Rheumatology最新文献

Objectives: Negative illness perceptions(IPs) are associated with poorer disease-outcomes in rheumatoid arthritis(RA). Unfortunately, IPs are generally stable in established RA. We hypothesized that IPs, especially in the cognitive domain, are modifiable in arthralgia-at-risk of RA. We aimed to study if receiving DMARD-treatment, or the offer of DMARD-treatment associates with more positive IPs in patients with clinically-suspect-arthralgia(CSA).

Methods: The population studied were CSA-patients to which a wait-and-see approach was adopted without offering DMARD-treatment, or patients were offered DMARD-treatment via the TREAT EARLIER-trial and subsequently randomized to receive methotrexate or placebo. IP was assessed using the Brief-Illness-Perception-Questionnaire(BIPQ), covering cognitive, emotional and comprehensibility domains. The effect of DMARD-treatment on IPs over time was studied by comparing the 2-year-course of BIPQs of patients receiving methotrexate or placebo. The effect of offering DMARD-treatment was examined by comparing the BIPQs of CSA-patients in the trial with those undergoing a 'wait-and-see'-policy.

Results: In total 375 CSA-patients were studied, of which 236 of the TREAT EARLIER-trial and 139 with a wait-and-see approach. Patients who received treatment showed sustained improvements in IPs over time compared with placebo in four cognitive domains: experience of physical complaints(p= 0.040), the illness' influence on life (p= 0.001), treatment-effectiveness(p= 0.041) and disease-duration (p= 0.045). Comparison at baseline showed that CSA-patients to whom treatment was offered had more confidence in treatment (p< 0.001) and tented to have a deeper understanding of their disease (p= 0.054).

Conclusion: Both the prospect of and DMARD-treatment itself improved IPs in CSA, mainly in cognitive domains. These data suggest CSA as a suitable time period for influencing IPs', which may provide possibilities to improve disease outcomes in patients developing RA.

Objectives: Corticosteroids are used to abort disease flares in PFAPA syndrome. We aimed to obtain a global overview of physicians' corticosteroid usage strategies and analyze the data in the literature regarding corticosteroid use in PFAPA syndrome.

Methods: The JIR-CliPS PFAPA questionnaire included nine questions on corticosteroid use in addition to the demographic data questions. The survey was distributed via e-mail to potential respondents. The MEDLINE/PubMed and Scopus databases were searched systematically to extract the data regarding corticosteroid use in PFAPA syndrome.

Results: From 47 countries, 144 physicians (F/M = 2.6; 67.4% pediatric rheumatologists) answered the survey. Most respondents (n = 133; 92.4%) prescribe corticosteroids in PFAPA flares. The most frequently prescribed corticosteroid was prednisolone (63.2%). The definition of response to corticosteroid was indicated as "response within 12 h" by the highest number of respondents (n = 61; 42.4%). When corticosteroids cause an increase in attack frequency, most (57.9%) consider another treatment if this causes a decrease in quality of life. Forty-four (30.6%) respondents were "routinely" prescribing corticosteroids to PFAPA patients, and this practice was more frequent among more experienced physicians (p< 0.001).We identified 46 articles in the literature describing 4564 PFAPA patients treated with corticosteroids. Prednisone was the most frequently preferred corticosteroid (48.2%). Response to corticosteroids was around 95%, although an increase in attack frequency was noted in almost 35% of the patients.

Conclusion: Physicians frequently use corticosteroids for PFAPA in their routine clinical practice. Regarding treatment modification, the quality of life was a prominent consideration for physicians.