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  • 1
    Online Resource
    Online Resource
    TNF‐α Antagonist Survival Rate in a Cohort of Rheumatoid Arthritis Patients Observed under Conditions of Standard Clinical Practice
    Wiley ; 2009
    In:  Annals of the New York Academy of Sciences Vol. 1173, No. 1 ( 2009-09), p. 837-846
    Details
    In: Annals of the New York Academy of Sciences, Wiley, Vol. 1173, No. 1 ( 2009-09), p. 837-846
    Abstract: A cohort of rheumatoid arthritis (RA) patients in the Lombardy Rheumatology Network (LOHREN) registry and receiving anti‐TNF therapy was evaluated after 6, 12, 24, and 36 months. Of the 1114 patients in the registry 1064 met the clinical criteria for inclusion with 519 receiving infliximab, 303 adalimumab, and 242 etanercept. The therapeutic survival curve of these patients showed that the likelihood of continuing anti‐TNF therapy was 78.8% after 12 months, 65.2% after 24 months, and 52.9% after 36 months, with a risk of dropout similar for inefficacy and adverse events. There were 405 anti‐TNF therapy discontinuations (38.1%): 180 (16.9%) due to inefficacy, 194 (18.2%) adverse events, and 31 (2.9%) other reasons. Four deaths (2 septicemia, 1 postinfective cerebritis, 1 heart failure) were considered to be related to anti‐TNF therapy. Of the discontinuations, 219 (54.1%) occurred within the first 12 months: 110 due to adverse events, 89 inefficacy, and 20 due to other reasons. After 36 months, the likelihood of survival on etanercept (62.5%) was significantly greater than the likelihood of survival on infliximab (49.1%) or adalimumab (53.6%). A higher risk of therapy discontinuations due to adverse events was associated with increasing age, a corticosteroid 〉 5 mg/day, a high erythrocyte sedimentation rate (ESR), a higher risk of therapy discontinuations due to inefficacy was associated with the previous use of ≥4 disease‐modifying antirheumatic drugs (DMARDs) and a high ESR. Comorbidities, increasing DAS28 values and co‐therapy with methotrexate were associated with a lower risk of discontinuation.
    Type of Medium: Online Resource
    ISSN: 0077-8923 , 1749-6632
    URL: Issue
    URL: Article
    DOI: 10.1111/nyas.2009.1173.issue-1
    DOI: 10.1111/j.1749-6632.2009.04621.x
    RVK:
    TD 7650
    Language: English
    Publisher: Wiley
    Publication Date: 2009
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    SSG: 11
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  • 2
    Online Resource
    Online Resource
    Glucocorticoid Effects on Adrenal Steroids and Cytokine Responsiveness in Polymyalgia Rheumatica and Elderly Onset Rheumatoid Arthritis
    Wiley ; 2006
    In:  Annals of the New York Academy of Sciences Vol. 1069, No. 1 ( 2006-06), p. 307-314
    Details
    In: Annals of the New York Academy of Sciences, Wiley, Vol. 1069, No. 1 ( 2006-06), p. 307-314
    Abstract: Abstract:  Polymyalgia rheumatica (PMR) usually exhibits a good clinical response to glucocorticoid (GC) treatment, but early clinical symptoms may create some difficulties in the differential diagnosis with elderly onset rheumatoid arthritis (EORA), particularly in patients complaining of shoulder and pelvic girdle involvement at onset (PMR‐like clinical onset) (EORA/PMR). Since neuroendocrine mechanisms seem to play a pathogenetic role in these clinical conditions, the aim of this study was to evaluate hormone and cytokine responsiveness to GC treatment in these patients. Cortisol (CO), dehydroepiandrosterone sulphate (DHEAS), 17‐OH‐progesterone (PRG), interleukin‐1 receptor antagonist (IL‐1Ra), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNF‐α) were evaluated at base line, and 1 month after GC treatment (prednisone 10 mg/day), in 14 PMR, 11 EORA/PMR, and 13 EORA patients (mean age 73 ± 5 years, ± SD, mean disease duration 3 ± 2 months, ± SD). No patient was taking GCs or immunosuppressive agents at base line. Following GC treatment, CO, DHEAS, and PRG decreased significantly in both PMR and EORA/PMR patients ( P 〈 0.05), but not in EORA patients. On the contrary, IL‐1Ra was significantly increased in both PMR and EORA/PMR patients ( P 〈 0.05). IL‐6 and TNF‐α serum levels were significantly decreased in all groups of patients ( P 〈 0.05). In conclusion, PMR and EORA/PMR seem to exhibit similar hormonal variations after GC administration, when compared to EORA patients. These differences suggest a deficient function of the hypothalamic‐pituitary‐adrenal (HPA) axis in PMR and EORA/PMR patients, with a related higher responsiveness to GC treatment. Interestingly, in PMR and EORA/PMR patients, GC treatment was found to downregulate PRG serum levels.
    Type of Medium: Online Resource
    ISSN: 0077-8923 , 1749-6632
    URL: Article
    DOI: 10.1196/annals.1351.029
    RVK:
    TD 7650
    Language: English
    Publisher: Wiley
    Publication Date: 2006
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    detail.hit.zdb_id: 211003-9
    detail.hit.zdb_id: 2071584-5
    SSG: 11
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Predictive Value of Antibodies to Citrullinated Peptides and Rheumatoid Factors in Anti‐TNF‐α Treated Patients
    Wiley ; 2007
    In:  Annals of the New York Academy of Sciences Vol. 1109, No. 1 ( 2007-08), p. 287-295
    Details
    In: Annals of the New York Academy of Sciences, Wiley, Vol. 1109, No. 1 ( 2007-08), p. 287-295
    Abstract: Abstract :  This article will focus on the relationship between serum levels of anti‐citrullinated peptide antibodies (anti‐CCP) or rheumatoid factor (RF) and clinical response to TNF‐α blockers in order to evaluate whether these antibodies may have a role as serological markers of response to therapy in rheumatoid arthritis (RA). The changes induced in anti‐CCP levels after TNF blocking therapy still remain a controversial issue even though a marked reduction following conventional DMARDs has been reported in early disease. On the other hand, a drop in RF levels during treatment has been reported by many authors. Decreased IgM RF levels seem to parallel clinical response suggesting that this antibody can also be regarded as a marker of response to treatment. Pre‐treatment RF positivity or negativity does not influence response to TNF‐α blocking therapy while high pre‐treatment levels of IgA RF seem to be associated with a poor response rate.
    Type of Medium: Online Resource
    ISSN: 0077-8923 , 1749-6632
    URL: Article
    DOI: 10.1196/annals.1398.034
    RVK:
    TD 7650
    Language: English
    Publisher: Wiley
    Publication Date: 2007
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    detail.hit.zdb_id: 211003-9
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    SSG: 11
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  • 4
    Online Resource
    Online Resource
    Is the Course of Steroid‐Treated Polymyalgia Rheumatica More Severe in Women?
    Wiley ; 2006
    In:  Annals of the New York Academy of Sciences Vol. 1069, No. 1 ( 2006-06), p. 315-321
    Details
    In: Annals of the New York Academy of Sciences, Wiley, Vol. 1069, No. 1 ( 2006-06), p. 315-321
    Abstract: Abstract:  Polymyalgia rheumatica (PMR) has a marked preponderance in women. The female sex has been claimed to be a risk factor for longer‐course corticosteroid therapy and to be associated with more severe systemic symptoms and lower hemoglobin levels. Eighty consecutive patients affected by PMR, seen at two tertiary referral centers, were followed‐up for a mean period of 14.9 months after initiating corticosteroid treatment. At presentation, women had longer disease duration and lower hemoglobin levels (both P = 0.05) than men. In contrast, their systemic signs of PMR were less common ( P = 0.01). Women were treated with a slightly higher mean daily dose of prednisone ( P = 0.055), and assumed a significantly higher cumulative dosage of the drug ( P = 0.01). Accordingly, the mean number of steroid‐related side effects was higher among women ( P = 0.003). The number of relapses during steroid treatment ( P = 0.02), but not that of recurrences, was increased in women. ESR, which was raised at presentation, significantly declined during follow‐up to normal values in both subgroups ( P 〈 0.00001 by analysis of variance [ANOVA]). Its decrease was significantly more pronounced in men than in women. Hemoglobin at follow‐up was significantly higher in men than in women at any given time point. In conclusion, sex is probably modulating the response to corticosteroids. This finding emphasizes the need to consider differences between males and females in the clinical and therapeutic approach to PMR patients.
    Type of Medium: Online Resource
    ISSN: 0077-8923 , 1749-6632
    URL: Article
    DOI: 10.1196/annals.1351.030
    RVK:
    TD 7650
    Language: English
    Publisher: Wiley
    Publication Date: 2006
    detail.hit.zdb_id: 2834079-6
    detail.hit.zdb_id: 211003-9
    detail.hit.zdb_id: 2071584-5
    SSG: 11
    Location Call Number Limitation Availability
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    Online Resource
  • 5
    Online Resource
    Online Resource
    Early disease control by low‐dose prednisone comedication may affect the quality of remission in patients with early rheumatoid arthritis
    Wiley ; 2010
    In:  Annals of the New York Academy of Sciences Vol. 1193, No. 1 ( 2010-04), p. 139-145
    Details
    In: Annals of the New York Academy of Sciences, Wiley, Vol. 1193, No. 1 ( 2010-04), p. 139-145
    Abstract: In order to identify rate and stability of remission induced by low‐dose prednisone comedication in early rheumatoid arthritis (RA), we evaluated patients with early RA ( 〈 1 year) who were randomized to receive (P) or not (non‐P) low‐dose prednisone in association with step‐up disease‐modifying antirheumatic drug therapy over 2 years. Prevalence and duration of clinical remission were evaluated in the first and second year. Each treatment group included 105 patients; no significant differences were found at baseline. During the first year, P patients achieved higher rates of clinical remission with a time‐averaged odds ratio (OR) of 1.965 (CI 95% 1.214–3.182, P = 0.006). Moreover, they showed a higher probability of sustained remission during the second year (OR 4.480, CI 95% 1.354–14.817, P = 0.014). In conclusion, we found as in early RA low‐dose prednisone comedication is associated with higher rate of clinical remission, earlier disease activity control and more stable remission over time.
    Type of Medium: Online Resource
    ISSN: 0077-8923 , 1749-6632
    URL: Issue
    URL: Article
    DOI: 10.1111/nyas.2010.1193.issue-1
    DOI: 10.1111/j.1749-6632.2009.05367.x
    RVK:
    TD 7650
    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2834079-6
    detail.hit.zdb_id: 211003-9
    detail.hit.zdb_id: 2071584-5
    SSG: 11
    Location Call Number Limitation Availability
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    Online Resource
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