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1.
Lancet ; 395(10217): 53-64, 2020 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-31813637

RESUMO

BACKGROUND: Ixekizumab, a high-affinity interleukin-17A (IL-17A) monoclonal antibody, has previously shown efficacy in radiographic axial spondyloarthritis (also known as ankylosing spondylitis). We aimed to evaluate the efficacy and safety of ixekizumab, an IL-17 inhibitor, in non-radiographic axial spondyloarthritis. Here, we report the primary results of COAST-X. METHODS: COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs (NSAIDs). Patients were randomly assigned (1:1:1) to receive subcutaneous 80 mg ixekizumab every 4 weeks (Q4W) or every 2 weeks (Q2W), or placebo. Changing background medications or switching to open-label ixekizumab Q2W, or both, was allowed after week 16 at investigator discretion. Primary endpoints were Assessment of SpondyloArthritis international Society-40 (ASAS40) response (defined as an improvement of 40% or more and an absolute improvement from baseline of 2 units or more [range 0-10] in at least three of the four domains [patient global, spinal pain, function, and inflammation] without any worsening in the remaining one domain) at weeks 16 and 52. Patients who switched to open-label ixekizumab were imputed as non-responders in logistic regression analysis. This trial is registered with ClinicalTrials.gov, number NCT02757352. FINDINGS: Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled (105 to placebo, 96 to ixekizumab Q4W, and 102 to ixekizumab Q2W). Both primary endpoints were met: ASAS40 at week 16 (ixekizumab Q4W: 34 [35%] of 96, p=0·0094 vs placebo; ixekizumab Q2W: 41 [40%] of 102, p=0·0016; placebo: 20 [19%] of 105) and ASAS40 at week 52 (ixekizumab Q4W: 29 [30%] of 96, p=0·0045; ixekizumab Q2W: 32 [31%] of 102, p=0·0037; placebo: 14 [13%] of 105). 60 (57%) of 104 patients in the placebo group, 63 (66%) of 96 in the ixekizumab Q4W group, and 79 (77%) of 102 in the ixekizumab Q2W group had at least one treatment-emergent adverse event. The most common treatment-emergent adverse events in the ixekizumab groups were nasopharyngitis and injection site reaction. Of the treatment-emergent adverse events of special interest, there was one case of serious infection in the ixekizumab Q4W group. The frequency of serious adverse events was low (four [1%] of 302) and similar across the three groups. There were no malignancies or deaths. No new safety signals were identified. INTERPRETATION: Ixekizumab was superior to placebo for improving signs and symptoms in patients with non-radiographic axial spondyloarthritis at weeks 16 and 52. Reports of adverse events were similar to those of previous ixekizumab studies. Ixekizumab offers a potential therapeutic option for patients with non-radiographic axial spondyloarthritis who had an inadequate response or were intolerant to NSAID therapy. FUNDING: Eli Lilly and Company.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Espondilite Anquilosante/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Ásia , Método Duplo-Cego , Esquema de Medicação , Europa (Continente) , Feminino , Humanos , Injeções Subcutâneas , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , América do Norte , América do Sul , Resultado do Tratamento
2.
An Bras Dermatol ; 94(6): 751-753, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789263

RESUMO

Lobular capillary hemangioma or pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes. Most patients present a single lesion. It manifests clinically as an erythematous, friable, and fast-growing tumor. This report details a case with exuberant presentation in a patient with ankylosing spondylitis, using adalimumab. Factors triggering pyogenic granuloma are not well known. They may spontaneously regress, but most require treatment.


Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Granuloma Piogênico/patologia , Dermatopatias/patologia , Espondilite Anquilosante/tratamento farmacológico , Granuloma Piogênico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/etiologia , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores
3.
Lancet ; 394(10214): 2108-2117, 2019 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-31732180

RESUMO

BACKGROUND: The JAK pathway is a potential therapeutic target in ankylosing spondylitis. This study assessed the efficacy and safety of upadacitinib, a selective JAK1 inhibitor, in patients with ankylosing spondylitis. METHODS: This multicentre, randomised, double-blind, placebo-controlled, two-period, parallel-group, phase 2/3 study, SELECT-AXIS 1, enrolled adults in 62 sites in 20 countries. Eligible patients had active ankylosing spondylitis, fulfilled modified New York criteria, were previously untreated with biological disease-modifying antirheumatic drugs, and had inadequate response to at least two or intolerance or contraindication to non-steroidal anti-inflammatory drugs. Patients were randomly assigned 1:1 using interactive response technology to take oral upadacitinib 15 mg once daily or oral placebo for the 14-week period 1; only period 1 data are reported here. The primary endpoint was the composite outcome measure of the Assessment of SpondyloArthritis international Society 40 response at week 14. Analyses were done in the full analysis set of patients who were randomly assigned and received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT03178487. FINDINGS: Between Nov 30, 2017, and Oct 15, 2018, 187 patients were randomly assigned to upadacitinib 15 mg (93 patients) or to placebo (94 patients), and 178 (95%) patients (89 in the upadacitinib group and 89 in the placebo group) completed period 1 on study drug (by the completion date of Jan 21, 2019). Significantly more patients had an Assessment of SpondyloArthritis international Society 40 response in the upadacitinib group versus in the placebo group at week 14 (48 [52%] of 93 patients vs 24 [26%] of 94 patients; p=0·0003; treatment difference 26% [95% CI 13-40]). Adverse events were reported in 58 (62%) of 93 patients in the upadacitinib group versus 52 (55%) of 94 in the placebo group. The most common adverse event in the upadacitinib group was increased creatine phosphokinase (eight [9%] of 93 patients in the upadacitinib group vs two [2%] of 94 patients with placebo). No serious infections, herpes zoster, malignancy, venous thromboembolic events, or deaths were reported; one serious adverse event was reported in each group. INTERPRETATION: Upadacitinib 15 mg was efficacious and well tolerated in patients with active ankylosing spondylitis who had an inadequate response or contraindication to non-steroidal anti-inflammatory drugs. These data support the further investigation of upadacitinib for the treatment of axial spondyloarthritis. FUNDING: AbbVie.


Assuntos
Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Inibidores de Janus Quinases/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Adulto , Antirreumáticos/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Mesalamina/uso terapêutico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Articulação Sacroilíaca/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Sulfassalazina , Resultado do Tratamento
5.
Ann Biol Clin (Paris) ; 77(4): 453-458, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418707

RESUMO

Infliximab (IFX) is a chimeric monoclonal antibody which has proven its efficacy in the treatment of inflammatory diseases. However, its efficacy can be limited by the development of anti-IFX antibodies (ATI) resulting in a therapeutic failure of IFX. ATI plasmatic monitoring is then indicated to optimize IFX treatment. The aim of this study was to validate an ELISA (enzyme linked immuno sorbent assay) method of ATI plasmatic monitoring. METHODS: Assessment of performance was based on the study of correlation and concordance (Bland Altman method) of the absorbances measured by the two readers. ELISA kit validation was made by calculating the accuracy and the exactitude. RESULTS: We collected 23 samples. Their mean age was 46 years and sex ratio M/W was 0.92. In nine cases, plasmatic AIT were positive and in 14 cases, they were not detected. Correlation between the two readers showed a correlation coefficient r2 of 99.95%. Concordance limits of the confidence interval 95% were [-112.768%-41.425%] with a bias of -35.671%. Repeatability and reproductibility were checked by a positive control and coefficients of variation were respectively of 5.574% and 14.184%. Limits of detection and quantification were respectively of 0.046 and 0.086. The positive predictive value was 0.5 and the negative predictive value was 1. The sensitivity was 100% and the specificity was 83%. CONCLUSION: The assessment of the performance of the tested microplate reader and the validation of the tested ELISA kit showed good results allowing ATI routine measurement to optimize therapeutic management of patients treated by IFX.


Assuntos
Anticorpos Monoclonais/sangue , Infliximab/imunologia , Kit de Reagentes para Diagnóstico , Testes Sorológicos/métodos , Adulto , Anticorpos Monoclonais/análise , Monitoramento de Medicamentos/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Kit de Reagentes para Diagnóstico/normas , Doenças Reumáticas/sangue , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/tratamento farmacológico , Sensibilidade e Especificidade , Espondilite Anquilosante/sangue , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico
6.
Bratisl Lek Listy ; 120(8): 586-592, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379182

RESUMO

OBJECTIVE: In recent years, neutrophil-lymphocyte rate (NLR) and platelet-lymphocyte rate (PLR) are reported to be increasing in plenty of rheumatological diseases and the latter rates to be disease activity indicators. In our study, we aimed to search for the difference in NLR and PLR before and after the treatment, their relationship with the disease activity and their seasonal differences in patients using anti-TNF medication for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) while. METHOD: Sixty-eight RA and 203 AS patients using anti-TNF medication for at least 6 months were included in the study. Patients with acute infection, diabetes, hypertension, cancer, renal failure and liver failure were excluded from the study. NLR, PLR, seasonal differences and the disease activities of the patients were evaluated retrospectively. RESULTS: We determined that NLR and PLR are strongly correlated with disease activity, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). In addition, we determined that disease activity, thrombocytes and PLR are increased in spring and winter, especially in patients with RA. CONCLUSION: NLR and PLR are simple, cheap, and easily accessible parameters which can be used to evaluate disease activity and treatment response before and after anti-TNF treatment. Further studies are needed to enlighten the effect of seasonal differences on disease activity (Tab. 2, Fig. 2, Ref. 43).


Assuntos
Artrite Reumatoide/tratamento farmacológico , Estações do Ano , Espondilite Anquilosante/tratamento farmacológico , Artrite Reumatoide/patologia , Plaquetas/citologia , Contagem de Células , Humanos , Linfócitos/citologia , Neutrófilos/citologia , Estudos Retrospectivos , Espondilite Anquilosante/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores
7.
Medicine (Baltimore) ; 98(27): e16160, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277118

RESUMO

RATIONALE: Acquired pure red cell aplasia (PRCA) can be a secondary response to some autoimmune disorders. However, there is no data about the possibility of acquired PRCA being a secondary complication to ankylosing spondylitis (AS). PATIENT CONCERNS: A 42-year-old male who had a history of AS for 14 years. He got serious anemia 17 months ago. Bone marrow smear indicated PRCA. DIAGNOSE: He was diagnosed with acquired PRCA secondary to AS. INTERVENTION: The combination treatment of immunosuppressants with hematopoiesis stimuli was successful. OUTCOMES: The patient recovered from PRCA, and showed improvement in his AS. LESSONS: Acquired PRCA can be secondary to AS. Cyclosporine is effective in controlling AS arthritis syndrome and in addition to immunosuppressants, promotion of erythroid hematopoiesis is equally important.


Assuntos
Aplasia Pura de Série Vermelha/etiologia , Espondilite Anquilosante/complicações , Adulto , Ciclosporina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Aplasia Pura de Série Vermelha/diagnóstico , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/tratamento farmacológico
9.
BMC Musculoskelet Disord ; 20(1): 278, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170957

RESUMO

BACKGROUND: LncRNA LINC00311 participates in osteoporosis, which shows inverse pathological changes to ankylosing spondylitis (AS), indicating that LINC00311 is also involved in AS. METHODS: All the participants were enrolled in Ganzhou People's Hospital between January 2016 and January 2018 after this study was approved by Ganzhou People's Hospital Ethics Committee. Disease activity determination, follow-up and RT-qPCR were carried out during the research. RESULTS: In the present study we found that LINC00311 was upregulated in AS patients comparing to healthy controls, and upregulation of LINC00311 distinguished AS patients from healthy controls. LINC00311 expression levels were positively correlated with disease activity. Comparing to pre-treatment levels, LINC00311 expression level decreased significantly after treatment. During 2-year follow-up, patients with high levels of LINC00311 showed a significantly higher rate of rehospitalization. CONCLUSIONS: Therefore, LINC00311 is overexpressed in AS and predict treatment outcomes and recurrence.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Lombar/sangue , RNA Longo não Codificante/sangue , Espondilite Anquilosante/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Índice de Gravidade de Doença , Espondilite Anquilosante/sangue , Espondilite Anquilosante/tratamento farmacológico , Resultado do Tratamento , Regulação para Cima , Adulto Jovem
10.
BioDrugs ; 33(4): 391-399, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172372

RESUMO

Psoriasis is a chronic inflammatory skin disease with significant psychological and physical impact. Over the last few decades, several highly effective target therapies have been developed, leading to a major paradigm shift in the way psoriatic disease is managed. Despite this, a proportion of patients still do not respond or lose response over time. Bispecific antibodies target two different cytokines simultaneously, potentially offering a better disease control. Interleukin (IL)-17A and IL-17F share structural homology and have similar biologic function. IL-17A is classically considered to be the most biologically active, but recent studies have shown that IL-17F is also increased in psoriatic skin and synovial cell in psoriatic arthritis, supporting the rationale for targeting both IL-17A and IL-17F in psoriatic disease. Bimekizumab is the first-in-class monoclonal antibody designed to simultaneously target IL-17A and IL-17F. Bimekizumab is currently in clinical development for psoriasis, psoriatic arthritis, and ankylosing spondylitis, with promising results. In early clinical trials, bimekizumab demonstrated a rapid onset of action, good safety profile, and high tolerability by treated study participants. Long-term results and head-to-head trials comparing bimekizumab with other agents will be crucial to define the role of bimekizumab in the treatment of psoriatic disease.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Psoríase/tratamento farmacológico , Espondilite Anquilosante/tratamento farmacológico , Anticorpos Monoclonais Humanizados/farmacologia , Ensaios Clínicos como Assunto , Humanos , Interleucina-17/antagonistas & inibidores , Interleucina-17/imunologia , Psoríase/imunologia , Pele/efeitos dos fármacos , Pele/imunologia , Espondilite Anquilosante/imunologia , Membrana Sinovial/efeitos dos fármacos , Membrana Sinovial/imunologia , Resultado do Tratamento
11.
Int J Clin Pharm ; 41(4): 864-871, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172410

RESUMO

Background Although TNF inhibitors are well established in ankylosing spondylitis treatment, the majority of studies on TNF inhibitors safety have been performed in rheumatoid arthritis patients. Meanwhile, it seems that TNF inhibitors in ankylosing spondylitis may present a better safety profile than we thought. Objective The aim of our study was to retrospectively investigate the occurrence of adverse events in ankylosing spondylitis patients treated with TNF inhibitors. Setting A single referral center in Poland. Methods Detailed medical history of ankylosing spondylitis patients was obtained during the interview with the patient and by reviewing electronic medical records. Patients treated with TNF inhibitors and patients without TNF inhibitors treatment were compared. Main outcome measure The incidence of adverse events during the 3 months period before the interview. Results A total of 150 patients, 103 in the treatment group and 47 in the control group, were included in the study. There were no differences in the incidence of adverse events, serious adverse events, infections and opportunistic infections between both groups. However, in the treatment group, noninfectious adverse events were significantly less frequent than in control group (RR 0.39, 95% CI 0.23-0.66), with abdominal pain as the most common noninfectious adverse event (RR 0.20, 95% CI 0.07-0.63). The differences in incidence rates of specific infections were not significant, except acute infectious diarrhea which also was less frequent in patients treated with TNF inhibitors (RR 0.17, 95% CI 0.03-0.85). The female gender was significantly associated with any adverse event occurrence (OR 2.36, 95% CI 1.15-4.83). Conclusion TNF inhibitors show a good safety profile in ankylosing spondylitis patients.


Assuntos
Dor Abdominal/epidemiologia , /efeitos adversos , Dor Abdominal/induzido quimicamente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Espondilite Anquilosante/tratamento farmacológico
14.
Rheumatol Int ; 39(7): 1263-1268, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31069444

RESUMO

The Internet is a widely used source for obtaining health-related information. With the widespread use of the Internet, access to information has become easier. YouTube is one of the major sources for health-related videos globally. YouTube provides a wide range of health-related information, but there are doubts about its quality and reliability. Therefore, we aimed to assess the quality of the most viewed secukinumab videos on YouTube. This is a descriptive study. A total of 180 secukinumab videos returned by the YouTube search engine ( http://www.youtube.com ) in response to a keywords query were evaluated in the study. The Global Quality Scale (GQS) was used to assess educational quality, and three groups were created: high quality, intermediate quality, and low quality. Video parameters were compared among the quality groups. After applying the exclusion criteria, 53 videos were analyzed; 18 (34%) videos were in the high-quality group, 17 (32%) were in the intermediate-quality group, and 18 (34%) were in the low-quality group. No significant difference was detected in terms of the number of views, likes, dislikes, and comments per day between the groups (p > 0.05). YouTube has a mixed structure of high, intermediate, and low-quality videos. The number of views, likes, dislikes, and comments per day should not be accepted as an indicator of quality for YouTube videos. In addition, patients should consider the importance of sources when obtaining online health-related information.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Disseminação de Informação , Educação de Pacientes como Assunto , Mídias Sociais , Espondilite Anquilosante/tratamento farmacológico , Humanos
15.
Int J Rheum Dis ; 22(7): 1202-1208, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062501

RESUMO

AIM: Several studies have described sensorineural deafness in ankylosing spondylitis (AS) patients while conductive hearing loss has been reported to be rare. In our study we have studied the prevalence of hearing loss (HL) among AS patients and its association with non-steroidal anti-inflammatory drug (NSAID) intake. METHODS: We studied 100 AS patients and 40 controls. HL was defined as pure-tone thresholds greater than 20 dB (decibel) in at least two frequencies of the audiogram. Severity of HL was defined as given by World Health Organization. Clinical details and cumulative NSAID doses were noted. RESULTS: Ninety-six of the 100 patients were male with mean age of 32 ± 12 years and mean duration of illness of 8.2 ± 6 years. Median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and cumulative NSAID dose were 3.5 ± 2.2, 2.75 ± 2, 3.7 ± 2.6 and 1202 ± 1290, respectively. Of the 48 with HL, 28 patients had bilateral HL. Twenty-nine patients had pure conductive HL while 16 had mixed HL (components of both sensory and conductive) and 3 had pure sensorineural HL. HL was mild in 38 patients, and moderate to severe in 10 patients. The presence of HL was associated with higher age (P ≤ 0.05). Conductive HL was at low frequency (0.25, 0.5, 1 kHz) in 70% of cases. Sensorineural HL was at high frequency (4, 8 kHz) in 75% of cases. There was no association of HL with disease parameters such as BASMI, BASDI, BASFI or cumulative NSAID dose. CONCLUSION: HL is common in AS. Conductive HL is more common than sensorineural HL. It is usually mild and occurs at low frequencies.


Assuntos
Perda Auditiva Bilateral/epidemiologia , Perda Auditiva Condutiva/epidemiologia , Perda Auditiva Neurossensorial/epidemiologia , Audição , Espondilite Anquilosante/epidemiologia , Adulto , Fatores Etários , Anti-Inflamatórios não Esteroides/efeitos adversos , Audiometria de Tons Puros , Estudos de Casos e Controles , Estudos Transversais , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/fisiopatologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Adulto Jovem
16.
Expert Opin Pharmacother ; 20(12): 1483-1491, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31095430

RESUMO

Introduction: Spondyloarthritis (SpA) refers to a group of disorders sharing common clinical, genetic and imaging characteristics. Axial (ax) SpA corresponds to a subgroup that mainly affects the axial skeleton, leading to inflammatory back pain and progressive radiographic changes of the sacroiliac joints and the spine. axSpA are currently subdivided into two forms, namely the radiographic and nonradiographic form, and are associated with musculoskeletal pain, restriction of spinal mobility, specific extra-articular features and overall, altered quality of life. The therapeutic management of axSpA has considerably progressed and is now well standardized. Areas covered: Herein, the author reviews the pharmacological treatments that may be used in axSpA, including radiographic and nonradiographic forms in addition to the role of nonsteroidal anti-inflammatory drugs (NSAIDs), TNF alpha (TNFi), and IL-17A (IL-17Ai) inhibitors. Expert opinion: NSAIDs remain the mainstay of initial therapy and biological agents may be then envisaged. TNFi and IL-17Ai may be used in axSpA, but physicians have more experience with TNFi. Only TNFi are licensed for the treatment of nonradiographic axSpA. IL-17Ai may be used as first or second line biologic disease modifying antirheumatic drugs (bDMARDs) and further results are needed to better define their position in the therapeutic management of axSpA.


Assuntos
Antirreumáticos/classificação , Antirreumáticos/uso terapêutico , Espondilartrite/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Humanos , Interleucina-17/antagonistas & inibidores , Dor/tratamento farmacológico , Dor/epidemiologia , Qualidade de Vida , Espondilartrite/epidemiologia , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores
17.
Arch Med Res ; 50(1): 41-46, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-31101242

RESUMO

BACKGROUND: Gut inflammation is closely related to spondyloarthritis (SpA) pathophysiology. Fecal calprotectin has been used to measure the degree of gut inflammation. The phenotype of SpA may change according to studied population. AIM: To study the fecal calprotectin levels in a sample of SpA in Brazilian patients and its relationship with epidemiological, clinical and treatment variables as well as with the macro and microscopic degree of gut inflammation. METHODS: Eighty five SpA patients were studied for epidemiological and clinical features, functional and inflammatory indexes and fecal calprotectin levels measured using a ELISA kit. Colonoscopy with intestinal biopsies were performed in 39 of them. At time of colonoscopy a second calprotectin level was done after suspension of at least 3 weeks of used anti-inflammatory nonsteroidal drugs (NSAIDs). RESULTS: Fecal calprotectin levels were higher in Ankylosing Spondylitis (AS) patients (p <0.0001) and in those with axial involvement (p = 0.002). No relationship was found with SpA inflammatory and functional parameters (all p = ns). After suspension of NSAIDs, a drop in fecal calprotectin levels was observed (from median levels of 215.0-76.0 µg/g; p = 0.01). In the colonoscopy, 33.3% had macroscopic signs of inflammation and these patients had higher calprotectin (p = 0.009) than others. Microscopic examination showed that all patients had lymphoplasmacytic infiltrate and eosinophilic infiltrate; epithelial erosion was present in 27.2%. CONCLUSIONS: Patients with ankylosing spondylitis and axial forms of diseases have higher fecal calprotectin levels. Patients with all types of SpA have microscopic inflammatory changes in the gut.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Intestinos/patologia , Complexo Antígeno L1 Leucocitário/análise , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/patologia , Biomarcadores/análise , Brasil/epidemiologia , Colonoscopia , Ensaio de Imunoadsorção Enzimática , Fezes/química , Feminino , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/epidemiologia
18.
Medicine (Baltimore) ; 98(20): e15227, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096431

RESUMO

The study aimed to demonstrate the clinical application value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing a clinical curative effect of early ankylosing spondylitis (AS).Forty-eight patients with early AS who were already treated combinations by traditional Chinese and Western medicine were involved in this study. All subjects underwent the conventional MRI, DWI, and DCE-MRI scanning of bilateral sacroiliac joints before and after treatment. The relevant data, such as the mean apparent diffusion coefficient (ADC) value, time-intensity curve of subarticular surface bone marrow, and the relationship between ADC value and enhancement factor (Fenh), enhancement slope (Senh), and time to peak (TTP), were obtained.1. The mean ADC value of the subarticular surface bone marrow of patients and after clinical treatment was (5.05 ±â€Š1.10) × 10 and (4.34 ±â€Š0.55) × 10 mm/s in ilium and (4.63 ±â€Š0.79) × 10 and (3.96 ±â€Š0.23) × 10 mm/s in sacrum, respectively. 2. In the DCE-MRI follow-up treatment imaging of 48 patients with AS (192 parts), the TIC curve type recorded was as follows: 43.75% (84/192) of type II, 56.25% (108/192) of type III, and type I curve was not seen. The number of type II curve was significantly reduced for pre treatment group (84 cases) compared with that post treatment group (124 cases). The Fenh, Senh, and TTP values were respective (113.38 ±â€Š44.71)%, (60.94 ±â€Š38.56)% min, (129.52 ±â€Š42.66) s in ilium and (83.03 ±â€Š20.39)%, (44.91 ±â€Š15.19)% min, (123.44 ±â€Š28.50) s in sacrum before clinical treatment. After the treatment, the Fenh, Senh, and TTP values were respective (75.90 ±â€Š17.97)%, (33.96 ±â€Š11.36)% min, (138.67 ±â€Š26.60) s in ilium and (73.28 ±â€Š15.67)%, (31.92 ±â€Š8.15)% min, (140.19 ±â€Š19.88) s in sacrum. The Fenh, Senh, and TTP values of semiquantitative indexes before and after clinical treatment were significantly different.DWI and DCE-MRI sequences can help evaluate the degree of active changes in AS inflammation and treatment effect in patients with early AS, and provide reliable imaging evidence.


Assuntos
Meios de Contraste/administração & dosagem , Imagem de Difusão por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Inflamação/patologia , Masculino , Articulação Sacroilíaca/efeitos dos fármacos , Articulação Sacroilíaca/patologia , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/patologia , Espondilite Anquilosante/terapia , Adulto Jovem
20.
Int J Rheum Dis ; 22(8): 1506-1511, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31090201

RESUMO

OBJECTIVES: To compare clinical characteristics, disease activity, patient-reported outcomes and associated comorbidities between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthitis (nr-axSpA) in a multi-ethnic Asian population of Singapore. METHODS: We used data from the PREcision medicine in SPONdyloarthritis for Better Outcomes and Disease Remission (PRESPOND) registry in Singapore General Hospital. All patients fulfilled 2009 Assessment in AS International Working Group classification criteria for axial SpA (axSpA). Of these, all AS patients fulfilled the 1984 modified New York criteria. Baseline characteristics, medications, disease activity, patient-reported outcomes and inflammatory markers were recorded using standardized questionnaires. RESULTS: Two hundred and sixty-two axSpA patients (82% Chinese, 79% male) were included. Mean age (SD) at diagnosis was 32.4 (13.1) years, which was similar between AS and nr-axSpA patients. AS patients were older (mean age 42.7 [13.5] vs 37.4 [13.8] years, P = 0.02), had longer disease duration (mean disease duration 10.9 [8.7] vs 6.4 [4.8] years, P < 0.01), higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (mean BASMI 3.1 [2.3] vs 1.5 [1.5], P < 0.01), more frequently human leukocyte antigen (HLA)-B27 positive (82% vs 68%, P = 0.03), associated with uveitis (33% vs 17%, P = 0.03), and hypertensive (17% vs 0%, P < 0.01) compared to nr-axSpA, respectively. Nr-axSpA patients had higher Bath Ankylosing Spondylitis Global Score (BAS-G) (mean BAS-G 46.9 [16.8] vs 38.6 [20.6], P < 0.01), Bath Ankylosing Spondylitis Disease Activity Index (mean [SD] 4.2 [1.6] vs 3.5 [1.9], P = 0.02) and AS quality of life (ASQoL) (mean ASQoL 4.9 [4.8] vs 3.5 [4.1], P = 0.04) scores compared to AS patients respectively at baseline. Patient global assessment, Bath Ankylosing Spondylitis Functional Index, AS Disease Activity Score - C-reactive protein (CRP), Health Assessment Questionnaire, Short-Form 36 physical component summary and mental component summary were similar in both groups at baseline, as were medications used and mean erythrocyte sedimentation rate and CRP. CONCLUSIONS: In our multi-ethnic Asian cohort, patients with AS are more likely to be HLA-B27 positive, have uveitis, hypertensive, and have poorer spinal mobility, while nr-axSpA patients tend to experience poorer well-being and quality of life.


Assuntos
Espondilartrite , Espondilite Anquilosante , Adulto , Grupo com Ancestrais do Continente Asiático , Comorbidade , Estudos Transversais , Progressão da Doença , Feminino , Antígeno HLA-B27/imunologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Singapura/epidemiologia , Espondilartrite/diagnóstico por imagem , Espondilartrite/tratamento farmacológico , Espondilartrite/etnologia , Espondilartrite/imunologia , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/etnologia , Espondilite Anquilosante/imunologia , Resultado do Tratamento , Adulto Jovem
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