International journal of rheumatic diseases
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Comparative Study
Serum procalcitonin as a diagnostic aid in patients with acute bacterial septic arthritis.
Septic arthritis is a common and serious problem. Early detection and prompt treatment improve outcomes. ⋯ Serum procalcitonin has a potential role in diagnosing acute bacterial septic arthritis, especially if arthrocenthesis cannot be performed.
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The aim of this study was to investigate the incidence of tuberculosis (TB) following anti-tumor necrosis factor (TNF) therapy in an intermediate TB burden area and to compare the risk between drugs and diseases. ⋯ The difference in TB risk between TNF inhibitors was similar with countries of low TB burden. This study suggests that particular attention is required for patients treated with TNF monoclonal antibodies.
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Autologous hematopoietic stem cell transplant (HSCT) for rapidly progressive disease has not been reported in localized scleroderma. Our patient, a 16-year-old girl had an aggressive variant of localized scleroderma, mixed subtype (linear-generalized) with Parry Romberg syndrome, with no internal organ involvement, that was unresponsive to immunosuppressive therapy and was causing rapid disfigurement. She was administered autologous HSCT in June 2011 and has maintained drug-free remission with excellent functional status at almost 3.5 years of follow-up.
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The management of systemic lupus erythematosus (SLE) is complicated by heterogeneous clinical presentations, a lack of universally accepted tools for the measurement of disease activity and a lack of powerful, safe, specific targeted therapies. Current medical treatment of disease activity relies on glucocorticoids as well as agents including hydroxychloroquine (HCQ), mycophenolate mofetil (MMF) azathioprine (AZA), and less frequently cyclophosphamide. ⋯ Measurement of drug or metabolite concentrations has been shown in a number of studies to identify under- and over-dosing, predict efficacy and detect non-adherence to therapy, with positive associations between optimum drug or metabolite levels and improved outcomes. In this paper, we will review the literature regarding the measurement of HCQ, MMF, AZA and cyclophosphamide drug and metabolite levels in SLE and inflammatory disease, and make recommendations for future research that could facilitate improved outcomes for patients with SLE.
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Significant progress has been made in the development of therapies for systemic lupus erythematosus (SLE). These include agents which target interferons, cytokines, T lymphocytes and co-stimulatory molecules, B-lymphocytes and B stimulatory molecules. The latter are of special interest having the most robust efficacy data to date, ranging from clinical experience to clinical trials, with belimumab as the first Food and Drug Administration-approved biologic for the treatment of SLE. Given the wide disease heterogeneity, certain issues like clinical trial design and pharmacogenomics will continue to challenge drug development in SLE, there will always be a growing and compelling need for more of these drugs in order to alleviate the burden of illness in lupus patients.