Therapeutic strategy for rheumatoid arthritis patients who have achieved remission

Publication date: December 2018Source: Joint Bone Spine, Volume 85, Issue 6Author(s): Bruno FautrelAbstractOnce remission or low disease activity (LDA) is attained in established rheumatoid arthritis (RA) patients, attempting disease-modifying anti-rheumatic drug (DMARD) tapering appears to be a viable option to avoid patient overtreatment. Potential benefits include reduction in the treatment burden and the risk of adverse events, although the latter has not been demonstrated convincingly. The feasibility of DMARD discontinuation has been tested in numerous studies or trials. All have revealed a high risk of relapse, ranging from 56%–87% at one year. Although remission/LDA can usually be re-established by re-initiation of the previous treatment, the associated risk appears to be more harmful than beneficial. DMARD tapering, either by dose reduction or by injection spacing, is conceptually more acceptable and two superiority randomized controlled trials (RCTs) comparing half-dose etanercept to full-dose continuation demonstrated no significant difference at one year. By contrast, two equivalence RCTs that tested disease activity-guided dose optimization by progressive etanercept and adalimumab injection spacing versus continuation revealed an increased risk of acute flare. Interestingly, one of these also demonstrated the equivalence of increasing injection spacing and standard of care in terms of recurrent flare and overall disease activity over the 18-month follow-up ...
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research

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Joint pain in rheumatoid arthritis (RA) represents a significant health burden. Although RA pain is conventionally thought to result from inflammation, it often persists even after control of inflammation with available therapies, suggesting the additional involvements of non-inflammatory mechanisms. Yet, such mechanisms remain largely unexplored. Our in situ hybridization assays suggested that the immune complex receptor Fc γRI was expressed in a subpopulation of joint sensory neurons. Consistent with this finding, the proportion of joint sensory neurons exhibiting a Ca2+ increase in response to IgG-immune complex (...
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
This study evaluated the efficacy of a single intraperitoneal injection of CA1001 (a novel dual-acting, peripherally restricted kappa/delta opioid agonist) on hyperalgesic nociceptive behaviors in the CFA (Complete Freund's Adjuvant) Model of Inflammatory Arthritis Pain in Rats.
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
Condition:   Rheumatoid Arthritis Intervention:   Drug: Infliximab [infliximab biosimilar 3] Sponsor:   Pfizer Not yet recruiting
Source: - Category: Research Source Type: clinical trials
This study is designed to examine and identify the factors influencing self-care competence in Korean women with rheumatoid arthritis. Methods: A cross-sectional descriptive design was employed. Participants included 132 women aged 20 years or older who were visiting rheumatoid arthritis outpatient clinics at hospitals in Seoul and Gyeonggi-do, South Korea. Measures included a demographics form, Self-as-Carer Inventory, Korean Activities of Daily Living scale, Visual Analogue Scale, Mishel Uncertainty in Illness Scale–Community Form, and Self-esteem Scale. Results: The analyses illustrated the significance of t...
Source: Journal of Nursing Research - Category: Nursing Tags: ORIGINAL ARTICLES Source Type: research
CONCLUSION: The reported results of treatments for plantar fasciitis and metatarsalgia are heterogeneous. The efficacy of the individual measures should be studied in randomized controlled trials. PMID: 30892183 [PubMed - in process]
Source: Deutsches Arzteblatt International - Category: General Medicine Tags: Dtsch Arztebl Int Source Type: research
Authors: Peixoto A, Martins Rocha T, Santos-Antunes J, Aguiar F, Bernardes M, Vaz C, Pereira P, Macedo G Abstract The authors report the case of a 76 year-old man with rheumatoid arthritis treated with prednisolone and etanercept. The patient was seen for persistent changes in liver tests lasting for six months, with a mixed pattern. The patient denied intake of new drugs or dietary/herbal supplements. Imaging studies showed mild steatosis. Additional study for chronic liver diseases only revealed positivity for anti-nuclear antibodies. Liver biopsy revealed noncaseating granulomas in some portal tracts. Consequent...
Source: Acta Gastro-Enterologica Belgica - Category: Gastroenterology Tags: Acta Gastroenterol Belg Source Type: research
Authors: Lenfant M, Callemeyn J, Alaerts H, Meersseman W, Van Moerkercke W Abstract A 62-year-old man of North African descent presented with weight loss in the past year and diarrhea for three weeks. His medical history included erosive rheumatoid arthritis, treated with methotrexate and adalimumab. Histological examination of a duodenal biopsy showed foamy macrophages in the lamina propria, with PAS-positive cytoplasmatic inclusions. These findings are compatible with Whipple's disease, a rare chronic infectious disease caused by Tropheryma whipplei, an opportunistic bacterium. It is typically seen in middle-aged...
Source: Acta Gastro-Enterologica Belgica - Category: Gastroenterology Tags: Acta Gastroenterol Belg Source Type: research
Authors: Zhang Z, Cao Y, Yuan Q, Zhang A, Zhang K, Wang Z Abstract Shexiang-Wulong Pill (SWP) is derived from "Moschus Yuan," first formulated during the Song Dynasty for the treatment of joint pain. The aim of this study was to evaluate the therapeutic effect of SWP in a mouse model of collagen-induced arthritis (CIA). Forty-five DBA/1 mice were randomly divided into control group, model group, and SWP-treated group. SWP was administered by oral gavage for 22 days after the booster immunization. The clinical arthritic scores and joint histopathology, including synovial hyperplasia and hypoxic regions, ca...
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
Discussion: The observed constellation of dependencies between variables indicates that the choice of treatment scheme differentiates pain levels. This confirms the assumption that pain intensity, coping strategies, and ego resiliency depend on the severity of anxiety and depression. PMID: 30886858 [PubMed - in process]
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
AbstractThis review aims to determine the specific effects of PA on systemic levels of interleukins and inflammatory markers. A systematic literature search was conducted in three computerized bibliographic databases (Medline, Embase, CENTRAL) to identify randomized controlled trials and matched case studies. Applied key words were: RA and PA including the terms exercise, exercise therapy, gymnastics and exercise movement techniques. Inclusion criteria were data on all types of proinflammatory interleukins (IL), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). For data synthesis, the populations, interven...
Source: Rheumatology International - Category: Rheumatology Source Type: research
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