A rheumatoid arthritis gyógyszeres terápiája; a nemzetközi és a hazai szakirodalom szisztematikus áttekintése

Az új DMARD-ok: leflunomide, etanercept és infliximab terápia a tudományos bizonyítékok szisztematikus áttekintése; az RA prevalenciája és az egészségügyi igénybevételi mutatók Magyarországon

Az osteoarthritis és a rheumatoid arthritis hazai epidemiológiája és költségei

A szelektív cyclooxigenase-2 (cox-2) inhibitorok; rofecoxibum; a tudományos bizonyítékok szisztematikus áttekintése (hatásosság), valamint a hatékonyság és várható költségek Magyarországon

Efficacy and safety of infliximab-biosimilar compared to other biological drugs in rheumatoid arthritis: a mixed treatment comparison.

OBJECTIVE: The aim of this meta-analysis was to compare the efficacy and safety of infliximab-biosimilar and other available biologicals for the treatment of rheumatoid arthritis (RA), namely abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab. METHODS: A systematic literature review of MEDLINE database until August 2013 was carried out to identify relevant randomized controlled trials (RCTs). Bayesian mixed treatment comparison method was applied for the pairwise comparison of treatments. Improvement rates by the American College of Rheumatology criteria (ACR20 and ACR50) at week 24 were used as efficacy endpoints, and the occurrence of serious adverse events was considered to assess the safety of the biologicals. RESULTS: Thirty-six RCTs were included in the meta-analysis. All the biological agents proved to be superior to placebo. For ACR20 response, certolizumab pegol showed the highest odds ratio (OR) compared to placebo, OR 7.69 [95 % CI 3.69-14.26], followed by abatacept OR 3.7 [95 % CI 2.17-6.06], tocilizumab OR 3.69 [95 % CI 1.87-6.62] and infliximab-biosimilar OR 3.47 [95 % CI 0.85-9.7]. For ACR50 response, certolizumab pegol showed the highest OR compared to placebo OR 8.46 [3.74-16.82], followed by tocilizumab OR 5.57 [95 % CI 2.77-10.09], and infliximab-biosimilar OR 4.06 [95 % CI 1.01-11.54]. Regarding the occurrence of serious adverse events, the results show no statistically significant difference between infliximab-biosimilar and placebo, OR 1.87 [95 % CI 0.74-3.84]. No significant difference regarding efficacy and safety was found between infliximab-biosimilar and the other biological treatments. CONCLUSION: This is the first indirect meta-analysis in RA that compares the efficacy and safety of biosimilar-infliximab to the other biologicals indicated in RA. We found no significant difference between infliximab-biosimilar and other biological agents in terms of clinical efficacy and safety.

Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

The Longitudinal Course of Fatigue in Rheumatoid Arthritis : Results from the Norfolk Arthritis Register

Acknowledgment: The authors would like to thank the University of Manchester for access to the Norfolk Arthritis Register data and Professor Deborah Symmons for comments on an earlier draft of the manuscript. K.L.D. is funded by a studentship from the Institute of Applied Health Sciences, University of Aberdeen.

Predicting functional disability : One year results from the Scottish Early Rheumatoid Arthritis Inception Cohort

Peer reviewed

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

Viral Delivery of the Fat-1 Gene to Treat Post-Traumatic Arthritis with Diet-Induced Obesity

Post-traumatic arthritis (PTA) is arthritis that develops following joint injury, including meniscus and ligament tears. Current treatments for PTA range from over-the-counter medication to knee replacement; however, in the presence of obesity, the levels of pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α,) are more elevated than in non-obese individuals. The role of fatty acids, obesity, and PTA has been examined, with omega-3 fatty acids showing promise as an anti-inflammatory after injury due to its ability to suppress IL-1 and TNF-α. Due to the difficulty in switching patients’ diets, an alternative solution to increasing omega-3 levels needs to be developed. The Fat-1 enzyme, an omega-3 desaturase that has the ability to convert omega-6 to omega-3 fatty acids, may be a good target for increasing the omega-3 levels in the body.

In the first study, we examined whether Fat-1 transgenic mice on a high-fat diet would exhibit lower levels of PTA degeneration following the destabilization of the medial meniscus (DMM). Both male and female Fat-1 and wild-type (WT) littermates were put on either a control diet (10% fat) or an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery. Arthritic changes were examined 12 weeks post-surgery. Fat-1 mice on both the control and high-fat diet showed protection from PTA-related degeneration, while WT mice showed severe arthritic changes. These findings suggest that the omega-6/omega-3 ratio plays an important role in reducing PTA following injury, and demonstrates the potential therapeutic benefit of the Fat-1 enzyme in preventing PTA in both normal and obese patients following acute injury.

Following this, we needed to establish a translatable delivery mechanism for getting the Fat-1 enzyme, which is not present in mammalian cells, into patients. In the second study, we examined whether anti-inflammatory gene delivery of the Fat-1 enzyme would prevent PTA following DMM surgery. In vitro testing of both lentivirus (LV) and adeno-associated virus (AAV) was completed to confirm functionality and conformation of the Fat-1 enzyme after transduction. Male WT mice were placed on an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery; either local or systemic AAV injections of the Fat-1 enzyme or Luciferase, a vector control, were given immediately following surgery. 12 weeks post-surgery, arthritic changes were assessed. The systemic administration of the Fat-1 enzyme showed protection from synovial inflammation and osteophyte formation, while administration of Luciferase did not confer protection. These findings suggest the utility of gene therapy to deliver the Fat-1 enzyme, which has potential as a therapeutic for injured obese patients for the prevention of PTA.

Angehörigenratgeber : nehmen sie Bezug auf die eigene Belastung? : am Beispiel der rheumatoiden Arthritis

Die vorliegende Arbeit befasst sich mit der Frage, wie sich chronische Erkrankungen auf die Angehörigen auswirken und auf welchen Ebenen die Beratungsliteratur darauf Bezug nimmt. Im Speziellen geht es dabei um das Krankheitsbild der rheumatoiden Arthritis. Da sich eine Person immer in einem sozialen Geflecht (= System) befindet, wirkt sich eine chronische Erkrankung nicht nur auf die Patienten selbst, sondern auch auf deren Familien, Partner und Freunde aus. Dabei sind alle Lebensbereiche (psychisch, körperlich, sozial, beruflich, finanziell) betroffen, was eine komplexe Vielfalt an Belastungen hervorbringt. Die Untersuchung von 54 Rat gebenden Büchern und Broschüren zeigte, dass das Hauptanliegen überwiegend auf der Wissensvermittlung über das Krankheitsbild und mögliche Behandlungsmaßnahmen liegt. Emotionale, soziale und finanzielle Probleme, sowie Schwierigkeiten im Beziehungsgeschehen werden nur selten aufgegriffen. Teilweise zeigten sich Überschneidungen der tatsächlichen Belastungen/Bedürfnisse der Angehörigen und der in den Ratgebern behandelten Themen. Diese wurden jedoch mehrheitlich nur kurz und oberflächlich behandelt.