scholarly journals Treatment recommendations for psoriatic arthritis

2008 ◽  
Vol 68 (9) ◽  
pp. 1387-1394 ◽  
Author(s):  
C T Ritchlin ◽  
A Kavanaugh ◽  
D D Gladman ◽  
P J Mease ◽  
P Helliwell ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Manifestations ◽  
Treatment Recommendations ◽  
Individual Treatment ◽  
Peripheral Arthritis ◽  
Online Questionnaire ◽  
Consensus Opinion ◽  
Literature Reviews ◽  
Axial Disease ◽  
The Individual

Objective:To develop comprehensive recommendations for the treatment of the various clinical manifestations of psoriatic arthritis (PsA) based on evidence obtained from a systematic review of the literature and from consensus opinion.Methods:Formal literature reviews of treatment for the most significant discrete clinical manifestations of PsA (skin and nails, peripheral arthritis, axial disease, dactylitis and enthesitis) were performed and published by members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations were drafted for each of the clinical manifestations by rheumatologists, dermatologists and PsA patients based on the literature reviews and consensus opinion. The level of agreement for the individual treatment recommendations among GRAPPA members was assessed with an online questionnaire.Results:Treatment recommendations were developed for peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis and enthesitis in the setting of PsA. In rotal, 19 recommendations were drafted, and over 80% agreement was obtained on 16 of them. In addition, a grid that factors disease severity into each of the different disease manifestations was developed to help the clinician with treatment decisions for the individual patient from an evidenced-based perspective.Conclusions:Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists and dermatologists. In addition, a grid was established to assist in therapeutic reasoning and decision making for individual patients. It is anticipated that periodic updates will take place using this framework as new data become available.

scholarly journals Drug Therapies for Peripheral Joint Disease in Psoriatic Arthritis: A Systematic Review

2014 ◽  
Vol 41 (11) ◽  
pp. 2277-2285 ◽  
Author(s):  
Maria Laura Acosta Felquer ◽  
Laura C. Coates ◽  
Enrique R. Soriano ◽  
Roberto Ranza ◽  
Luis R. Espinoza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Current Literature ◽  
Therapeutic Strategies ◽  
Treatment Recommendations ◽  
Joint Disease ◽  
Joint Involvement ◽  
Evidence Based ◽  
Peripheral Arthritis ◽  
New Information

In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for peripheral joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.

GRAPPA Treatment Recommendations: An Update from the GRAPPA 2014 Annual Meeting and GRAPPA Meeting Adjacent to the 2014 ACR Meeting

2015 ◽  
Vol 42 (6) ◽  
pp. 1052-1055 ◽  
Author(s):  
Laura C. Coates ◽  
Arthur F. Kavanaugh ◽  
Philip J. Mease ◽  
Christopher T. Ritchlin
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Previous Treatment ◽  
Treatment Recommendations ◽  
Treatment Algorithms ◽  
Assessment Development ◽  
American College Of Rheumatology ◽  
Final Treatment ◽  
Literature Reviews ◽  
Associated Conditions

At the 2014 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members discussed an update of their previous treatment recommendations published in 2009. Domain subcommittees representing the different aspects of psoriatic arthritis (PsA) had been reconvened in 2013 and a new group was formed that focused on PsA comorbidities and associated conditions. A combined literature review was completed in February 2013 followed by individual group literature reviews and analyses. Articles from each of these subcommittees were published in 2014, updating the evidence for individual therapies in PsA. At their 2014 annual meeting, GRAPPA members discussed their plans for a summary article on treatment recommendations, finalized the Grading of Recommendations Assessment, Development and Evaluation (GRADE)-formatted recommendations for individual drugs within the domain subcommittees, and presented these for debate. Modifications to the GRAPPA grid were also discussed in breakout groups and presented to the full membership. At the GRAPPA meeting adjacent to the 2014 American College of Rheumatology meeting, a new GRAPPA treatment schema was proposed to replace the original GRAPPA grid. Each domain subcommittee discussed treatment algorithms based on their GRADE recommendations for inclusion in the final treatment recommendations article, which will be submitted in 2015.

Development of Composite Measures for Psoriatic Arthritis: A Report from the GRAPPA 2010 Annual Meeting

2012 ◽  
Vol 39 (2) ◽  
pp. 398-403 ◽  
Author(s):  
PHILIP S. HELLIWELL ◽  
OLIVER FITZGERALD ◽  
PHILIP J. MEASE
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Manifestations ◽  
Disease Status ◽  
Composite Measure ◽  
Full Spectrum ◽  
Single Measure ◽  
Composite Measures ◽  
American College Of Rheumatology ◽  
Axial Disease ◽  
Single Score

Composite disease outcome measures have been used in rheumatology for some time, but a disease-specific composite measure for psoriatic arthritis (PsA) has not yet been validated. Currently, instruments developed for use in rheumatoid arthritis are employed in PsA and include the American College of Rheumatology response criteria (ACR20, 50, and 70) and the Disease Activity Score for 28 and 44 joints (DAS28 and DAS44); however, these instruments do not cover the full spectrum of psoriatic disease. A composite measure is one way of incorporating an assessment of all relevant clinical outcomes into one single measure. By definition, it incorporates several dimensions of disease status, often by combining these different domains into a single score, which in the case of PsA includes joints, skin, entheses, dactylitis, and axial disease. New indices that combine these diverse clinical manifestations of PsA are under development and, in some cases, in the validation phase. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) established the GRAPPA Composite Exercise (GRACE) project to compare existing and emerging composite measures and to develop a new index. At the GRAPPA 2010 meeting, initial results from this project were presented, and existing and new candidate measures were compared.

scholarly journals AB0468 IS THE USE OF INTERLEUKIN 17 INHIBITORS IN SPONDYLOARTHRITIS RELATED TO THE CLINICAL MANIFESTATIONS? 12-MONTH EXPERIENCE OF ONE RHEUMATOLOGY CENTER

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1261.1-1261
Author(s):  
M. Khapsirokova ◽  
Z. Kolkhidova ◽  
S. Erdes
Keyword(s):  
Psoriatic Arthritis ◽  
Biological Therapy ◽  
Clinical Manifestations ◽  
Previous Treatment ◽  
Interleukin 17 ◽  
Disease Modifying Antirheumatic Drugs ◽  
Peripheral Arthritis ◽  
Antirheumatic Drugs ◽  
Male Patients ◽  
Necrosis Factor

Background:Therapy with interleukin 17 (iIL17) inhibitors in Russia is indicated for patients with ankylosing spondylitis (AS) or psoriatic arthritis (PSA). If standard therapy is ineffective in these diseases, both tumor necrosis factor inhibitors (iTNF) and iIL17 can be prescribed as the first biologics.Objectives:To study the clinical features of patients with spondyloarthritis (SPA) who were first prescribed iIL17 in a rheumatology center for 12 months.Methods:During the period from January to December 2019, iIL17 was initiated to 43 SPA patients. To compare the clinical picture, the study additionally included 40 SPA patients who were prescribed iTNF during the same period. The diagnosis of AS was based on the mNY criteria, and psoriatic arthritis was based on the CASPAR criteria. In the combined group of 83 patients, AS was in 52 (62.7%), and PSA – in 31; the age of patients was 39.3±10.8 years, and the duration of the disease was 15.1±8.2 years; men were 47 (56.6%).Results:In the iIL17 group, AS had 23 (53.5%) patients, and PSA – 20 (46.5%), while in the iTNF group, respectively, 29 (72.5%) and 11 (27.5%; χ2=3.2, p=0.76). Among the patients who were prescribed iIL17, men were 29 (67%), and in the iTNF group – 18 (45%; χ2=4.2, p=0.04). In terms of activity indicators (ESR, CRP, BASDAI ASDAS-CRP), patients who were prescribed iIL17 or iTNF did not differ significantly from each other. Peripheral arthritis, dactylitis, and entesitis were observed with almost the same frequency in both groups. In the iIL17 group, there were almost 2 times more patients with psoriasis (53.5% and 25.0%; p<0.05) than in group iTNF and among them, significantly more frequent the patients had previous experience of iTNF treatment (41,9% and 17.5%; p<0.05). Disease-modifying antirheumatic drugs often received patients in iTNF group (80.0% and 48.8%; p<0.05).Conclusion:Thus, in clinical practice iIL17 often prescribed for SPA male patients with psoriasis and previous treatment experience by iTNF. The activity of the disease and the presence of non-axial manifestations practically do not affect the choice of biological therapy.Disclosure of Interests:None declared.

The Development of Language-Training Programs for Postrubella Hearing-Impaired Children

1973 ◽  
Vol 38 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Linda Lynch ◽  
Annette Tobin
Keyword(s):  
Hearing Impaired ◽  
Treatment Programs ◽  
Individual Treatment ◽  
Target Behaviors ◽  
Systematic Fashion ◽  
Development Of Language ◽  
The Individual ◽  
Impaired Children ◽  
Hearing Impaired Children

This paper presents the procedures developed and used in the individual treatment programs for a group of preschool, postrubella, hearing-impaired children. A case study illustrates the systematic fashion in which the clinician plans programs for each child on the basis of the child’s progress at any given time during the program. The clinician’s decisions are discussed relevant to (1) the choice of a mode(s) for the child and the teacher, (2) the basis for selecting specific target behaviors, (3) the progress of each program, and (4) the implications for future programming.

STUDYING SOME CLINICAL AND PARACLINICAL CHARACTERISTICS OF POSMATURE BABIES CARED IN NICU AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 74-84
Author(s):  
Thi Kieu Nhi Nguyen
Keyword(s):  
Respiratory Rate ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
University Hospital ◽  
Maternal Characteristics ◽  
Exact Test ◽  
Menstrual Cycles ◽  
Term Newborns ◽  
Student’S T ◽  
The Individual

Objectives: 1. Estimating the ratios of clinical and paraclinical signs of post-term newborns hospitalized at Pediatric Department of Hue University Hospital. 2. Identifying the relation between clinical signs and paraclinical signs. Materials and Method: 72 post- term babies < 7 days of life hospitalized at NICU from 2010/5 to 2011/4. Classification of post - term newborn was based on WHO 2003: gestational age ≥ 42 weeks with clinical manifestations: desquamation on press with fingers or natural desquamation, withered or meconial umbilicus, meconial long finger nails (*) or geatational age still < 42 weeks with theses clinical manifestations (*). Data were recorded on a clinical record form. Per-protocol analysis of clinical outcomes was performed by using Medcalc 11.5 and Excell 2007. Analyses used the χ2 test or Fisher's exact test for categorical data; Student's t test was used for continuous data and the Mann-Whitney U test for nonparametric data. Data were presented as means or proportions with 95% CIs. Results: Clinical characteristics: Tachypnea and grasp were main reasons of hospitalisation (48.61%). Poor feeding, vomitting (16.67%). Asphyxia (8.34%). Jawndice (6.94%). Hypothermia < 36.50C (13.89%), fever (13.89%). Tachypnea (59.72%). Bradycardia (1.39%). Poor feeding (11.11%). Hypertonia (9.72%). Paraclinical characteristics: Erythrocytes < 4.5.1012/l (51.39%), Leucocytes 5 – 25.103/mm3 (81.94%), Thrombocytes 100- 400.103/mm3 (94.44%). Hemoglobinemia < 10mg/l (67.61%). Maternal characteristics: Menstrual cycles regular (75%). Primiparity (75%). Amniotic volume average (70.42%), little (29.58%). Aminiotic liquid clair (62.5%), aminiotic liquid yellow (4.17%), aminiotic meconial liquid (33.33%). Maternal manifestation of one of many risk factors consist of genital infection; urinary infection; fever before, during, after 3 days of birth; prolonged delivery; medical diseases influence the foetus (75%). The relation between clinical signs and paraclinical signs: There was significantly statistical difference: between gestationnal age based on obstetrical criteria and amniotic volume on ultrasound (p < 0.05); between birth weight and glucosemia p < 0.02). There was conversional correlation of average level between erythroctes number and respiratory rate (r = - 0.5158; p < 0,0001), concordance correlation of weak level betwwen leucocytes number and respiratory rate r = 0.3045; p = 0.0093). Conclusion: It should made diagnosis of postterm baby based on degree of desquamation. The mother who has menstrual cycles regular is still delivered of a postterm baby. A postterm baby has the individual clinical and paraclinical signs.

scholarly journals Public Roads as Places of Interspecies Conflict: A Study of Horse-Human Interactions on UK Roads and Impacts on Equine Exercise

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1072
Author(s):  
Danica Pollard ◽  
Tamzin Furtado
Keyword(s):  
Near Miss ◽  
Online Questionnaire ◽  
Near Misses ◽  
Logistic Regression Models ◽  
Emotional Management ◽  
The Road ◽  
Human Interactions ◽  
Road Users ◽  
Conflict Risk ◽  
The Individual

Real or perceived traffic risk is a significant barrier to walking and cycling. To understand whether similar barriers influence equestrians, this study obtained exercise behaviours, road use and experiences of road-related incidents from UK equestrians (n = 6390) via an online questionnaire. Multivariable logistic regression models were used to identify factors associated with road use and experiencing a near-miss or injury-causing incident in the previous year. Content analysis identified themes around equestrians’ decisions not to use roads. Our results show that most equestrians (84%) use roads at least once weekly, and in the previous year, 67.7% had a near-miss and 6.1% an injury-causing incident. Road use differs regionally, with exercise type and off-road route availability. Road-using equestrians covered greater daily distances and were younger. However, younger equestrians were at higher risk of near-misses. Respondents’ decisions not to use roads were based on individualised risk assessments arising from: the road itself, perceptions of other road users, the individual horse and the handler’s own emotional management. Roads were perceived as extremely dangerous places with potentially high conflict risk. Injury-causing incidents were associated with increasing road-use anxiety or ceasing to use roads, the proximity of off-road routes, having a near-miss and type of road use. Targeted road-safety campaigns and improved off-road access would create safer equestrian spaces.

scholarly journals POS0239 ROOT JOINT INVOLVEMENT IN SPONDYLOARTHRITIS: A POST-HOC ANALYSIS FROM THE INTERNATIONAL ASAS-PERSPA STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 340.1-341
Author(s):  
N. Ziade ◽  
J. El-Hajj ◽  
J. Rassi ◽  
S. Hlais ◽  
C. López-Medina ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Positive Answer ◽  
Categorical Variables ◽  
Joint Involvement ◽  
Main Diagnosis ◽  
Post Hoc Analysis ◽  
Wall Distance ◽  
History Of ◽  
Axial Disease ◽  
Post Hoc

Background:In patients with spondyloarthritis (SpA), root joint diseases (RJD), i.e. hip or shoulder involvement, may be associated with a distinct disease phenotype compared to those with other affected joints. The ASAS-PerSpA study (PERipheral involvement in SPondyloArthritis) [1], offers a unique opportunity to study the phenotypes of patients with RJD in a global cohort.Objectives:Primary objective was to compare the clinical characteristics of SpA patients with and without RJD. Secondary objectives were to compare the prevalence of RJD across the different SpA subtypes and the different regions of the world, compare the severity of axial disease as well as the disease burden in SpA patients with and without RJD.Methods:This is a post-hoc analysis of the ASAS-PerSpA study, which included 4,465 patients with any subtype of SpA (axial SpA (axSpA), peripheral SpA (pSpA), psoriatic arthritis (PsA), inflammatory bowel disease associated SpA (IBD-SpA), reactive arthritis (ReA) and Juvenile SpA (Juv-SpA)) according to the rheumatologist’s diagnosis. RJD was defined as a positive answer by the investigator to the following question: “Do you consider that the patient has ever suffered from RJD (e.g. hip, shoulder) related to SpA?” In case of a positive answer, a potential specific treatment (e.g. Total Articular Replacement) was investigated. The patient’s characteristics were compared between those with and without RJD involvement, using Chi-2 or Fisher exact test for the categorical variables and t-test for the continuous variables. Two separate multivariable stepwise binary logistic regression analyses were conducted to identify factors associated with the dependent variables “hip involvement” and “shoulder involvement”.Results:RJD occurred in 1,503 patients (33.7%), with more prevalent hip (24.2%) than shoulder (13.2%) involvement. The prevalence of RJD as a group was the highest in Juv-SpA (52.7%), followed by pSpA (44.3%) and axSpA (33.9%). The highest prevalence of RJD was found in Asia and the lowest in Europe and North America. Among patients with hip involvement, 6.0% had a history of hip replacement (highest in the Middle East and North Africa and Latin America); among patients with shoulder involvement, 0.8% had a history of shoulder replacement. Hip had a distinct pattern of associations compared to shoulder involvement (Figure 1). Hip involvement was significantly associated with the SpA main diagnosis (highest in pSpA, lowest in PsA), younger age at first SpA symptom, lower prevalence of family history of psoriasis, positive HLA-B27, occiput-to-wall distance>0, and treatment with cs-DMARDs and b-DMARDs. Shoulder involvement was associated with the SpA main diagnosis (highest in Juv-SpA and pSpA, lowest in axSpA), older age at first SpA symptom, higher prevalence of enthesitis, dactylitis, tender joints count, IBD, occiput-to-wall distance>0, EQ5D score and treatment with cs-DMARDs.Conclusion:Hip involvement was more prevalent than shoulder involvement in patients with SpA, and had a distinct phenotype resembling axial disease whereas shoulder involvement was mostly associated with features of peripheral disease. Hip and shoulder involvement should be analyzed separately in future studies rather than under the RJD entity.References:[1]Lopez-medina, C. et al. Prevalence and Distribution of Peripheral Musculoskeletal Manifestations in Axial Spondyloarthritis, Peripheral Spondyloarthritis and Psoriatic Arthritis: Results of the International, Cross-sectional ASAS-PerSpA Study. RMD Open; 2021;7:e001450.Disclosure of Interests:None declared

scholarly journals Development of the Mental, Emotional, and Bodily Toughness Inventory in Collegiate Athletes and Nonathletes

2008 ◽  
Vol 43 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Mick G. Mack ◽  
Brian G. Ragan
Keyword(s):  
Undergraduate Students ◽  
Rating Scale ◽  
Collegiate Athletes ◽  
Rehabilitation Program ◽  
Mental Toughness ◽  
Individual Treatment ◽  
Model Data ◽  
Fit Statistics ◽  
The People ◽  
The Individual

Abstract Context: The assessment of an individual's mental toughness would assist clinicians in enhancing an individual's performance, improving compliance with the rehabilitation program, and improving the individual treatment program. However, no sound measure of mental toughness exists. Objective: To develop a new measure of mental toughness, the Mental, Emotional, and Bodily Toughness Inventory (MeBTough). Design: Participants were invited to complete a 45-item questionnaire. Setting: University research laboratory. Patients or Other Participants: A total of 261 undergraduate students were recruited to complete the questionnaire. Main Outcome Measure(s): The Rasch-calibrated item difficulties, fit statistics, and persons' mental toughness ability estimates were examined for model-data fit of the MeBTough. Results: Forty-three of the 45 items had good model-data fit with acceptable fit statistics. Results indicated that the distribution of items was fittingly targeted to the people and the collapsed rating scale functioned well. The item separation index (6.31) and separation reliability statistic (.98) provided evidence that the items had good variability with a high degree of confidence in replicating placement of the items from another sample. Conclusions: Results provided support for using the new measure of mental, emotional, and bodily toughness.

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