM MDCD (n = 7,537) and 0.75 in IBM MDCR (n = 36,090). There was little change in the prediction model assessing discrimination 730 days following index diagnosis (prediction model AUC in Optum was 0.79). CONCLUSIONS: A prediction model demonstrated good discrimination across multiple claims databases to identify RA patients with a prescription claim for advanced therapies during different time-at-risk periods as proxy for current and future moderate-to-severe disease. This work provides a robust model-derived risk score that can be used as a potential covariate and proxy measure to adjust for confounding by severity in multivariable models in the RA population. An R package to develop the prediction model and risk score are available in an open source platform for researchers.


Assuntos
Artrite Reumatoide/fisiopatologia , Bases de Dados Factuais , Revisão da Utilização de Seguros , Antirreumáticos/administração & dosagem , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Piperidinas/administração & dosagem , Pirimidinas/administração & dosagem , Pirróis/administração & dosagem , Índice de Gravidade de Doença
12.
J Shoulder Elbow Surg ; 28(11): 2205-2214, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31630751

RESUMO

BACKGROUND: Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA. METHODS: All patients with RA who underwent TEA at a single center with a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up. RESULTS: We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components. CONCLUSION: TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo/métodos , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Idoso , Artrite Reumatoide/fisiopatologia , Artroplastia de Substituição do Cotovelo/efeitos adversos , Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Prótese de Cotovelo/efeitos adversos , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Força Muscular , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Pronação , Desenho de Prótese/efeitos adversos , Falha de Prótese , Amplitude de Movimento Articular , Reoperação , Resultado do Tratamento
13.
Isr Med Assoc J ; 21(7): 460-463, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507121

RESUMO

BACKGROUND: Inflammation is the basic mechanism leading to many pathological processes, including degenerative diseases, atherosclerosis, and cancer. We found an interesting link connecting rheumatoid arthritis and atherosclerosis that may explain the high cardiovascular event rate among patients with rheumatoid arthritis, but also may lead to a new way of thinking and a better understanding of atherosclerosis. Rheumatoid arthritis could serve as a model of accelerated atherosclerosis. Understanding the basic mechanisms of rheumatoid arthritis may solve some of the complexity of atherosclerosis.


Assuntos
Artrite Reumatoide/fisiopatologia , Aterosclerose/fisiopatologia , Inflamação/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Fatores de Risco
14.
Isr Med Assoc J ; 21(7): 464-470, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507122

RESUMO

BACKGROUND: Rheumatic diseases commonly affect women of childbearing age, when women may be contemplating pregnancy or they discover an unplanned pregnancy. Therefore, specific issues about pregnancy planning and management are commonly encountered in patients during these times. Knowledge of the effect of pregnancy on disease activity is important for counseling. This review summarizes recent data on the course of different rheumatic diseases during pregnancy and the postpartum period. Rheumatoid arthritis and systemic lupus erythematosus are the most commonly investigated diseases. Data are increasing about spondyloarthritis. Sparse data are available for other rheumatic diseases. Despite the differences in these diseases and the various courses these disease take during pregnancy, a common feature is that active maternal disease in the months prior to conception increases the risk of flares during pregnancy, which in turn can lead to adverse pregnancy outcomes. Therefore, maternal and fetal health can be optimized if conception is planned when disease is inactive so that a treatment regimen can be maintained throughout pregnancy.


Assuntos
Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Doenças Reumáticas/fisiopatologia , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Período Pós-Parto , Gravidez
15.
J Biosci ; 44(4)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31502572

RESUMO

The goal of the current investigation was to prepare PEGylated Lipova E120 liposomes loaded with celecoxib for the effective treatment of rheumatoid arthritis (RA). PEGylated liposomes were prepared and were characterized using techniques such as particle size distribution, polydispersity index (PDI), zeta potential, encapsulation efficiency and in-vitro release, in-vivo and stability studies. The morphological study was characterized by scanning electron microscopy and transmission electron microscopy. To determine the interaction between drug and polymer Fourier transform infrared, Raman, thermogravimetric analysis and differential scanning calorimetry studies were performed. Results show that formulation F6 was optimized with a particle size of 92.12 +/- 1.7 nm, a PDI of 0.278 +/- 0.22, a zeta potential of - 40.8 +/- 1.7 mV with a maximum encapsulation of 96.6 +/- 0.05% of drug in the PEGylated liposomes. The optimized formulation shows a maximum release of drug i.e. 94.45 +/- 1.13% in 72 h. Tail immersion assay shows that the optimized formulation F6 significantly increases the reaction time and carrageenan-induced assay shows that the optimized formulation inhibits the increase in paw edema thus providing a pain relief treatment in RA. These results suggest that the PEGylated liposomes provide a sustained release of celecoxib and helps in effective treatment of RA.


Assuntos
Anti-Inflamatórios/farmacologia , Artrite Reumatoide/tratamento farmacológico , Celecoxib/farmacologia , Lipossomos/farmacologia , Animais , Anti-Inflamatórios/química , Artrite Reumatoide/fisiopatologia , Celecoxib/química , Modelos Animais de Doenças , Humanos , Lipossomos/química , Masculino , Tamanho da Partícula , Polietilenoglicóis/química , Polietilenoglicóis/farmacologia , Ratos
16.
BMJ Case Rep ; 12(7)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366614

RESUMO

A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Colectomia , Ileostomia , Laparotomia , Pneumatose Cistoide Intestinal/patologia , Rituximab/uso terapêutico , Idoso , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Trials ; 20(1): 494, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409388

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, causes joint destruction, and leads to physical disability. Advances in the treatment of RA, such as biologic disease-modifying anti-rheumatic drugs (DMARDs), have provided better clinical outcomes, including the achievement of remission for patients with RA, but some patients cannot receive these treatments because of their side effects and high cost, and not all patients achieve remission. Although the efficacy of denosumab, which is a human IgG2 monoclonal antibody with a high affinity for the receptor activator of nuclear factor kappa B (RANK) ligand (RANKL), in the treatment of RA has been reported in clinical trials, the efficacy of denosumab in both preventing joint destruction and improving disease activity has not been evaluated in a real-world setting. METHODS/DESIGN: This open-label, randomized, parallel-group study will compare the continued use of conventional synthetic DMARDs (csDMARDs) alone with the combined use of csDMARDs and denosumab in patients whose RA is treated with csDMARDs. In total, 44 patients with RA will be randomly assigned to receive additional treatment with denosumab or to continue RA treatment without additional denosumab. The duration of the intervention will be 12 months. To analyze bone erosion and bone micro-architecture precisely, high-resolution peripheral quantitative computed tomography (HR-pQCT) will be performed every 6 months. The primary endpoint is changes in the depth of bone erosion as measured by HR-pQCT from baseline to 6 months. Important secondary endpoints are the changes from baseline in the width and volume of bone erosion as measured by HR-pQCT and changes from baseline in the depth of bone erosion at 12 months. Changes in bone micro-architecture will also be analyzed as an exploratory endpoint. DISCUSSION: The results of this study are expected to provide strong evidence regarding the usefulness of denosumab for the treatment of RA. Moreover, by using HR-pQCT, this study will also reveal the effect of denosumab not only on bone erosion but also on bone micro-architecture. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network Clinical Trials Registry as UMIN000030575 on December 26, 2017.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Denosumab/uso terapêutico , Articulações/efeitos dos fármacos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Progressão da Doença , Humanos , Japão , Articulações/diagnóstico por imagem , Articulações/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
18.
Nutrients ; 11(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394758

RESUMO

Diet and microbiota each have a direct impact on many chronic, inflammatory, and metabolic diseases. As the field develops, a new perspective is emerging. The effects of diet may depend on the microbiota composition of the intestine. A diet that is rich in choline, red meat, dairy, or egg may promote the growth, or change the composition, of microbial species. The microbiota, in turn, may produce metabolites that increase the risk of cardiovascular disease. This article reviews our current understanding of the effects of the molecule trimethylamine-N-oxide (TMAO) obtained from food or produced by the microbiota. We review the mechanisms of actions of TMAO, and studies that associate it with cardiovascular and chronic kidney diseases. We introduce a novel concept: TMAO is one among a group of selective uremic toxins that may rise to high levels in the circulation or accumulate in various organs. Based on this information, we evaluate how TMAO may harm, by exacerbating inflammation, or may protect, by attenuating amyloid formation, in autoimmune diseases such as rheumatoid arthritis.


Assuntos
Artrite Reumatoide/fisiopatologia , Doenças Autoimunes/fisiopatologia , Dieta , Metilaminas/farmacologia , Microbiota/fisiologia , Amiloide/metabolismo , Animais , Doenças Cardiovasculares/etiologia , Disbiose/fisiopatologia , Intolerância à Glucose , Humanos , Inflamação/etiologia , Metilaminas/metabolismo , Insuficiência Renal Crônica , Fatores de Risco
19.
Trials ; 20(1): 524, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443729

RESUMO

INTRODUCTION: In some randomised trials, the primary interest is in the mechanisms by which an intervention exerts its effects on health outcomes. That is, clinicians and policy-makers may be interested in how the intervention works (or why it does not work) through hypothesised causal mechanisms. In this article, we highlight the value of understanding causal mechanisms in randomised trials by applying causal mediation analysis to two randomised trials of complex interventions. MAIN BODY: In the first example, we examine a potential mechanism by which an exercise programme for rheumatoid arthritis of the hand could improve hand function. In the second example, we explore why a rehabilitation programme for ankle fractures failed to improve lower-limb function through hypothesised mechanisms. We outline critical assumptions that are required for making valid causal inferences from these analyses, and provide results of sensitivity analyses that are used to assess the degree to which the estimated causal mediation effects could have been biased by residual confounding. CONCLUSION: This paper demonstrates how the application of causal mediation analyses to randomised trials can identify the mechanisms by which complex interventions exert their effects. We discuss methodological issues and assumptions that should be considered when mediation analyses of randomised trials are used to inform clinical practice and policy decisions.


Assuntos
Determinação de Ponto Final , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/reabilitação , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/reabilitação , Causalidade , Interpretação Estatística de Dados , Determinação de Ponto Final/estatística & dados numéricos , Terapia por Exercício , Consolidação da Fratura , Articulação da Mão/fisiopatologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Recuperação de Função Fisiológica , Projetos de Pesquisa/estatística & dados numéricos , Resultado do Tratamento
20.
Arq Gastroenterol ; 56(2): 113-117, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31460572

RESUMO

BACKGROUND: Few studies regarding arthritic diseases have been performed to verify the presence of the neurodegeneration. Given the increased oxidative stress and extra-articular effects of the rheumatoid arthritis, the gastrointestinal studies should be further investigated aiming a better understanding of the systemic effects the disease on enteric nervous system. OBJECTIVE: To determine whether the rheumatoid arthritis affects the nitrergic density and somatic area of the nNOS- immunoreactive (IR) myenteric neurons, as well as the morphometric areas of CGRP and VIP-IR varicosities of the ileum of arthritic rats. METHODS: Twenty 58-day-old male Holtzmann rats were distributed in two groups: control and arthritic. The arthritic group received a single injection of the Freund's Complete Adjuvant in order to induce arthritis model. The whole-mount preparations of ileum were processed for immunohistochemistry to VIP, CGRP and nNOS. Quantification was used for the nitrergic neurons and morphometric analyses were performed for the three markers. RESULTS: The arthritic disease induced a reduction 6% in ileal area compared to control group. No significant differences were observed in nitrergic density comparing both groups. However, arthritic group yielded a reduction of the nitrergic neuronal somatic area and VIP-IR varicosity areas. However, an increase of varicosity CGRP-IR areas was also observed. CONCLUSION: Despite arthritis resulted in no alterations in the number of nitrergic neurons, the retraction of ileal area and reduction of nitrergic somatic and VIP-IR varicosity areas may suggest a negative impact the disease on the ENS.


Assuntos
Artrite Reumatoide/fisiopatologia , Sistema Nervoso Entérico/fisiopatologia , Neurônios Nitrérgicos/fisiologia , Óxido Nítrico Sintase Tipo I/metabolismo , Animais , Modelos Animais de Doenças , Imuno-Histoquímica , Masculino , Plexo Mientérico/metabolismo , Plexo Mientérico/fisiopatologia , Neurônios Nitrérgicos/metabolismo , Óxido Nítrico Sintase Tipo I/fisiologia , Ratos , Ratos Sprague-Dawley
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