scholarly journals Choosing the right treatment for patients with psoriatic arthritis

2020 ◽  
Vol 12 ◽  
pp. 1759720X2096262
Author(s):  
Maria Noviani ◽  
Marie Feletar ◽  
Peter Nash ◽  
Ying Ying Leung
Keyword(s):  
Psoriatic Arthritis ◽  
Treatment Options ◽  
Unmet Need ◽  
Current Treatment ◽  
Low Disease Activity ◽  
Appropriate Treatment ◽  
Chronic Inflammatory Condition ◽  
Axial Disease ◽  
Inflammatory Bowel ◽  
The Right

Psoriatic arthritis (PsA) is a chronic inflammatory condition with articular and extra-articular manifestations: peripheral arthritis, axial disease, enthesitis, dactylitis, psoriasis, inflammatory bowel disease and uveitis. Anti-tumour necrosis factors (anti-TNFs) have demonstrated clinical efficacies exceeding those of conventional disease-modifying antirheumatic drugs (DMARDs). New understanding in pathogenic pathways have led to novel therapeutic targets. The current treatment paradigms emphasize early diagnosis and treatment, and treating towards remission and low disease activity status, particularly in long-standing disease. This review addresses the evidence of current treatment options for each of the domains of PsA. We present a simple guide that weighs on clinical efficacies for each PsA domain to aid clinicians in choosing the most appropriate treatment for patients. We highlight the unmet need for biomarkers of treatment response, and future perspectives with precision medicine in PsA.

Comprehensive Treatment of Dactylitis in Psoriatic Arthritis

2014 ◽  
Vol 41 (11) ◽  
pp. 2295-2300 ◽  
Author(s):  
Shawn Rose ◽  
Sergio Toloza ◽  
Wilson Bautista-Molano ◽  
Philip S. Helliwell
Keyword(s):  
Psoriatic Arthritis ◽  
Primary Outcome ◽  
Treatment Options ◽  
Current Treatment ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Clinical Feature ◽  
Comprehensive Treatment ◽  
Limited Data ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antiinflammatory Drugs

Dactylitis, a hallmark clinical feature of psoriatic arthritis (PsA) and other spondyloarthropathies, may also be a severity marker for PsA and psoriasis. Traditionally, clinicians have used nonsteroidal antiinflammatory drugs and local corticosteroid injections to treat dactylitis, although conventional disease-modifying antirheumatic drugs are also used. We performed a systematic literature review to determine the most efficacious current treatment options for dactylitis in PsA. Effect sizes were greatest for the biologic agents ustekinumab, certolizumab, and infliximab, suggesting that therapy with one of these agents should be initiated in patients with dactylitis. However, the limited data highlight the need for randomized, placebo-controlled trials, with dactylitis as a primary outcome, to determine a valid, reliable, and responsive clinical outcome measure for PsA patients with dactylitis.

scholarly journals Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

2019 ◽  
Vol 78 (11) ◽  
pp. 1517-1523
Author(s):  
Jørgen Guldberg-Møller ◽  
Rene Lindholm Cordtz ◽  
Lars Erik Kristensen ◽  
Lene Dreyer
Keyword(s):  
Cohort Study ◽  
Psoriatic Arthritis ◽  
General Population ◽  
Time Trends ◽  
Unmet Need ◽  
Current Treatment ◽  
Incidence Rates ◽  
Joint Surgery ◽  
Rate Ratios

ObjectiveTo investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population.MethodsIn this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method.ResultsFrom 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18–40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up.ConclusionsThe use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18–40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.

scholarly journals Chronic Constipation: Current Management and Challenges

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 5B-6B ◽  
Author(s):  
Martin Storr
Keyword(s):  
Canadian Journal ◽  
Chronic Constipation ◽  
Initial Treatment ◽  
Unmet Needs ◽  
Treatment Options ◽  
Unmet Need ◽  
Current Treatment ◽  
Current Management ◽  
Novel Drugs ◽  
Canadian Market

Many challenges are associated with the diagnosis and management of patients with chronic constipation. Some of these challenges arise from the currently incomplete understanding of what causes constipation and from the difficulties in diagnosing and classifying the heterogeneous group of patients with chronic constipation. Despite the availability of different treatment options for constipation, an unmet need for drugs in the treatment of patients with chronic constipation remains. This holds especially true for patients who fail an initial treatment. With promising novel drugs either close to approval for the Canadian market or on the horizon, many of these unmet needs may be addressed. The present supplement toThe Canadian Journal of Gastroenterologyprovides an educational overview of the current understanding of the diagnosis, epidemiology, pathophysiology and management of chronic constipation, and summarizes current treatment options in light of current and newly available drugs.

scholarly journals Current Treatment Options for Patients with Myotonic Dystrophy Type 2

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
Federica Montagnese
Keyword(s):  
Myotonic Dystrophy ◽  
Treatment Options ◽  
Current Treatment ◽  
Standards Of Care ◽  
Myotonic Dystrophy Type ◽  
Myotonic Dystrophy Type 2 ◽  
Appropriate Treatment ◽  
Symptomatic Management ◽  
The Moment

Abstract Purpose of the review Myotonic dystrophy types 1 and 2 are frequent forms of muscular dystrophies in adulthood. Their clinical differences need to be taken into account for the most appropriate treatment of patients. The aim of this article is to provide an overview on the current and upcoming therapeutic options for patients with myotonic dystrophy type 2 (DM2). Recent findings At the moment, no disease-modifying therapies are available for DM2; next-generation therapies may however be available in the near future. In the meanwhile, the symptomatic management of patients has greatly improved, thank to the production of consensus-based standards of care and the growing evidence of efficacy of anti-myotonic drugs, promising employment of cannabinoids for symptom’s relief, regular monitoring, and early detection of treatable extra-muscular manifestations. Summary The treatment of DM2 is currently symptomatic and relies on the coordinated intervention of a multidisciplinary team. It remains to be determined whether upcoming causal therapies for myotonic dystrophy type 1 will be applicable also in DM2.

scholarly journals Inflammasomes and Proteostasis Novel Molecular Mechanisms Associated With Atrial Fibrillation

2020 ◽  
Vol 127 (1) ◽  
pp. 73-90 ◽  
Author(s):  
Na Li ◽  
Bianca J.J.M. Brundel
Keyword(s):  
Atrial Fibrillation ◽  
Histone Deacetylases ◽  
Molecular Mechanisms ◽  
Treatment Options ◽  
Unmet Need ◽  
Current Treatment ◽  
Cytoskeletal Proteins ◽  
Age Related ◽  
Research Findings ◽  
Shock Proteins

Atrial fibrillation (AF), the most common progressive and age-related cardiac arrhythmia, affects millions of people worldwide. AF is associated with common risk factors, including hypertension, diabetes mellitus, and obesity, and serious complications such as stroke and heart failure. Notably, AF is progressive in nature, and because current treatment options are mainly symptomatic, they have only a moderate effect on prevention of arrhythmia progression. Hereto, there is an urgent unmet need to develop mechanistic treatments directed at root causes of AF. Recent research findings indicate a key role for inflammasomes and derailed proteostasis as root causes of AF. Here, we elaborate on the molecular mechanisms of these 2 emerging key pathways driving the pathogenesis of AF. First the role of NLRP3 (NACHT, LRR, and PYD domains-containing protein 3) inflammasome on AF pathogenesis and cardiomyocyte remodeling is discussed. Then we highlight pathways of proteostasis derailment, including exhaustion of cardioprotective heat shock proteins, disruption of cytoskeletal proteins via histone deacetylases, and the recently discovered DNA damage-induced nicotinamide adenine dinucleotide + depletion to underlie AF. Moreover, potential interactions between the inflammasomes and proteostasis pathways are discussed and possible therapeutic targets within these pathways indicated.

scholarly journals POS1043 NETAKIMAB REDUCES PSORIATIC ARTHRITIS ACTIVITY IN PATIENTS WITH OR WITHOUT AXIAL DISEASE: SUBANALYSIS OF THE PATERA STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 796-797
Author(s):  
T. Korotaeva ◽  
I. Gaydukova ◽  
V. Mazurov ◽  
A. Samtsov ◽  
V. Khayrutdinov ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Missing Values ◽  
Categorical Variables ◽  
Inflammatory Back Pain ◽  
Rapid Decline ◽  
Inadequate Response ◽  
Low Disease Activity ◽  
Axial Disease ◽  
The Impact

Background:PATERA is an ongoing phase 3 international double-blind, placebo-controlled clinical study of netakimab (NTK) in psoriatic arthritis (PsA) (NCT03598751). Netakimab (NTK) is an anti-interleukin-17A monoclonal antibody approved for psoriasis, ankylosing spondylitis, PsA in Russia and Belarus.Objectives:A subanalysis was performed to define the impact of NTK on PsA activity depending on the presence of axial disease: a subset of patients with inflammatory back pain (IBP) according to self-reported ASAS IBP criteria, 2009 (IBP(+) was compared to those without IBP (IBP(-)).Methods:194 eligible adult patients with PsA fulfilling the CASPAR criteria, with inadequate response to csDMARD or one TNFi, were randomly assigned to receive NTK 120mg or placebo at weeks 0,1,2,4,6,8,10,14,18,22. Patients with missing values for categorical variables were considered as non-responders in the analysis. For quantitative variables, missing values were replaced using the multiple imputation method.Results:97 PsA patients (N=54 IBP(+), N=43 IBP(-)) received NTK. Both subpopulations were comparable in gender, age and PsA activity at baseline. The treatment led to a pronounced decline in PsA activity in both subpopulations, significant differences between arms were observed only in DAPSA remission and very low disease activity (VLDA) at week 24 (Figure 1A). Changes from baseline in DAS28-CRP were consistent between IBP(+) and IBP(-) patients with a rapid decline during the first month with further improvement up to week 24 (Figure 1B). A similar trend was observed PsA-specific composite responder index (PSARC) (data not shown). A comparable percentage of IBP(+) and IBP(-) patients achieved PSARC at each timepoint of evaluation with 87% and 86% of responders respectively at week 24.Conclusion:NTK significantly improved PsA activity regardless of the presence of IBP.Figure 1.PsA activity after 24-week treatment with NTK. (A) Percentage of patients with DAPSA remission (0-4), very low disease activity (VLDA), minimal disease activity (MDA) at week 24; (B) change from baseline in DAS28-CRPAcknowledgements:This study was sponsored by JSC BIOCAD.Disclosure of Interests:Tatiana Korotaeva Speakers bureau: Abbvie, Biocad, Eli Lilly, Johnson & Johnson, Janssen, Novartis, Pfizer, UCB, Inna Gaydukova Speakers bureau: Abbvie, Biocad, Eli Lilly, MSD, Novartis, Pfizer, Sandoz, V Mazurov: None declared, Aleksey Samtsov: None declared, Vladislav Khayrutdinov: None declared, Andrey Bakulev: None declared, Alena Kundzer: None declared, Nikolaj Soroka: None declared, Anna Eremeeva Employee of: Biocad.

scholarly journals Chronic Constipation: Current Management and Challenges

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 5B-6B
Author(s):  
Martin Storr
Keyword(s):  
Canadian Journal ◽  
Chronic Constipation ◽  
Initial Treatment ◽  
Unmet Needs ◽  
Treatment Options ◽  
Unmet Need ◽  
Current Treatment ◽  
Current Management ◽  
Novel Drugs ◽  
Canadian Market

Many challenges are associated with the diagnosis and management of patients with chronic constipation. Some of these challenges arise from the currently incomplete understanding of what causes constipation and from the difficulties in diagnosing and classifying the heterogeneous group of patients with chronic constipation. Despite the availability of different treatment options for constipation, an unmet need for drugs in the treatment of patients with chronic constipation remains. This holds especially true for patients who fail an initial treatment. With promising novel drugs either close to approval for the Canadian market or on the horizon, many of these unmet needs may be addressed. The present supplement toThe Canadian Journal of Gastroenterologyprovides an educational overview of the current understanding of the diagnosis, epidemiology, pathophysiology and management of chronic constipation, and summarizes current treatment options in light of current and newly available drugs.

scholarly journals Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management

2016 ◽  
Vol 10 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Gautam Dagur ◽  
Jason Gandhi ◽  
Yiji Suh ◽  
Steven Weissbart ◽  
Yefim R. Sheynkin ◽  
...  
Keyword(s):  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Techniques ◽  
Current Treatment ◽  
Serous Fluid ◽  
Secondary Complications ◽  
Appropriate Treatment ◽  
Iatrogenic Trauma ◽  
Life Threatening

Introduction: A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression. Materials and Methods: A MEDLINE® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management. Results: Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options. Conclusion: Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.

scholarly journals The Anti-inflammatory Effects of Dietary Anthocyanins against Ulcerative Colitis

2019 ◽  
Vol 20 (10) ◽  
pp. 2588 ◽  
Author(s):  
Shiyu Li ◽  
Binning Wu ◽  
Wenyi Fu ◽  
Lavanya Reddivari
Keyword(s):  
Ulcerative Colitis ◽  
Animal Studies ◽  
Fruits And Vegetables ◽  
Treatment Options ◽  
Current Treatment ◽  
Bacterial Metabolism ◽  
Inflammatory Bowel ◽  
Negative Side Effects ◽  
Dietary Strategies

Ulcerative colitis (UC), which is a major form of inflammatory bowel disease (IBD), is a chronic relapsing disorder of the gastrointestinal tract affecting millions of people worldwide. Alternative natural therapies, including dietary changes, are being investigated to manage or treat UC since current treatment options have serious negative side effects. There is growing evidence from animal studies and human clinical trials that diets rich in anthocyanins, which are pigments in fruits and vegetables, protect against inflammation and increased gut permeability as well as improve colon health through their ability to alter bacterial metabolism and the microbial milieu within the intestines. In this review, the structure and bioactivity of anthocyanins, the role of inflammation and gut bacterial dysbiosis in UC pathogenesis, and their regulation by the dietary anthocyanins are discussed, which suggests the feasibility of dietary strategies for UC mitigation.

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