Seminars in arthritis and rheumatism
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Semin. Arthritis Rheum. · Jun 2017
Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): A nested case-control analysis.
Giant cell arteritis (GCA) is an inflammatory vasculitis preferentially affecting large and medium-sized arteries. High-dose oral glucocorticoids (GCs) are the mainstay of GCA therapy. Using data from the UK Clinical Practice Research Datalink (CPRD), we examined the risk of oral GC-related serious adverse events (SAEs) in a UK population of patients with giant cell arteritis (GCA). ⋯ Compared to lower average daily prednisolone doses, high average daily doses were associated with an increased risk of serious adverse effects.
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Semin. Arthritis Rheum. · Apr 2017
Multicenter Study Comparative StudyA multicenter, open-label, comparative study of B-cell depletion therapy with Rituximab for systemic sclerosis-associated interstitial lung disease.
Rituximab (RTX) may favorably affect lung function and skin fibrosis in patients with systemic sclerosis (SSc). We aimed to assess long-term efficacy and safety of RTX in SSc compared to standard treatment. ⋯ Our data indicate that RTX has a beneficial effect on lung function and skin fibrosis in patients with SSc. Randomized controlled studies are highly needed.
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Semin. Arthritis Rheum. · Feb 2017
Changes in gene expression profiles in patients with pulmonary arterial hypertension associated with scleroderma treated with tadalafil.
Pulmonary arterial hypertension (PAH) is one of the most devastating complications in scleroderma (SSc) patients and has a poorer outcome than other PAH subgroups. Tadalafil (Adcirca®) is a phosphodiesterase-5 inhibitor (PDE5-I) approved by the FDA for treatment of PAH; however, its effectiveness specifically in SSc-PAH patients is unclear. We investigated whether there were differences in gene expression associated with 16 weeks of treatment with tadalafil and, if so, whether these changes differed with respect to treatment outcome. ⋯ The results of this pilot study suggest that outcomes of SSc-PAH patients treated with tadalafil are associated with specific changes in gene expression and biological pathways.
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Telerheumatology services were developed at Dartmouth-Hitchcock Medical Center (DHMC) to bring specialty care to New Hampshire (NH) and Vermont (VT) where a large proportion of the population lives in rural areas (60%) with limited resources and access to care. We sought to learn what challenges and accomplishments our early telemedicine program has encountered since inception. ⋯ The use of telerheumatology has successfully increased access to specialty care in rural regions of NH and VT with good patient and provider satisfaction. While telerheumatology improved the access to specialty care, consideration should be given to selecting the appropriate patient for this visit type given that 19% of patients were deemed inappropriate. We propose a triage mechanism to ensure that patients are appropriately paired to the proper visit type in the future.
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Semin. Arthritis Rheum. · Dec 2016
Juvenile fibromyalgia syndrome: Blunted heart rate response and cardiac autonomic dysfunction at diagnosis.
To assess aerobic capacity and cardiac autonomic modulation in juvenile fibromyalgia syndrome (JFM) patients at diagnosis in response to graded exercise text. ⋯ This study identified chronotropic incompetence and delayed HR recovery in JFM patients, indicating autonomic dysfunction. Aerobic exercise training should be considered in all JFM patients and may improve cardiac autonomic impairment, thus reducing cardiovascular risk.