scholarly journals FRI0125 IMPACT OF RAMADAN DIURNAL INTERMITTENT FASTING ON CHRONIC MEDICATIONS INTAKE IN PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 644.2-644
Author(s):  
K. Maatallah ◽  
D. Ben Nessib ◽  
H. Ferjani ◽  
D. Kaffel ◽  
W. Hamdi
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Adverse Effects ◽  
Rheumatic Diseases ◽  
Biological Agents ◽  
Intermittent Fasting ◽  
Ramadan Fasting ◽  
Chronic Medications ◽  
Disease Modifying ◽  
The Impact

Background:Fasting during Ramadan, the ninth month of Islamic calendar, requires the abstinence from food and drink from sunrise to sunset [1]. Muslims are allowed to consume two major meals per day, one shortly before dawn (Suhoor) and the other immediately after sunset (Iftar). Although some previous investigations have reported a beneficent impact of fasting on rheumatic diseases’ activity [1,2], very few studies have dealt with the possible impact of intermittent fasting on chronic medications intake.Objectives:The objective of this study was to assess the impact of Ramadan intermittent fasting on adherence and tolerance of Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in patients with rheumatoid arthritis (RA).Methods:This is a prospective monocentric study including patients with rheumatoid arthritis (RA) who fasted Ramadan 2019. Each patient was evaluated during 2 visits: 6 months before starting Ramadan fasting and after fasting at least 7 days. The following parameters were assessed: compliance with treatments, tolerability and timing of intake (Iftar meal, evening, Suhoor meal).Results:Thirty-six patients were enrolled: 7 men and 29 women. The average age of patients was 57.5 years ± 10.9 [39-79] and the mean disease duration was 6.7 years ± 3.3 [1-13]. Biological agents, methotrexate (MTX), Salazopyrin (SLZ) and Leflunomide (LFN) were respectively prescribed in 8, 22, 4 and 4 patients.Ramadan fasting did not affect either compliance with biological agents or tolerance. No additional side effects have been reported during this period.The compliance to MTX was comparable before and during fasting in 68.4% of cases. It was impaired by fasting in the rest with a full stop in 26.3% of patients. MTX was taken away from meals (as recommended) by 42.8% of patients. The timing of drug intake was the Iftar meal in 21.4% of patients, the Suhoor meal in 14.3% of patients and the evening in 64.3% of patients.Except 1 patient, adherence to SLZ was adequate during Ramadan fasting. It was taken with the 2 major meals in 50% of cases and during the evening in 50% of cases.Patients under LFN did not report any discontinuation.The reported reasons of discontinuations of Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) were: objective adverse effects (25%), apprehension of gastrointestinal adverse effects (25%) and lack of time between the two major meals (50%) (since they were advised to take MTX away from meals).Regarding the tolerance, gastrointestinal side effects of MTX were reported to be more frequent during Ramadan by 20% of patients, fewer by 13.3% of patients and unchanged by the rest of the patients. The gastrointestinal tolerance of SLZ and LFN was similar before and during Ramadan fasting.Conclusion:Even if the tolerability of chronic medications was not impaired by Ramadan fasting in the majority of patients, adherence to conventional DMARDs was reported to be reduced by more than a quarter of patients, mainly because of a lack of time between the two major meals. Physicians should be aware of the impact of Ramadan fasting on chronic drugs intake because they have a crucial role in helping patients with RA adjust medications safely.References:[1]Adawi M, Damiani G, Bragazzi NL, et al (2019) The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study. Nutrients 11[2]Bragazzi NL, Watad A (2017) The Impact of Fasting on Rheumatic Diseases. Isr Med Assoc J IMAJ 19:378–379Disclosure of Interests:None declared

scholarly journals AB0129 IL-6R GENETIC VARIANTS AS PREDICTORS OF CLINICAL RESPONSE TO TOCILIZUMAB IN RHEUMATOID ARTHRITIS PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1093.1-1093
Author(s):  
L. Sainz Comas ◽  
P. Riera ◽  
P. Moya ◽  
S. Bernal ◽  
A. Lasa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Effects ◽  
Rheumatic Diseases ◽  
Laboratory Data ◽  
Antirheumatic Drug ◽  
Age At Diagnosis ◽  
Unknown Etiology ◽  
Duration Of Treatment ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug

Background:Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease of unknown etiology. Tocilizumab (TCZ) is a first-line biological disease-modifying anti-rheumatic drug (bDMARD) which inhibits Interleukin 6 (IL-6) pathway through blockade of its receptor. At present, there is a lack of evidence to recommend the treatment of one bDMARD over another.(1) Seeking for genetic biomarkers to predict response to treatment could be key towards a personalized treatment strategy in rheumatology.(2)Objectives:We aimed to evaluate whether functional single nucleotide polymorphisms (SNPs) in the IL6R gene could predict response and/or toxicity to TZC in Caucasian patients diagnosed with RA.Methods:Retrospective analytical preliminar study of a cohort of 31 patients diagnosed with RA (ACR/EULAR 2010 criteria) who received treatment with TCZ within the last 10 years. Epidemiological, clinical and laboratory data were collected. DNA was extracted from EDTA blood samples. Three SNPs in the IL-6 receptor gene (rs12083537, rs2228145, rs4329505) were genotyped by real-time PCR with TaqMan probes. The associations between polymorphisms and clinicopathological features were evaluated using parametric tests. Efficacy was assessed as the difference of DAS-28 CRP at 6 months. The toxicities recorded were hepatotoxicity, infections, hypersensibility, gastrointestinal, hematological and dyslipidemia.Results:The 31 DNA samples from patients included were mainly female (83.9%) and had a mean age at diagnosis of 46.8 years. The mean duration of treatment was 51.3 months and, previously to initiate TCZ, they received a mean of 2,6 csDMARD and 1,7 bDMARD.The more frequent adverse effects were hypertransaminasemia (22.6%) and neutropenia (32.3%). Most relevant epidemiologic and clinical data is shown in Table 1.Table 1.Clinical characteristics. RA=Rheumatoid Arthritis. CCP= anti-Cyclic Citrullinated Peptides. RF=Rheumatoid factor. csDMARDs= conventional synthetic Disease-modifying antirheumatic drug. bDMARD= biological Disease-modifying antirheumatic drug. BMI=Body Mass Index. Sc=subcutaneous. Ev=endovenous. DAS28= Disease Activity Score in 28 jointsSex (n=31), n (% women/men) 26/5 (83,9%/16,1%)Age at diagnosis (n=31), years +- SD 46,8+- 12,8Erosive RA (n=31), n(%) 14 (45,2%)Anti-CCP positive (n=31), n(%)UI+- SD 23 (74,2%)259,7 +- 137,3RF positive (n=31), n (%)UI+-SD 21 (67,7%)189,4+- 114Previous csDMARD (n=31), n°+-SD2,6 +-1,3Previous bDMARD (n=31), n°+- SD1,7 +- 1,4BMI (n=29), mean +- SD29,3+- 5,1Duration of treatment (n=31), months +-SD51,3 +- 36,3-Active treatment (n=12)-80,9+- 18,3-Finished treatment (n=19)-32,6+- 32,2Route of administration (n=31), n (%) sc/ev 11/20 (35,5/64,5)Basal DAS28 (n=30), mean+- SD5,3 +- 1,1DAS28 reduction at 6 months (n=28), mean+-SD2,9 +-1,1The univariate analyses showed that the rs2228145 variant was statistically associated with differences in DAS28 reduction at 6 months (p=0.042). Regarding efficacy, we also found a trend with the SNP rs4329505 (p=0.173), which could achieve statistical significance with the projected inclusion of more patients. No associations were found regarding adverse effects.Conclusion:The rs2228145 polymorphisms in the IL6R gene may be considered as a pharmacogenetic biomarker of TCZ response in RA patients. More studies are required in order to investigate the clinical use of pharmacogenetic biomarkers in rheumatic diseases.References:[1]Smolen, Josef S., Robert B., et al. 2020. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update.” Annals of the Rheumatic Diseases 79 (6): 685–99.[2]Tarnowski, Maciej, Agnieszka Paradowska-Gorycka, et al. 2016. “The Effect of Gene Polymorphisms on Patient Responses to Rheumatoid Arthritis Therapy.” Expert Opinion on Drug Metabolism & Toxicology 12 (1): 41–55.Disclosure of Interests:None declared

The Use of Methotrexate in Rheumatoid Arthritis

1985 ◽  
Vol 19 (5) ◽  
pp. 349-358 ◽  
Author(s):  
Peter W. Letendre ◽  
Douglas J. DeJong ◽  
Donald R. Miller
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Folic Acid ◽  
Side Effects ◽  
Adverse Effects ◽  
Systemic Administration ◽  
Refractory Disease ◽  
Controlled Clinical Trials ◽  
Folic Acid Antagonist ◽  
Acid Antagonist

The use of methotrexate in rheumatoid arthritis is reviewed. Methotrexate, a folic acid antagonist, is sometimes employed in an attempt to symptomatically control patients whose disease does not respond adequately to conventional therapies. Systemic administration of 7.5–15 mg/wk in a “pulse” fashion appears to be effective without precipitating severe adverse effects. However, concern over potentially serious side effects and a lack of well-controlled clinical trials have limited its use to severe, refractory disease. Further studies are needed before its role in rheumatoid arthritis can justifiably be expanded.

scholarly journals POS0642 THE IMPACT OF AGE ON DISCONTINUATION OF BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 559.2-560
Author(s):  
V. Rivera Teran ◽  
S. Sicsik ◽  
D. Vega-Morales ◽  
F. Irazoque-Palazuelos ◽  
D. Miranda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Effects ◽  
Adverse Events ◽  
Cox Regression ◽  
Retention Rate ◽  
Drug Discontinuation ◽  
Discontinuation Rate ◽  
Biologic Dmards ◽  
Conventional Dmards ◽  
The Impact

Background:Rheumatoid arthritis (RA) is the most common autoimmune disease. Older patients treated with biologic DMARDs (bDMARDs) are at a significantly greater risk of adverse effects (AEs) [1]. However, the rate of drug discontinuation because of adverse effects caused by bDMARDs has not differed in elderly compared to younger patients in different registries.Objectives:Determine if drug discontinuation of bDMARDs differs by age in patients with rheumatoid arthritis in the Mexican Adverse Events Registry (BIOBADAMEX).Methods:BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs since 2016. In this analysis we included all patients with diagnosis of RA with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including age older than median age in the sample were investigated by Cox regression analyses.Results:Among 743 patients in the registry, 497 had RA diagnosis, from which, 214 had at least two assessments. At baseline, patients had a median (IQR) age of 53.4 (45-61) years old, median disease duration of 10.7 (6-17) months and median DAS28 of 4.7 (3-6). Conventional DMARDS were used by 185 (87%) patients and 94 (44%) patients used corticosteroids. Comorbidities were present in 194 (91%). The most common bDMARDs received at baseline were abatacept 59 (27%), tocilizumab 45(21%), adalimumab 31 (15%) and certolizumab 30 (14%). At the time of analysis, the median bDMARDs treatment duration was 21.0(13-34) months, 128 (59%) had discontinued treatment, 66 for inefficacy, 32 for adverse events and 30 for others. Fig 1 shows discontinuation rate curves in patients younger and older than median age. Cox proportional-hazards demonstrated no significant differences regarding age older than median age (HR 1.1, 95% CI 0.8-1.4, p=0.7), female sex (HR 1.2, 95% CI 0.7-1.9, p=0.44), use of corticosteroids (HR 1.2, 95% CI 0.9-1.6, p=0.20), comorbidities (HR 0.9, 95% 0.6-1.5, p=0.78), DAS28 (HR 0.9, 95% 0.9-1.1, p=0.93) or other factors.Figure 1.Discontinuation rate curves in patients younger and older than median age (< 53.4 and >=53.4 years old)Conclusion:This analysis did not show a role of age on discontinuation of bDMARDs in Mexican RA patients. Further longitudinal analyses will be performed including more patients to assess retention rate of bDMARDs and identify predictive variables of discontinuation in Mexican population.References:[1]Akter R, et al. Can Geriatr J. 2020 May 1;23(2):184-189.[2]Ikari Y, et al. Medicine (Baltimore). 2020 Dec 24;99(52):e23861.Disclosure of Interests:None declared

scholarly journals FRI0651-HPR A RANDOMIZED PROSPECTIVE OPEN-LABEL CONTROLLED TRIAL COMPARING THE PERFORMANCE OF A CONNECTED MONITORING INTERFACE IN PATIENTS WITH RHEUMATOID ARTHRITIS VERSUS PHYSICAL ROUTINE MONITORING

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 929.1-930
Author(s):  
Y. M. Pers ◽  
V. Valsecchi ◽  
T. Mura ◽  
S. Aouinti ◽  
N. Filippi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Tight Control ◽  
Link Type ◽  
Functional Scores ◽  
Monitoring Group ◽  
Disease Modifying

Background:Telemedicine has found wider application in chronic diseases for encouraging tight home-monitoring in order to improve patients’ outcome (Smolen et al. 2017).In previous studies, a high feasibility and high patient-satisfaction rate was found as well as the evidence for a superior or equal effectiveness of telemedicine compared to the standard face-to-face approach, however the results were weakened by some methodological biases and wide heterogeneity of interventions, thus preventing to draw definitive conclusions (Piga et al. 2017; Najm, Gossec, et al. 2019).Objectives:In rheumatoid arthritis (RA), telemedicine may allow a tight control of disease activity while reducing hospital visits. We developed a smartphone application connected with a physician’s interface to monitor RA patients. We aimed to assess the performance of this e-Health solution in comparison with routine practice in the management of patients with RA.Methods:A 6-month pragmatic, randomized, controlled, prospective, clinical trial was conducted in RA patients with high to moderate disease activity starting a new Disease Modifying Anti-Rheumatic Drug (DMARD) therapy. Two groups were established: “connected monitoring” and “conventional monitoring”. The primary outcome was the number of physical visits between baseline and 6 months. Secondary outcomes included adherence, satisfaction, changes in clinical, functional, and health status scores (SF-12).Results:Of the 94 randomized patients, 89 completed study: 44 in the “conventional monitoring” arm and 45 in the “connected monitoring” arm. The total number of physical visits between baseline and 6 month was significantly lower in the “connected monitoring” group (0.42 ± 0.58 versus 1.93 ± 0.55; p<0.05). No differences between groups were observed in the clinical and functional scores. A better quality of life for SF-12 subscores (Role-Physical, Social-Functioning and Role-Emotional) were found in the “connected monitoring” group.Conclusion:According to our results, a connected monitoring reduces the number of physical visits while maintaining a tight control of disease activity and improving quality of life in patients with RA starting a new treatment.References:[1] Najm, Aurelie, Laure Gossec, Catherine Weill, David Benoist, Francis Berenbaum, and Elena Nikiphorou. 2019. “Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review.”JMIR MHealth and UHealth7 (11): e14730.https://doi.org/10.2196/14730.[2] Piga, Matteo, Ignazio Cangemi, Alessandro Mathieu, and Alberto Cauli. 2017. “Telemedicine for Patients with Rheumatic Diseases: Systematic Review and Proposal for Research Agenda.”Seminars in Arthritis and Rheumatism47 (1): 121–28.https://doi.org/10.1016/j.semarthrit.2017.03.014.[3] Smolen, Josef S, Robert Landewe, Johannes Bijlsma, Gerd Burmester, Katerina Chatzidionysiou, Maxime Dougados, Jackie Nam, et al. 2017. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2016 Update.”Annals of the Rheumatic Diseases76 (6): 960–77.https://doi.org/10.1136/annrheumdis-2016-210715.Disclosure of Interests:None declared

scholarly journals COST ANALYSIS OF DISEASE MODIFYING ANTI RHEUMATIC DRUGS: THE INDIAN SCENARIO

2020 ◽  
pp. 1-2
Author(s):  
Zarrin Ansari ◽  
Sharmada Nerlekar ◽  
Sagar Karia ◽  
Sudhir Pawar
Keyword(s):  
Rheumatoid Arthritis ◽  
Work Capacity ◽  
Biological Agents ◽  
Medical Specialties ◽  
Cost Variation ◽  
Conscious Choice ◽  
Socioeconomic Burden ◽  
Disease Modifying ◽  
The Cost ◽  
Indian Scenario

Background: Rheumatoid arthritis is a chronic, autoimmune and inflammatory disease affecting the joints and cartilages, eventually leading towards deformity and resultant disability. Today’s rheumatologists have an armamentarium of Disease Modifying Anti Rheumatic Drugs (DMARDs) to choose from. The chronicity of the disease, resultant deformities and reduced work capacity adds to the socioeconomic burden of the disease. This study aims to compare the costs of various brands of DMARDs (both biological and non-biological agents), so as the give the readers an idea about the cost range and variation present amongst the available DMARDs. Materials and Methods: Current Index of Medical Specialties (CIMS India) application was accessed in the month of August 2020 to note the cost of various brands of DMARDs. The information was tabulated. The cost difference and percentage cost variation was calculated and compared. Results:The maximum number of brands was available for methotrexate amongst the biological as well as non-biological agents. Least and highest percentage cost variation was observed for 2.5 mg strength of methotrexate and 100 mg of cyclosporine, respectively. In general, biologicals had fewer brands in the market as the cost was considerably higher than the non-biological agents. Conclusion:There is a wide variation amongst the costs of various DMARDs. This has its own advantages. Conscious choice of economical brands can profoundly effect the socioeconomic burden of rheumatoid arthritis management.

Rheumatoid Arthritis: Strategies for Pharmacotherapy

1999 ◽  
Vol 12 (4) ◽  
pp. 271-281
Author(s):  
Bruce C. Carlstedt ◽  
Walter F. Stanaszek
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Adverse Reactions ◽  
Initial Therapy ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying

Historically, treatment of rheumatoid arthritis (RA) has been conservative and symptom or patient-complaint oriented. Newer approaches use disease-modifying antirheumatic drugs (DMARDs), sometimes known as slow-acting antirheumatic drugs (SAARDs), to slow the progression of the disease earlier in its course. Some of these drugs may be used as initial therapy and some may be used in combinations to reduce the side effects or adverse reactions.

scholarly journals Aspects of Diode Laser (805 nm) Hair Removal Safety in a Mixed-Race Group of Patients

2019 ◽  
Vol 10 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Izabela Załęska ◽  
Magdalena Atta-Motte
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Diode Laser ◽  
Skin Reaction ◽  
Skin Irritation ◽  
Mixed Race ◽  
Hair Removal ◽  
Laser Hair Removal ◽  
The Impact ◽  
Treatment Settings

Introduction: Laser hair removal (LHR) has become one of the most popular treatments in aesthetics. Side effects are an inevitable part of laser therapy, therefore managing them is crucial for every laser practitioner to ensure patients’ safety along with achieving the best results. The available references describe the effectiveness of the diode LHR for all skin types according to the Fitzpatrick scale, but the question of patient safety and minimization of side effects and postoperative complications in mixed-race patients remains unanswered. This study aims to illustrate aspects of specific side effects in patients of mixed ethnicity and the impact of those effects on the results of the treatment. Methods: The study was conducted in Poland and the United Kingdom on 216 patients of various ethnic backgrounds. This study analyses the frequency of side effects in a mixed-race group of 32 participants, taking into account their skin type according to the Fitzpatrick scale. The patients received a course of 6 treatments using diode laser 805 nm. An objective and a subjective method were used to analyse treatment results and side effects, with adverse effects documented, if observed. Treatment settings were adjusted to skin reaction during the patch test. Results: Objective analysis was different from the subjective analysis of the treatment’s effectiveness. No adverse effects were observed. Side effects such as hyperpigmentation, skin irritation, skin burns, and skin hypersensitivity were found. Conclusion: 805 nm diode laser is effective and efficient at hair removal in mixed-race patients. It is a safe treatment in terms of skin reaction as only short-term side effects were observed in the treated area and no adverse effects were noted. To achieve the best results and to avoid adverse effects it is necessary to adjust treatment settings according to the individual patient’s skin reaction.

scholarly journals Modern Modeling of Water Hammer

2017 ◽  
Vol 24 (3) ◽  
pp. 68-77 ◽  
Author(s):  
Kamil Urbanowicz
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Water Hammer ◽  
Hydraulic Systems ◽  
Weighting Functions ◽  
Transient Flows ◽  
Hydraulic Equipment ◽  
Pressure Changes ◽  
The Impact ◽  
Reduced Pressures

Abstract Hydraulic equipment on board ships is common. It assists in the work of: steering gear, pitch propellers, watertight doors, cargo hatch covers, cargo and mooring winches, deck cranes, stern ramps etc. The damage caused by transient flows (which include among others water hammer) are often impossible to repair at sea. Hence, it is very important to estimate the correct pressure runs and associated side effects during their design. The presented study compares the results of research on the impact of a simplified way of modeling the hydraulic resistance and simplified effective weighting functions build of two and three-terms on the estimated results of the pressure changes. As it turns out, simple effective two-terms weighting functions are able to accurately model the analyzed transients. The implementation of the presented method will soon allow current automatic protection of hydraulic systems of the adverse effects associated with frequent elevated and reduced pressures.

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