ARP Rheumatology最新文献

Introduction: Analyzing the high cost of long rehabilitation programs and clinical experiences from the recent pandemic, the aim of the study was to compare the effect of supervised and non-supervised physical exercises in patients with knee osteoarthritis considering pain and function.

Methods: Searches were conducted on the database PubMed, EMBASE, PEDro, and Cochrane for randomized clinical trials (RCT) involving adults with knee osteoarthritis. The risk of bias was analyzed using the risk of bias 2 tool and quality of evidence, using the GRADE. Meta-analysis was carried out by applying the differences of means and heterogeneity by the I2 statistics.

Results: Regarding the results, 642 studies were checked, out of them 7 were included in the qualitative analysis and 6 on the quantitative analysis, of which 6 for the outcome pain and 5 for the outcome function. Total sample consisted of 903 individuals, mostly female, mean age 63.05 years (SD=4.40), and strengthening and aerobic exercises were the most used. In general, the risk of bias was considered uncertain, the randomization process was effective in most articles and participant blinding was impaired because of the intervention with exercises. According to GRADE, the quality of evidence was moderate for both outcomes. Treatment effect was estimated at -0.67 (CI 95%, -2.09 to 0.74) for pain and -1.07 (CI 95%, -4.30 to 2.16) for function, and heterogeneity was classified as high for both outcomes.

Conclusions: In conclusion, no significant differences were observed between supervised and non-supervised physical exercises in terms of pain and function of the osteoarthritis knee.

A 76-year-old woman with a 19-year history of rheumatoid arthritis (RA) presented with progressive cachexia and constitutional symptoms. Imaging revealed a suspicious hypermetabolic lesion in the cervical region, initially raising concerns of malignancy. Following excision, histopathology identified the lesion as a rheumatoid nodule, a rare extra-articular manifestation of RA in deep tissues like the thyroid membrane. The patient's symptoms were attributed to her autoimmune disease and cognitive decline. This case highlights the importance of considering rheumatoid nodules in the differential diagnosis of cervical masses in RA patients, potentially avoiding unnecessary surgical interventions.

Introduction: The current standard of care of patients with spondyloarthritis (SpA), in addition to pharmacological treatment, includes regular exercise and patient education.(1) The primary goal of this systematic literature review (SLR) is to update the evidence of the effectiveness of education programs for patients with axial SpA (axSpA).

Methods: We systematically searched three databases, PubMed, Embase and Web of Science Core Collection, from January 2000 to June 2023, using the following terms: "patient education", "patient counselling", "patient teaching", "patient engaging", "patient empowerment", "health education", "spondyloarthritis", "spondyloarthropaties", "spondylitis" and "ankylosing spondylitis". The "Population (P)", "Intervention (I)", "Comparator (C)", "Outcome (O)", PICO criteria were used. "P", defined as axSpA, "I" as education, "C" as standard of care or physical exercise and "O" as disease activity, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS); disease functional repercussion, Bath Ankylosing Spondylitis Functional Index (BASFI); disease metrological repercussion, Bath Ankylosing Spondylitis Metrological Index (BASMI); disease quality of life Ankylosing Spondylitis Quality of Life (ASQoL), EuroQol-5D (EQ-5D) and Short Form 36 Health Survey (SF36); disease economic impact, cost-utility, cost-benefit and incremental cost-effectiveness ratio (ICER). Only randomized clinical trials were included. Two reviewers independently assessed the identified papers according to the established criteria and extracted the data.

Results: From the initial 494 studies identified, 6 were selected for data extraction and qualitative analysis. The study sample sizes ranged between 41-65 individuals, all diagnosed with ankylosing spondylitis. The leaders of the programs varied, the intervention period ranged between 4-12 weeks and the follow up ranged between 3-12 months. In three studies, the comparator was standard of care, and in the other three was physical exercise. Overall, there was an improvement in BASDAI, BASFI, BASMI, ASQoL and SF-36, after the application of educational programs. No studies evaluated the economic impact of educational programs.

Conclusion: Education appears to be an important adjuvant as non-pharmacological treatment for patients with axSpA, enhancing various disease outcomes, particularly when delivered by Health Professionals using physical materials such as pamphlets. However, there is an ongoing need for additional research to obtain more robust conclusions.

Background: Case reports suggest that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) may trigger inflammatory flares in patients with autoimmune diseases.

Case description: A 56-year-old woman with a history of severe migraines, experienced improvement in migraine frequency and intensity after starting fremanezumab 225 mg monthly. However, three months into treatment, she developed symmetric inflammatory polyarthralgias. Physical examination confirmed polyarthritis in the hands, feet, and knees. Laboratory tests showed elevated inflammatory markers and positive anti-cyclic citrullinated peptide antibodies, with baseline X-rays of hands, feet, and knees being normal. Diagnosed with rheumatoid arthritis (RA), she was treated with prednisolone, methotrexate (MTX), folic acid, calcium carbonate, and cholecalciferol, resulting in clinical improvement. Despite recommendations, she continued fremanezumab; her articular symptoms persisted after discontinuation. Later, she switched to leflunomide 20 mg due to gastrointestinal intolerance to MTX and is currently in remission.

Discussion/conclusions: CGRP mAbs are effective for migraine prevention, but cases of immune-mediated disease flares are documented. This case suggests a possible association between CGRP mAbs and RA onset. Further research is essential to understand the impact of CGRP modulation in autoimmune diseases.

Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition affecting the axial skeleton, leading to pain, stiffness, and fatigue. While biologic therapies have improved clinical management, many patients experience partial or no responses, resulting in delays in disease control. Additionally, the risk of adverse events and increased costs remains a concern.

Objectives: Our primary objectives are: 1. to identify reliable markers for treatment response to Tumor Necrosis Factor alpha inhibitors (TNFi), in particular Adalimumab, enabling the identification of individuals most likely to benefit; 2. to analyze the impact of TNFi on gene and protein expression.

Methods: A multicenter, prospective 14-week study will be conducted with 36 participants aged 18-75 years, meeting the ASAS criteria for axSpA. Patient enrollment will follow the National Guidelines for the use of TNFi in axSpA treatment, with all included patients using TNFi (Adalimumab) as a first-line option. Epidemiological and clinical data will be collected, along with peripheral blood samples, for integrated transcriptome, using RNA Seq (whole genome sequencing) and proteome analysis at various time points (baseline, 3-5 days, weeks 2 and 14), corresponding to the initial administration of TNFi. Patients will be classified as responders and non-responders, primarily based on ASAS20 criteria and secondarily based on ASDAS-C Reactive Protein (CRP), at week 14.

Discussion: This project's innovative approach lies in identifying potential biomarkers for TNFi (Adalimumab) response at baseline, paving the way for advancements in precision medicine in this field. Additionally, it seeks to establish evidence of the therapy's impact on gene and protein expression, offering deeper insights into the pathophysiological mechanisms underlying the therapeutic response.