Clinical rheumatology
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Clinical rheumatology · Dec 2015
Biologic therapy for inflammatory arthritis and latent tuberculosis: real world experience from a high prevalence area in the United Kingdom.
Biologic therapies have resulted in a sea change in the management of inflammatory arthritis; however, a higher risk of opportunistic infection, particularly tuberculosis (TB), is well recognised. This has led to the development of TB screening guidelines. The aim of this study was to investigate the prevalence of latent TB in patients prescribed biologic therapy in an endemic area (prevalence of TB 50/100,000) and to assess the risk of subsequent reactivation. ⋯ Overall prevalence of latent TB in patients with inflammatory arthritis prescribed biologic therapy in an endemic area is 10 %. The risk warrants careful screening and monitoring in all patients. Adherence to strict screening protocol reduces the risk of active TB infection irrespective of the biologic therapy employed.
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Clinical rheumatology · Nov 2015
Review Meta AnalysisEfficacy of tripterygium glycosides tablet in treating ankylosing spondylitis: a systematic review and meta-analysis of randomized controlled trials.
Hundreds of randomized controlled trials (RCTs) on tripterygium glycosides tablet (TGT) in the treatment of ankylosing spondylitis (AS) have been published, but the therapeutic effects have never been systematically reviewed yet. The aim of this meta-analysis was to evaluate the efficacy of TGT on AS based on RCTs. PubMed, ScienceDirect, Cochrane Library, China Journals Full-text Database, and Wanfang Data were searched. ⋯ MD of CRP was 1.86 (95% CI -2.03, 5.76). Subgroup, sensitivity, and meta-regression analyses found the robust results. In conclusion, TGT could not treat AS effectively, as suggested by the moderate RCT quality and meta-analysis evidence.
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Clinical rheumatology · Nov 2015
Comparative Study Observational StudyFactors that influence fatigue status in patients with severe rheumatoid arthritis (RA) and good disease outcome following 6 months of TNF inhibitor therapy: a comparative analysis.
The objective of the present study is to determine the factors associated with persistent fatigue in patients with severe rheumatoid arthritis (RA) and good disease response to 6 months of tumour necrosis factor inhibitor therapy. Eligible patients with either persistent (PF) or no fatigue (NF) were compared. Using validated questionnaires and bivariate analysis, this cross-sectional survey explored if clinical characteristics, pain, self-efficacy, sleep and mood/depression differed between groups. ⋯ These findings enhance the fatigue literature in patients with RA prescribed tumour necrosis factor (TNF) inhibition therapy, identifying the potentially modifiable factors of pain and depression, previously demonstrated to be strongly associated with fatigue in non-biologic populations. In addition, this study highlights the association between persistent fatigue and an on-going state of low disease activity. This infers that more judicious disease management could minimise the symptom burden of pain and depression and consequentially fatigue.
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Clinical rheumatology · Nov 2015
Anti-TNFα agents and methotrexate in spondyloarthritis related uveitis in a Chinese population.
This study seeks to evaluate the clinical characteristics of spondyloarthritis (SpA)-related uveitis in a cohort from South China and to assess the efficacy and safety of therapies based on TNF blockers. SpA patients with uveitis admitted to a south China hospital were enrolled. Demographic information, clinical characteristics, laboratory findings, intraocular inflammation, visual acuity, macular thickness, and treatments were documented. ⋯ Uveitis is common in SpA patients. Severe complications may develop in prolonged and intractable cases. Treatments based on anti-TNFs had good clinical response, and better safety documentation were observed in etanercept plus MTX compared to the other two anti-TNF monoclonal antibodies plus MTX.
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Clinical rheumatology · Oct 2015
Meta AnalysisEffects of home-based exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis.
The objective of this paper was to objectively evaluate the effectiveness of home-based exercise interventions for improving health-related quality of life in patients with ankylosing spondylitis (AS). Databases including PubMed, Web of Science, EMBASE, Ovid-Medline, and The Cochrane Library were electronically searched published from inception through October 2014 involving home-based exercise intervention in AS patients. Studies that measured the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), depression and pain as outcomes were included. ⋯ Meta-analyses showed that home-based exercise interventions significantly reduced the BASFI scores (MD = -0.39, 95 % CI -0.57, -0.20, p = 0.001), BASDAI scores (MD = -0.50, 95 % CI -0.99, -0.02, p = 0.04), depression scores (MD = -2.31, 95 % CI -3.33, -1.30, p = 0.001), and for pain scores because of different evaluation methods among these studies; therefore, a subgroup analysis should be conducted for comparison. The results show that home-based exercise interventions can effectively improve the health-related quality of life in patients with AS. The benefit and clinical performance of home-based exercise care requires further investigation by a series of multicenter, large-sample size randomized controlled trails.