Clinical rheumatology
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Clinical rheumatology · Oct 2013
Review Meta AnalysisThe effectiveness of tofacitinib, a novel Janus kinase inhibitor, in the treatment of rheumatoid arthritis: a systematic review and meta-analysis.
The aim of the present study was to conduct a meta-analysis of the effectiveness of tofacitinib, a novel oral Janus kinase inhibitor, recently approved for the treatment of active rheumatoid arthritis in patients who have failed previous treatment with methotrexate (MTX) or other disease-modifying antirheumatic drugs (DMARDs). A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, and other databases till 3 May 2013. All included studies were analyzed with the use of the Review Manager 5.1.0. software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement protocol. ⋯ The findings of this systematic review with meta-analysis indicate that tofacitinib monotherapy or with background methotrexate provides early statistically significant and clinically important improvement in rheumatoid arthritis symptoms and has an acceptable safety profile comparable to that of placebo. The results of the present meta-analysis show that the frequency of serious adverse events was not increased after tofacitinib treatment. In addition, tofacitinib might provide an effective treatment option compared to intravenous or subcutaneous biological DMARDs, as suggested by the result of the comparison made regarding tofacitinib vs. adalimumab ACR50 response rate.
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Clinical rheumatology · Oct 2013
Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations.
This study aims to explore patient's concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was carried out. ⋯ Ability to communicate on the topic was associated with the decrease of patient sexual satisfaction and limited by patient illiteracy. Our study evidences that sex discussion between patient and healthcare provider is restricted by several barriers and that patients expect more involvement from their healthcare provider on the subject. Illiteracy and level of sexual satisfaction seem to be the strongest factors influencing this communication.
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Clinical rheumatology · Oct 2013
Transcultural adaptation and testing psychometric properties of the Korean version of the Foot and Ankle Outcome Score (FAOS).
This study was performed to translate and transculturally adapt the English version of the Foot and Ankle Outcome Score (FAOS) into a Korean version, and to test psychometric properties of the Korean FAOS in terms of internal consistency, test-retest reliability, convergent validity, and dimensionality. Translation and transcultural adaptation of FAOS into a Korean version was performed according to internationally recommended guidelines. Internal consistency (N = 294) and test-retest reliability (N = 21) were evaluated. ⋯ Translation and transcultural adaptation of FAOS into the Korean language was performed successfully. The items were understandable, and the subscales showed satisfactory test-retest reliability. Some minor revision might be needed to enhance the internal consistency of Q subscale and reduce the redundancy of ADL subscale.
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Clinical rheumatology · Sep 2013
Proprioceptive accuracy in women with early and established knee osteoarthritis and its relation to functional ability, postural control, and muscle strength.
The purpose of this study was to identify differences in knee proprioceptive accuracy between subjects with early knee osteoarthritis (OA), established knee OA, and healthy controls. Furthermore, the relation between proprioceptive accuracy on the one hand and functional ability, postural balance, and muscle strength on the other hand was also explored. New MRI-based classification criteria showing evidence of beginning joint degeneration have been used to identify subjects with early knee OA. ⋯ Impaired proprioceptive accuracy was not associated with disease-related functionality in knee OA patients. Treatment strategies designed to address proprioceptive deficits may be not effective in prevention of knee OA progression and may have no impact on patients' functionality. However, this should be confirmed further in well-designed clinical trials.
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Clinical rheumatology · Sep 2013
Derangement of hemostasis in rheumatoid arthritis: association with demographic, inflammatory and metabolic factors.
Disturbance of fibrinolysis is common in rheumatoid arthritis (RA), and it may be associated with the increased cardiovascular risk observed in this population. We aimed to assess coagulation derangement and investigate whether abnormalities are influenced by demographic, inflammatory or metabolic factors in patients with RA. Levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), fibrinogen, prothrombin fragment 1 + 2 (PF1 + 2), thrombomodulin (TM), protein C and Von Willebrand factor (vWF) were compared between 141 RA patients and 50 healthy hospital controls. ⋯ Metabolic factors linked with coagulation factors were hypertriglyceridaemia (tPA, P < 0.05; PAI-1, P < 0.05; protein C, P < 0.05) and insulin resistance (tPA, P < 0.01; PAI-1, P < 0.01; vWF, P < 0.05). Imbalance of coagulation and fibrinolytic mechanisms is common in RA and associates with age, inflammation, and metabolic factors. Further studies may determine whether these abnormalities are the consequence of acute inflammation or markers of vascular dysfunction.