scholarly journals POS1477-HPR GOUT PATIENTS IN REMISSION, AND THEIR PERSPECTIVES ON URATE LOWERING THERAPY TREATMENT STOP OR CONTINUATION STRATEGIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1023.2-1024
Author(s):  
I. R. Peeters ◽  
S. A. C. Wanten ◽  
L. M. Verhoef ◽  
A. Den Broeder ◽  
N. Van Herwaarden ◽  
...  
Keyword(s):  
General Practice ◽  
Side Effects ◽  
The Netherlands ◽  
Medication Use ◽  
Joint Damage ◽  
Treatment Strategies ◽  
Serum Urate ◽  
The Body ◽  
Treat To Target

Background:Urate lowering therapies (ULT) are used to reduce hyperuricemia in gout patients (1). When gout remission is reached, patients often ask if ULT should be continued lifelong (treat to target strategy, T2T), or if tapering or stopping (a treat to symptom approach, T2S) can be attempted. In fact, although current rheumatology guidelines (1,2) suggest continuation, conclusive evidence for this is absent. Since ULT therapy adherence also remains suboptimal, exploring gout patients’ beliefs on different long term ULT treatment strategies is of great value.Objectives:To identify cognitions and emotions on ULT treatment strategies (T2T continuation and T2S cessation) of gout patients in remission with current or previous ULT use.Methods:Purposive sampling (3) was used to recruit patients from a general practice and a rheumatology department (Nijmegen, the Netherlands), with a clinical diagnosis of gout, current or previous ULT use and remission according to adapted (without serum urate criterion) preliminary gout remission criteria(4). Semi-structured interviews were conducted by two interviewers and audio-records were fully transcribed. Inductive thematic analysis (5) was used to analyse and interpret our data using the ATLAS.ti. software.Results:From a total of 18 patients (16 male/2 female), 14 patients were treated by a rheumatologist (10 currently using ULT, 1 intermittent and 3 previously) and 4 were treated by a general practitioner (all currently using ULT). Patients were satisfied with a T2T strategy, due to the absence of flares, a feeling of certainty and the reassurance of serum urate monitoring. Reluctance towards medication was reported, the importance of indefinite ULT use was questioned and its chronic use was addressed as a drawback. Reducing medication use by a T2S strategy was assessed positively and this strategy was considered less burdensome. A wish for and the willingness to follow a T2S approach was expressed. Fear and concerns of flaring after ULT cessation were expressed and were deemed both acceptable and unacceptable. See Table 1 for a schematic overview of the results.Table 1.Overview of patients’ perspectives on ULT treatment strategiesMotivation for a T2T strategyDrawbacks of a T2T strategy1. Being free of flares2. Acceptance of and contentment with chronic ULT use3. Feels secure due to regular SU monitoring4. No desire for change1. Resistance to (any) medication use2. Side effects of ULT3. Possibly detrimental to healthcare costsMotivation for a T2S strategyDrawbacks of a T2S strategy1. Doubt if chronic ULT use is necessary a. Possible restorative capacity of the body b. Curious to effects of ULT cessation2. Being free of ULT side effects3. Long term damage ULT unknown4. Less burdensome for patient and body5. Wish for minimization of (any) medication use1. Fear and insecurities on a. Flaring and not being able to function b. Joint damage2. Feels uncontrolled3. Hassle with visits, blood tests and medication adjustments when a flare occurs.Conclusion:This study provides an overview of perspectives on ULT treatment strategies of gout patients in remission. These results must be considered in developing educational material for patients and in future research on gout management, particularly in designing randomised clinical trials on this subject.References:[1]Richette P et al. Ann Rheum Dis. 2017;76(1):29-42.[2]FitzGerald JD et al. Arthritis Care Res (Hoboken). 2020;72(6):744-60.[3]Pope C et al. Qual Saf Health Care. 2002;11(2):148-52.[4]de Lautour H et al. Arthritis Care Res (Hoboken). 2016;68(5):667-72.[5]Pope C et al. Bmj. 2000;320(7227):114-6.Acknowledgements:We would like to thank dr. Erik Bischoff for his cooperation and help in including primary care patients from his general practice UGC Heyendael, Nijmegen the Netherlands.Disclosure of Interests:None declared

scholarly journals Cardiooncology—dealing with modern drug treatment, long-term complications, and cancer survivorship

2021 ◽  
Author(s):  
Claudia de Wall ◽  
Johann Bauersachs ◽  
Dominik Berliner
Keyword(s):  
Side Effects ◽  
Checkpoint Inhibitors ◽  
Heart Diseases ◽  
Tumor Therapy ◽  
Treatment Strategies ◽  
Tumor Treatment ◽  
Cardiac Side Effects ◽  
Cardiovascular Side Effects ◽  
Modern Drug

AbstractModern treatment strategies have improved prognosis and survival of patients with malignant diseases. The key components of tumor treatment are conventional chemotherapy, radiotherapy, targeted therapies, and immunotherapy. Cardiovascular side-effects may occur in the early phase of tumor therapy or even decades later. Therefore, knowledge and awareness of acute and long-lasting cardiac side effects of anti-cancer therapies are essential. Cardiotoxicity impairs quality of life and overall survival. The new cardiologic subspecialty ‘cardio-oncology’ deals with the different cardiovascular problems arising from tumor treatment and the relationship between cancer and heart diseases. Early detection and treatment of cardiotoxicity is of crucial importance. A detailed cardiac assessment of patients prior to administration of cardiotoxic agents, during and after treatment should be performed in all patients. The current review focusses on acute and long-term cardiotoxic side effects of classical cytotoxic and selected modern drug treatments such as immune checkpoint inhibitors and discusses strategies for the diagnosis of treatment-related adverse cardiovascular effects in cancer patients.

scholarly journals The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout

2019 ◽  
Vol 8 (7) ◽  
pp. 1067
Author(s):  
Woo-Joong Kim ◽  
Jung Soo Song ◽  
Sang Tae Choi
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Multivariable Analysis ◽  
Serum Urate ◽  
Disease Stage ◽  
Treat To Target ◽  
Renal Outcomes ◽  
Significant Difference

Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a “treat-to-target” approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m2 vs. 80.30 ± 20.41 mL/min/1.73 m2, p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (−0.35 ± 3.87 mL/min/1.73 m2 vs. 5.33 ± 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13–0.75, p = 0.009). Conclusions: The “treat-to-target” approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

scholarly journals Treat-to-target (T2T) recommendations for gout

2016 ◽  
Vol 76 (4) ◽  
pp. 632-638 ◽  
Author(s):  
U Kiltz ◽  
J Smolen ◽  
T Bardin ◽  
A Cohen Solal ◽  
N Dalbeth ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Scientific Evidence ◽  
Randomised Trial ◽  
Treatment Strategies ◽  
Indirect Evidence ◽  
Serum Urate ◽  
Treat To Target ◽  
Inflammatory Rheumatic Diseases ◽  
Evidence Strength ◽  
Expert Recommendations

ObjectivesThe treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout.MethodsA committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived.ResultsAlthough no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance.ConclusionsThis is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon.

Spaying-related urinary incontinence and oestrogen therapy in the bitch

2009 ◽  
Vol 57 (1) ◽  
pp. 171-182 ◽  
Author(s):  
Maria Veronesi ◽  
Alessandro Rota ◽  
Massimiliano Battocchio ◽  
Massimo Faustini ◽  
Antonio Mollo
Keyword(s):  
Urinary Incontinence ◽  
Side Effects ◽  
Replacement Therapy ◽  
The Body ◽  
Oestrogen Therapy ◽  
Oestrogen Replacement Therapy ◽  
Tail Docking ◽  
Age At Surgery ◽  
Type Of Surgery

Some aspects of spaying-related urinary incontinence in the bitch still remain incompletely clarified. Therefore, the aims of the present study were to evaluate the prevalence of the disease among spayed dogs, to detect differences in risk related to the type of surgery, to describe the characteristics of incontinent bitches, to assess the influence of age at surgery on the onset of incontinence occurrence, and to assess the effectiveness and long-term side effects of oestrogen therapy in affected bitches. Among 750 bitches submitted to ovariectomy or ovariohysterectomy, those showing spaying-related urinary incontinence were evaluated. Oestrogen replacement therapy consisted of administering an effective dose followed by an individual maintenance dose. The results showed that the disease occurred in 5% of neutered bitches, the type of surgery did not affect the disease occurrence, affected bitches frequently represented large or giant breeds or large-size mongrels, the body weight of the affected bitches at surgery was often ≥ 20 kg, the disease seems to be associated with tail docking, the age at surgery influences the onset of incontinence, with earlier occurrence in older bitches, and that a strong co-operation between owners and veterinarians is necessary to achieve successful response to oestrogen replacement therapy. Long-term administration seems to be unrelated to oestrogenic side effects.

scholarly journals A Permanent Cure for Vitiligo: Immigration of Healthy Skin Cells to Unhealthy Sides of the Skin in Vitiligo Through a New Treatment

2018 ◽  
Vol 3 (8) ◽  
Keyword(s):  
Side Effects ◽  
Skin Disorder ◽  
The Body ◽  
Healthy Skin ◽  
Economic Issues ◽  
Skin Cells ◽  
Blood Tests ◽  
Permanent Cure ◽  
New Treatment

This article is about a skin disorder which manifests itself as white patches (pigment destruction) in different locations of the body. There are many classifications for this disorder such as segmented, focal, generalized and universal vitiligo. In my article, I have mentioned some of the current methods used in the treatment such as UV rooms. However, there are many risks and long term side effects to this treatment. Besides at the end of the treatment, the patient leaves the clinic in disappointment and without being treated. I was suffering from the same disorder for 14 years, so I can feel how deep is the depression and suffering of those vitiligo patients. My motivation behind the discovery of this treatment was me myself. I was suffering from the same disorder. It was so painful to be out in the society where everybody gazed at you and some were even afraid to talk to you. Because of my economic issues, I did not have access to labs and research centesrs. So I studied a lot and broadened my understanding and knowledge abut human body and biology. After I dicovered the treatment, I cured myself in 5months and then many more patients from England, Iran, Turkey and Azerbaijan. In my article, I have written about some blood tests the patients have to take. I have also mentioned the vitamins, pills and the creams they should use (different for kids and adults). My only intention for writing this article is to let all my colleague dermatologists know about the new treatment. Moreover, the whole treatment takes 5 months or so and is affordable by everybody. If the patients follow the simple advice mentioned in the article, the disorder will not come back. I would kindly ask you to go through my article and read it deep. I have treated myself and many others, so I can replicate the treatment on the cases given by you. The treatment and progress is visiblr from the first month.

scholarly journals Side Effects and Determinant of the Use of 3-Month Contraceptive Injection

2018 ◽  
Vol 14 (1) ◽  
pp. 20-27
Author(s):  
Sari Priyanti ◽  
Agustin Dwi Syalfina
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Side Effects ◽  
The Body ◽  
Menstrual Disorders ◽  
Cross Sectional ◽  
Primary Health ◽  
Estrogen Effect

Acceptor of contraceptive injection increased from 11.7% to 27.8% since 2010-2013. Contraceptive injection of Depo Medroxy Progesterone Acetate (DMPA) is given every 3 months by intramuscular. The long-term use of 3-month contraceptive injetion for more than two years can cause side effects such as menstrual disorders and decreased libido due to accumulation of progesterone hormone in the body that suppressed estrogen effect. This study aimed to analyze the association in long-term use of 3-month contraceptive injetion with menstrual disorders and decreased libido in Puskesmas (Primary health care) Puri, Mojokerto Regency in 2016. The study was observational analytics with cross sectional approach with sample 73 contraceptive acceptors. The data were analyzed by using univariate, bivariate and multivariate analysis with logistic regression and multivariate general model. The results showed that the duration of use of 3-month contraceptive injetion was significant with side effect of menstrual disorders (PR=0.142; 95%CI: 0.040-0.502) and decreased libido (PR=0.275; 95%CI: 0.100-0.756). Conclusion: menstrual disorders and decreased libido associated with the duration of use of 3-month contraceptive injetion.

Understanding a national increase in COVID-19 vaccination intention: a mixed methodological approach

2021 ◽  
Author(s):  
Jet Sanders ◽  
pita spruijt ◽  
Mart van Dijk ◽  
Janneke Elberse ◽  
Mattijs Lambooij ◽  
...  
Keyword(s):  
Side Effects ◽  
The Netherlands ◽  
Qualitative Methods ◽  
Quantitative Methods ◽  
Contextual Factors ◽  
Methodological Approach ◽  
Vaccination Campaigns

Recently the Netherlands saw a substantial increase in pro-COVID-19 vaccination intention (48 to 75%). Using qualitative methods we identified vaccination beliefs and contextual factors informing this increase. Quantitative methods confirm that intentions were a function of beliefs: people with stronger intention to vaccinate were motivated most by protecting others and reopening society, those reluctant were mostly concerned by (unknown long-term) side effects. We demonstrate that belief shifts track intentional shifts, and offer insights for improving pro-vaccination campaigns.

Gout

2013 ◽  
pp. 1199-1210
Author(s):  
Nicola Dalbeth
Keyword(s):  
Disease Patient ◽  
Joint Damage ◽  
Serum Urate ◽  
Acute Attack ◽  
Dietary Factors ◽  
Acute Gout ◽  
Chronic Synovitis ◽  
Renal Tubular

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

scholarly journals Three-Dimensional Gait Analysis Can Shed New Light on Walking in Patients with Haemophilia

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Sébastien Lobet ◽  
Christine Detrembleur ◽  
Firas Massaad ◽  
Cedric Hermans
Keyword(s):  
Gait Analysis ◽  
Functional Performance ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Three Dimensional ◽  
Joint Damage ◽  
Treatment Strategies ◽  
Gait Pattern ◽  
Metabolic Energy

In patients with haemophilia (PWH) (from Greek “blood love”), the long-term consequences of repeated haemarthrosis include cartilage damage and irreversible arthropathy, resulting in severe impairments in locomotion. Quantifying the extent of joint damage is therefore important in order to prevent disease progression and compare the efficacy of treatment strategies. Musculoskeletal impairments in PWH may stem from structural and functional abnormalities, which have traditionally been evaluated radiologically or clinically. However, these examinations are performed in a supine position (i.e., non-weight-bearing condition). We therefore suggest three-dimensional gait analysis (3DGA) as an innovative approach designed to focus on the functional component of the joint during the act of walking. This is of the utmost importance, as pain induced by weight-bearing activities influences the functional performance of the arthropathic joints significantly. This review endeavors to improve our knowledge of the biomechanical consequences of multiple arthropathies on gait pattern in adult patients with haemophilia using 3DGA. In PWH with arthropathy, the more the joint function was altered, the more the metabolic energy was consumed. 3DGA analysis could highlight the effect of an orthopedic disorder in PWH during walking. Indeed, mechanical and metabolic impairments were correlated to the progressive loss of active mobility into the joints.

scholarly journals Steroid-Dependent Crohn’s Disease

2000 ◽  
Vol 14 (suppl c) ◽  
pp. 17C-22C ◽  
Author(s):  
William J Sandborn
Keyword(s):  
Monoclonal Antibody ◽  
Crohn’S Disease ◽  
Side Effects ◽  
Crohn's Disease ◽  
Treatment Strategies ◽  
Steroid Use ◽  
Steroid Dependent ◽  
One Year ◽  
Steroid Sparing

Placebo controlled trials have demonstrated that a tapering course of corticosteroids is an effective therapy for active Crohn’s disease. A populationbased study of 109 patients with Crohn’s disease undergoing their first course of corticosteroids showed that, at the end of one year, 44% of patients were steroid responsive, 36% were steroid dependent and 20% were steroid refractory. Side effects occur frequently during a four-month tapering course of corticosteroids, including moon face, acne, infection, ecchymoses, hypertension, hirsutism, petechial bleeding and striae. More serious side effects occur with long term use, including hypertension, diabetes, infection, osteonecrosis, osteoporosis, myopathy, cataracts, glaucoma and psychosis. Low dose corticosteroids, alternate-day corticosteroids and mesalamine (5-aminosalicylate) are not effective steroid-sparing agents in patients with Crohn’s disease. Controlled ileal release budesonide, 6 mg/day, is an effective steroid-sparing agent, but it does result in some decrease in adrenal function. Azathioprine, 6-mercaptopurine and methotrexate are all effective steroidsparing agents, as is the humanized, anti-tumour necrosis factor monoclonal antibody, CDP571. A preliminary, uncontrolled study has suggested that the mouse/human chimeric monoclonal antibody infliximab may also be steroid sparing. Surgical resection is an effective strategy to reduce steroid use in the short to intermediate term, but postoperative reoccurrence of Crohn’s disease occurs frequently. Given the morbidity associated with prolonged corticosteroid use, medical and surgical treatment strategies to reduce steroid use should be employed routinely.

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