Clin Exp Rheumatol
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MTX is still considered the anchor drug among the disease-modifying antirheumatic agents, and it is widely accepted as first line treatment in the management of rheumatoid arthritis (RA). The ultimate therapeutic goal in treatment of RA is remission or at least low disease activity and this goal may not always be achieved with MTX monotherapy. Over the last two decades drug combinations based on MTX have been used increasingly to treat patients with RA. ⋯ Frequently used combinations on an MTX background include leflunomide, cyclosporine, azathioprine, sulfasalazine, gold and hydroxychloroquine. In conclusion, the use of MTX in combination with other DMARDs may still represent a valuable therapeutic option in patients who fail to DMARD monotherapy or in whom combination therapy is considered initially. However, in patients at risk for rapid radiographic progression, the early use of biologics has to be considered.
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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of autoimmune disorders including Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), Churg-Strauss syndrome (CSS) and renal-limited vasculitis (RLV). This paper reviews updated information on the pathogenesis of AAV. Additional clinical evidence for a pathogenic role of ANCA comes from the observation that patients with severe acute renal failure treated with plasma exchange had a lower risk for progression to end-stage renal disease than patients who received intravenous methylprednisolone therapy, both in addition to standard treatment. ⋯ Rats developed both cross-reactive antibodies to LAMP-2 and crescentic glomerulonephritis when immunized with FimH, an adhesin from Gram-negative bacteria which has strong homology with human LAMP-2. Together, clinical, in vitro and in vivo data support a pathogenic role for ANCA in AAV, although this role is more evident for myeloperoxidase-ANCA than for PR3-ANCA. The role of anti- LAMP-2 requires further studies.
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Systemic sclerosis is a rare and potentially devastating connective tissue disease. It is highly heterogeneous in terms of clinical presentation, extent and severity of organ involvement, immunologic abnormalities, and clinical course. ⋯ Results of these studies are presented and discussed, with emphasis on methodological limitations. Suggestions are made for the design, conduct, and reporting of further research on these themes.
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The aim of this consensus process was to construct a preliminary version of the ICF Core Set for acute inflammatory arthritis. ⋯ The ICF Core Set for acute arthritis is a clinical framework designed to comprehensively assess patients in acute care hospitals and early post-acute rehabilitation facilities. This preliminary version of the ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.
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Viscosupplementation with hyaluronic acid (HA) or its derivatives for the symptomatic relief of osteoarthritis (OA) of the hip joint has never been studied in placebo-controlled, double-blinded trials and conflicting results have been obtained from the published open trials. The aim of this study was to review the literature on viscosupplementation as a symptomatic treatment of hip OA. ⋯ To date, in the absence of placebo-controlled studies, the efficacy of IA injections of HA or its derivatives in the symptomatic treatment of hip OA cannot be determined conclusively. Nevertheless the published data suggest that viscosupplementation may be effective. Double-blind, controlled studies are required to confirm these data, before viscosupplementation should be included into the treatment paradigm for patients with hip osteoarthritis.