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  • Online Resource  (14)
  • SAGE Publications  (14)
  • 1
    Online Resource
    Online Resource
    Standardization of the Modified Rodnan Skin Score for Use in Clinical Trials of Systemic Sclerosis
    SAGE Publications ; 2017
    In:  Journal of Scleroderma and Related Disorders Vol. 2, No. 1 ( 2017-01), p. 11-18
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 2, No. 1 ( 2017-01), p. 11-18
    Abstract: The modified Rodnan skin score (mRSS) is a measure of skin thickness and is used as a primary or secondary outcome measure in clinical trials of systemic sclerosis (scleroderma). This state-of-art review provides a historical perspective of the development of the mRSS, summarizes the performance of mRSS as an outcome measure, provides guidance on assessing mRSS, and makes recommendations for incorporation of the mRSS into clinical trials.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.5301/jsrd.5000231
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2964332-6
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  • 2
    Online Resource
    Online Resource
    Patient-reported outcome instruments for assessing Raynaud’s phenomenon in systemic sclerosis: A SCTC vascular working group report
    SAGE Publications ; 2018
    In:  Journal of Scleroderma and Related Disorders Vol. 3, No. 3 ( 2018-10), p. 249-252
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 3, No. 3 ( 2018-10), p. 249-252
    Abstract: The episodic nature of Raynaud’s phenomenon in systemic sclerosis has led to a reliance on patient-reported outcome instruments such as the Raynaud’s Condition Score diary. Little is known about the utilization in routine clinical practice and health professional attitudes toward existing patient-reported outcome instruments for assessing systemic sclerosis-Raynaud’s phenomenon. Members of the Scleroderma Clinical Trials Consortium Vascular Working Group (n = 28) were invited to participate in a survey gauging attitudes toward the Raynaud’s Condition Score diary and the perceived need for novel patient-reported outcome instruments for assessing patient-reported outcome. Nineteen Scleroderma Clinical Trials Consortium Vascular Working Group members (68% response rate) from academic units based in North America (n = 9), Europe (n = 8), South America (n = 1) and Australasia (n = 1) took part in the survey. There was broad consensus that Raynaud’s Condition Score diary returns could be influenced by factors including seasonal variation in weather, efforts made by patients to avoid or ameliorate attacks of Raynaud’s phenomenon, habituation to Raynaud’s phenomenon symptoms, evolution of Raynaud’s phenomenon symptom characteristics with progressive obliterative microangiopathy, patient-coping strategies, respondent burden and placebo effect. There was consensus that limitations of the Raynaud’s Condition Score diary might be a barrier to drug development (79% of respondents agree/strongly agree) and that a novel patient-reported outcome instrument for assessing systemic sclerosis-Raynaud’s phenomenon should be developed with the input of both clinicians and patients (84% agree/strongly agree). Perceived potential limitations of the Raynaud’s Condition Score diary have been identified along with concerns that such factors might impede drug development programs for systemic sclerosis-Raynaud’s phenomenon. There is support within the systemic sclerosis community for the development of a novel patient-reported outcome instrument for assessing systemic sclerosis-Raynaud’s phenomenon.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.1177/2397198318774307
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 3
    Online Resource
    Online Resource
    Progress and Priorities in Systemic Sclerosis: The Next 10 Years – Report from the World Scleroderma Foundation
    SAGE Publications ; 2016
    In:  Journal of Scleroderma and Related Disorders Vol. 1, No. 1 ( 2016-01), p. 7-9
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 1, No. 1 ( 2016-01), p. 7-9
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.5301/jsrd.5000195
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 4
    Online Resource
    Online Resource
    Immunosuppression use in early systemic sclerosis may be increasing over time
    SAGE Publications ; 2022
    In:  Journal of Scleroderma and Related Disorders Vol. 7, No. 1 ( 2022-02), p. 33-41
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 7, No. 1 ( 2022-02), p. 33-41
    Abstract: Immunosuppression remains the main treatment for progressing skin involvement, interstitial lung disease and inflammatory joint or muscle disease in systemic sclerosis. This study investigated the pattern and trends in immunosuppressive agents used in early systemic sclerosis (diagnosed before and after 2007) to determine whether the changes in the preferred type, timing and combination of immunosuppression took place over the past decade. Methods: In total, 397 Canadian Scleroderma Research Group database patients (183 diffuse cutaneous systemic sclerosis and 214 limited cutaneous systemic sclerosis) who had baseline and follow-up visits within 3 years (mean: 1.8 ± 0.8) after disease onset were included: 82% females, age at diagnosis 53 ± 13 years. Bivariate, chi-square, analysis of variance and adjusted regression analyses were used. Results: In total, 115 diffuse cutaneous systemic sclerosis patients (63%) and 62 limited cutaneous systemic sclerosis (29%) received immunosuppressive drugs, most commonly methotrexate, followed by mycophenolate mofetil and cyclophosphamide. In diffuse cutaneous systemic sclerosis, immunosuppressants were prescribed after 2007 more often (74% vs 50%, p = 0.001), especially methotrexate ( p = 0.02) and mycophenolate mofetil ( p = 0.04), and earlier (peak at 2 years after onset). Immunosuppressive therapy was associated with male gender, interstitial lung disease, anti-Scl70 positivity, ACA negativity and inflammatory joint disease in limited cutaneous systemic sclerosis and with ACA negativity and a higher modified Rodnan skin score in diffuse cutaneous systemic sclerosis. Multivariate regression analysis showed that the use of immunosuppressants after 2007 was predicted only by ACA negativity in limited cutaneous systemic sclerosis and by younger age in diffuse cutaneous systemic sclerosis. Conclusion: Over the past decade, there has been a trend to prescribe immunosuppressants more often and earlier in diffuse cutaneous systemic sclerosis patients, regardless of modified Rodnan skin score. Methotrexate is being more frequently used, and mycophenolate mofetil has gained favour over cyclophosphamide. Autoantibody status was the most consistent predictor of immunosuppressive therapy.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.1177/23971983211000971
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    Digital Ulcers in Ssc Treated with Oral Treprostinil: A Randomized, Double-Blind, Placebo-Controlled Study with Open-Label Follow-up
    SAGE Publications ; 2017
    In:  Journal of Scleroderma and Related Disorders Vol. 2, No. 1 ( 2017-01), p. 42-49
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 2, No. 1 ( 2017-01), p. 42-49
    Abstract: Prostacyclins are routinely used to treat vascular features of systemic sclerosis (SSc, scleroderma) but require parenteral infusion or inhalation. This study evaluated the safety and efficacy of oral treprostinil in digital ulcers secondary to SSc. Methods This was a randomized (1:1) placebo-controlled, multicenter study in adults with SSc and at least one active digital ulcer at entry. Oral treprostinil was administered twice daily and titrated to maximum tolerated dose with clinical assessments at Weeks 5, 10, 15 and 20. The primary endpoint was change in net digital ulcer burden. Secondary outcomes included ulcer healing and prevention, measures of hand function, quality of life, Raynaud phenomenon and global assessments. Simplified data were gathered during open-label follow up. Results Enrolled were 147 patients (109F/38M), mean age 48.8 years with SSc of mean duration 10.5 years. At week 20, mean net ulcer burden was reduced −0.43 ulcers on treprostinil (1.80 vs. 1.37) and −0.10 ulcers on placebo (1.61 vs. 1.51; p = 0.20). There were no effects on ulcer healing or prevention, and small, inconsistent effects on Raynaud phenomenon, global assessment, hand function and quality-of-life measures. In open-label follow-up, there was a continued, small reduction in net ulcer burden (-0.52 month 3, n = 104; −0.64 month 12, n = 36). Common adverse effects were headache, nausea, diarrhea, jaw pain, flushing and other gastrointestinal symptoms. Conclusions Administration of oral treprostinil twice daily over 20 weeks was associated with small and statistically insignificant reduction in net ulcer burden in comparison to placebo.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.5301/jsrd.5000232
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 6
    Online Resource
    Online Resource
    Reduction in Serum Uric Acid may be Related to Methotrexate Efficacy in Early Rheumatoid Arthritis: Data from the Canadian Early Arthritis Cohort (CATCH)
    SAGE Publications ; 2016
    In:  Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders Vol. 9 ( 2016-01), p. CMAMD.S38092-
    Details
    In: Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, SAGE Publications, Vol. 9 ( 2016-01), p. CMAMD.S38092-
    Abstract: The mechanism of action of methotrexate in rheumatoid arthritis (RA) is complex. It may increase adenosine levels by blocking its conversion to uric acid (UA). This study was done to determine if methotrexate lowers UA in early RA (ERA). Methods Data were obtained from Canadian Early Arthritis Cohort, an incident ERA cohort. All ERA patients with serial UA measurements were included, comparing those with methotrexate use vs. no methotrexate exposure (controls). Analyses were exploratory. Patients with concomitant gout or taking UA-lowering therapies were excluded. Results In total, 49 of the 2,524 ERA patients were identified with data available for both pre-methotrexate UA levels and post-methotrexate UA levels (300 μmol/L and 273 μmol/L, respectively; P = 0.035). The control group not taking methotrexate had a mean baseline UA level of 280 μmol/L and a follow-up level of 282 μmol/L ( P = 0.448); mean change in UA with methotrexate was -26.8 μmol/L vs. 2.3 μmol/L in the no methotrexate group ( P = 0.042). Methotrexate users with a decrease in UA had a disease activity score of 2.37 for 28 joints when compared with the controls (3.26) at 18 months ( P = 0.042). Methotrexate users with decreased UA had a lower swollen joint count (SJC) of 0.9 at 18 months, whereas methotrexate users without lowering of UA had an SJC of 4.5 ( P = 0.035). Other analyses were not significant. Conclusions Methotrexate response is associated with lowering of serum UA in ERA compared to nonusers. This may be due to changes in adenosine levels. Methotrexate response is associated with lower UA and fewer swollen joints compared to nonresponders.
    Type of Medium: Online Resource
    ISSN: 1179-5441 , 1179-5441
    URL: Article
    DOI: 10.4137/CMAMD.S38092
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2590933-2
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  • 7
    Online Resource
    Online Resource
    Psoriasis and Smoking : A Systematic Literature Review and Meta-Analysis With Qualitative Analysis of Effect of Smoking on Psoriasis Severity
    SAGE Publications ; 2016
    In:  Journal of Cutaneous Medicine and Surgery Vol. 20, No. 3 ( 2016-05), p. 221-227
    Details
    In: Journal of Cutaneous Medicine and Surgery, SAGE Publications, Vol. 20, No. 3 ( 2016-05), p. 221-227
    Abstract: Smoking has been associated with psoriasis prevalence and severity. Objective: To evaluate prevalence of smoking in patients with psoriasis and to examine the relationship between smoking and psoriasis severity. Methods: MEDLINE, EMBASE, and Cochrane databases (1960-2012) and conference proceedings (2010-2012) were systematically searched using keywords relevant to psoriasis and smoking. Controlled studies addressing psoriasis and smoking status were included. A meta-analysis for the relative risk of smoking in psoriasis patients was performed. Results: Meta-analysis identified a significant association between smoking and psoriasis with a relative risk of 1.88 (95% CI, 1.66-2.13) for smoking in patients with psoriasis versus patients without psoriasis. Eight articles of 11 with data on smoking and psoriasis severity suggested that severity increases with smoking status. Conclusions: This literature review is in favor of a positive association between the prevalence of smoking and psoriasis as well as an association between smoking and severity of psoriasis.
    Type of Medium: Online Resource
    ISSN: 1203-4754 , 1615-7109
    URL: Article
    DOI: 10.1177/1203475415616073
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2038674-6
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  • 8
    Online Resource
    Online Resource
    Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies
    SAGE Publications ; 2019
    In:  Journal of Cutaneous Medicine and Surgery Vol. 23, No. 1 ( 2019-01), p. 50-74
    Details
    In: Journal of Cutaneous Medicine and Surgery, SAGE Publications, Vol. 23, No. 1 ( 2019-01), p. 50-74
    Abstract: Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal. Objectives: To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations. Methods: A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system. Results: Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance. Conclusions: Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.
    Type of Medium: Online Resource
    ISSN: 1203-4754 , 1615-7109
    URL: Article
    DOI: 10.1177/1203475418811335
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 9
    Online Resource
    Online Resource
    A randomized, single-blinded cross-over trial of ischemic preconditioning in Raynaud's phenomenon
    SAGE Publications ; 2017
    In:  Journal of Scleroderma and Related Disorders Vol. 2, No. 3 ( 2017-09), p. 213-220
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 2, No. 3 ( 2017-09), p. 213-220
    Abstract: Ischemic preconditioning (IPC) is protective against future ischemia, with brief cycles of ischemia and reperfusion leading to the release of circulating endogenous compounds from ischemic cells. IPC may increase vasodilatory substances and improve Raynaud's phenomenon (RP). We hypothesized that IPC would be more effective than sham in RP treatment. Sample size required 18 participants to detect 5 fewer RP attacks per week. Methods This was a randomized single-blinded cross-over trial. The IPC intervention of inflating a standard blood pressure cuff on the upper arm (200 mmHg) and sham intervention (60 mmHg) were performed 3 times per week for 2 weeks, with a 2-week washout period between IPC and sham interventions. Cuff inflation was performed 4 times for 2.5 minutes, with 2.5 minutes between cuff inflation. Participants completed a daily diary on RP disease activity. Results Eighteen participants were enrolled (17 with secondary RP and 1 with primary RP); mean age 60.8 (SD 9.4) years, 89% female; and mean number of RP attacks/2 weeks in screen was 16.9 (SD 11.3). With IPC versus sham, results were not significant including an increase of 0.5 RP episodes/week (SD: 10.0; p = 0.84), decrease of 55.6 minutes per week (SD 516.4; p = 0.66), and a decrease in average severity of 0.4 points (on a scale of 0 to 10) (SD 12.9; p = 0.88). Secondary outcomes were also not significant. Conclusions No significant differences in RP disease activity were found between IPC and sham. This could be due to lack of effect of IPC on RP, too few treatments, or sham having a partial effect.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.5301/jsrd.5000253
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 10
    Online Resource
    Online Resource
    Management of Raynaud’s phenomenon in systemic sclerosis—a practical approach
    SAGE Publications ; 2019
    In:  Journal of Scleroderma and Related Disorders Vol. 4, No. 2 ( 2019-06), p. 102-110
    Details
    In: Journal of Scleroderma and Related Disorders, SAGE Publications, Vol. 4, No. 2 ( 2019-06), p. 102-110
    Abstract: Raynaud’s phenomenon is nearly universal in systemic sclerosis. Vasculopathy is part of systemic sclerosis. Raynaud’s phenomenon can cause of complications and impairment, especially when tissue ischemia and digital ulcers develop. There are many treatment options for Raynaud’s phenomenon in systemic sclerosis often with sparse data and few robust studies comparing the different treatment options. Recommendations from guidelines usually include calcium channel blockers as first-line pharmacological treatment. In the clinical setting, multiple variables such as financial factors, geography where access to medications varies, and patient factors, baseline hypotension, can influence the treatment for Raynaud’s phenomenon and digital ulcers. Prostacyclins and PDE-5 inhibitors are reserved for more severe Raynaud’s phenomenon or healing of digital ulcers. Prevention of digital ulcers may also include endothelin receptor blocker (bosentan) in some countries. Other treatments had less consensus. Algorithms developed by systemic sclerosis experts might be helpful in deciding which treatment to choose for each setting, using a step-wise strategy, which intends to complement guidelines. This review focuses on a practical approach to the treatment of Raynaud’s phenomenon and digital ulcers in systemic sclerosis, based on algorithms designed by systemic sclerosis experts using consensus, and we review the evidence that supports treatment from initial to second and third-line options.
    Type of Medium: Online Resource
    ISSN: 2397-1983 , 2397-1991
    URL: Article
    DOI: 10.1177/2397198318823951
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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