scholarly journals Clinical Course of Patients with Rheumatoid Arthritis Who Continue or Discontinue Biologic Therapy After Hospitalization for Infection: A Retrospective Observational Study

2021 ◽  
Author(s):  
Yusuke Kashiwado ◽  
Chikako Kiyohara ◽  
Yasutaka Kimoto ◽  
Shuji Nagano ◽  
Takuya Sawabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lower Risk ◽  
Biologic Therapy ◽  
Clinical Course ◽  
Biologic Agents ◽  
Oral Steroid ◽  
History Of ◽  
Independent Risk Factors ◽  
Oral Steroid Therapy ◽  
Clinical Records

Abstract Background: To analyse the subsequent clinical course of patients with rheumatoid arthritis (RA) who either continued or discontinued biologic agents after hospitalization for infections. Methods: We retrospectively reviewed the clinical records of 230 RA patients with 307 hospitalizations for infections under biologic therapy between September 2008 and May 2014 in 15 institutions for up to 18 months after discharge. The risks of RA flares and subsequent hospitalizations for infections from 61 days to 18 months after discharge were evaluated. Results: Survival analyses indicated that patients who continued biologic therapy had a significantly lower risk of RA flares (31.4% vs. 60.6%, P < 0.01), and a slightly lower risk of subsequent infections (28.7% vs. 34.5%, P = 0.37). Multivariate analysis showed that discontinuation of biologic therapy, diabetes, and a history of hospitalization for infection under biologic therapy were associated with RA flares. Oral steroid therapy equivalent to prednisolone 5 mg/day or more and chronic renal dysfunction were independent risk factors for subsequent hospitalizations for infections. Conclusions: Discontinuation of biologic therapy after hospitalization for infections may result in RA flares. Continuation of biologic therapy is preferable, particularly in patients without immunodeficiency.

scholarly journals Peripheral Ulcerative Keratitis following Laser in situ Keratomileusis

2016 ◽  
Vol 7 (1) ◽  
pp. 9-15
Author(s):  
Bryn M. Burkholder ◽  
Irene C. Kuo
Keyword(s):  
Clinical Course ◽  
Laser In Situ Keratomileusis ◽  
Oral Steroid ◽  
Postoperative Monitoring ◽  
Epithelial Ingrowth ◽  
Peripheral Ulcerative Keratitis ◽  
History Of ◽  
Oral Steroid Therapy ◽  
Ulcerative Keratitis

Purpose: We report a case of a patient with a history of glomerulonephropathy, not disclosed prior to laser in situ keratomileusis (LASIK), who developed severe postoperative peripheral ulcerative keratitis (PUK) soon after surgery. Method: Case report. Results: Within a week of surgery, the patient, who had no blepharitis or ocular surface disease, also developed diffuse lamellar keratitis (DLK) that was not contiguous with the PUK. Microbiologic evaluation of the flap interface disclosed no organisms, and no epithelial ingrowth was found. Both PUK and DLK resolved with topical and oral steroid therapy, and the patient's induced refractive error improved over the 12 months following LASIK. Conclusions: Necrotizing keratitis has been described after LASIK surgery in patients with or without autoimmune disease. However, to our knowledge, there has been no case of PUK following LASIK. As shown by our patient's clinical course and the typical association of PUK with systemic conditions, patients with a history of atypical postinfectious sequelae may require additional preoperative counseling, vigilant postoperative monitoring, and possibly additional intervention. Because patients do not always divulge medical details, especially if an extraocular site was involved or illness occurred many years prior, this case demonstrates the importance of performing a diligent history that excludes autoimmune disorders or atypical postinfectious sequelae prior to proceeding with keratorefractive intervention.

Treatment with Biologic Agents Improves the Prognosis of Patients with Rheumatoid Arthritis and Amyloidosis

2012 ◽  
Vol 39 (7) ◽  
pp. 1348-1354 ◽  
Author(s):  
TAKESHI KURODA ◽  
NAOHITO TANABE ◽  
DAISUKE KOBAYASHI ◽  
HIROE SATO ◽  
YOKO WADA ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Biologic Therapy ◽  
Statistical Significance ◽  
Biologic Agents ◽  
Aa Amyloidosis ◽  
Free Survival ◽  
Risk Of Death ◽  
Amyloid A ◽  
Systemic Complication

Objective.Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA). We evaluated the safety of therapy with anti-tumor necrosis factor and anti-interleukin 6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with patients with AA amyloidosis without such therapy.Methods.One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically or the date when biologic therapy was started until the time of death or to the end of 2010 for surviving patients. Patients who had started HD were selected for inclusion only after the presence of amyloid was demonstrated.Results.Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (nonbiologic group). Survival rate was significantly higher in the biologic group than in the nonbiologic group. Nine patients in the biologics group and 33 in the nonbiologic group started HD. Biologic therapy had a tendency for reduced risk of initiation of HD without any statistical significance.Conclusion.Patients with amyloidosis have a higher mortality rate, but the use of biologic agents can reduce risk of death. The use of biologics may not significantly influence the HD-free survival rate.

Safety of Biologic Agents in Elderly Patients with Rheumatoid Arthritis

2016 ◽  
Vol 43 (11) ◽  
pp. 1984-1988 ◽  
Author(s):  
Atsuko Murota ◽  
Yuko Kaneko ◽  
Kunihiro Yamaoka ◽  
Tsutomu Takeuchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Adverse Events ◽  
Elderly Patients ◽  
Young Patients ◽  
Pulmonary Complications ◽  
Biologic Agents ◽  
Treatment Withdrawal ◽  
Old Patients ◽  
Independent Risk Factors

Objective.To clarify the safety of biologics in elderly patients with rheumatoid arthritis.Methods.Biologics were analyzed for safety in relation to age in 309 patients.Results.Young (< 65 yrs old, n = 174), elderly (65–74 yrs old, n = 86), and older elderly patients (≥ 75 yrs old, n = 49) were enrolled. Although the incidence of adverse events causing treatment withdrawal was significantly higher in elderly and old elderly compared with young patients, no difference was found between elderly and older elderly patients. Pulmonary complications were independent risk factors.Conclusion.Old patients require special attention, although the safety of biologics in those ≥ 75 years old and 65–74 was comparable.

scholarly journals Adjusted Morbidity Groups and Intracerebral Haemorrhage: A Retrospective Primary Care Cohort Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13320
Author(s):  
Blanca Lorman-Carbó ◽  
Josep Lluis Clua-Espuny ◽  
Eulalia Muria-Subirats ◽  
Juan Ballesta-Ors ◽  
Maria Antònia González-Henares ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Intracerebral Haemorrhage ◽  
Antiplatelet Agents ◽  
Community Based ◽  
Group 4 ◽  
Complex Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Clinical Records

Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients. The main objective of this study was to identify modifiable risk factors of intracerebral haemorrhage. Methods: Multicentre, retrospective, community-based cohort study was conducted, including patients in the Adjusted Morbidity Group 4 with no history of intracerebral haemorrhage. Cases were obtained from electronic clinical records of the Catalan Institute of Health and were followed up for five years. The primary outcome was the occurrence of intracerebral haemorrhage during the study period. Demographic, clinical and pharmacological variables were included. Logistic regression analyses were carried out to detect prognostic variables for intracerebral haemorrhage. Results: 4686 subjects were included; 170 (3.6%) suffered an intracerebral haemorrhage (85.8/10,000 person–year [95% CI 85.4 to 86.2]). The HAS-BLED score for intracerebral haemorrhage risk detection obtained the best AUC (0.7) when used in the highest complexity level (cut-off point ≥3). Associated independent risk factors were age ≥80 years, high complexity and use of antiplatelet agents. Conclusions: The Adjusted Morbidity Group 4 is associated with a high risk of intracerebral haemorrhage, particularly for highly complex patients and the use of antiplatelet agents. The risk of bleeding in these patients must be closely monitored.

scholarly journals Autoimmune polyglandular syndrome type 3 variant in rheumatoid arthritis

2020 ◽  
Vol 58 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Taro Horino ◽  
Masami Ogasawara ◽  
Osamu Ichii ◽  
Yoshio Terada
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Clinical Course ◽  
Syndrome Type ◽  
Autoimmune Polyglandular Syndrome ◽  
History Of ◽  
Autoimmune Polyglandular Syndrome Type ◽  
Type 3

AbstractIntroduction. Although type 1 diabetes mellitus is largely associated with autoimmune thyroid disease and this entity has been recently referred to as autoimmune polyglandular syndrome type 3 variant, the autoimmune polyglandular syndrome type 3 variant in patients with rheumatoid arthritis has not been reported so far. We herein describe the first case of rheumatoid arthritis that was associated with autoimmune polyglandular syndrome type 3 variant.Case report. A 77-year-old woman with a 15-year history of rheumatoid arthritis (RA) and a 10-year history of type 2 diabetes mellitus (T2D) presented with polyarthralgia and hyperglycaemia. Methotrexate 16 mg/week had been started from the onset and was continued, and adalimumab 40 mg/day was started for RA. Insulin treatment was also started for the diabetes. Laboratory examinations revealed high levels of C-reactive protein (CRP), rheumatoid factor, anti-cyclic citrullinated peptide antibody, and matrix metalloprotease 3. She was admitted multiple times as the symptoms recurred after treatment. Subsequently, based on the clinical course and investigations, she was diagnosed with type 1 diabetes mellitus and Graves’ disease occurring during the course of RA and T2D. Her clinical course improved after reinforcement of insulin therapy and the addition of thiamazole therapy.Conclusion. In patients with rheumatoid arthritis, the autoimmune polyglandular syndrome type 3 variant should be considered as the cause of the deterioration.

scholarly journals AB0293 FACTORS ASSOCIATED WITH INITIATION OF BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN MOROCCAN PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1445.3-1445
Author(s):  
O. Hammou ◽  
F. Chennouf ◽  
H. Azzouzi ◽  
I. Linda
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Pressure ◽  
High Blood Pressure ◽  
Biologic Agents ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Biologic Dmards ◽  
Factors Associated ◽  
History Of ◽  
Disease Modifying

Background:Rheumatoid arthritis (RA) is a progressive autoimmune disorder of joints that is associated with high health care costs, yet guidance is lacking on how early to initiate biologic disease-modifying antirheumatic drugs (DMARDs). Few studies have examined the factors associated with the transition from non biologic DMARDs to biologic DMARDs in RA patients.Objectives:to examine the association of patient’s comorbidities with initiation of biologic DMARDs (disease-modifying antirheumatic drugs) in rheumatoid arthritis (RA).Methods:cross-sectional study was designed on a cohort of RA patients. Sociodemographic, clinical data and comorbidities were collected. Logistic regression analysis was used to explore the impact of comorbidities on the initiation of bDMARD. The statistical analysis was done by SPSS. 20, p <0.05 was considered significant.Results:among the 257 patients, 90.5% were females. Their mean age was 54.66 ± 11.9 years. The most frequent comorbidities in our population were: high blood pressure (22.5%), diabetes (16.6%), history of heart disease (5.1%), history of neoplasia (2.4%) and nephropathies (2%). RA patients with comorbidities were more likely to initiate bDMARD: high blood pressure (p = 0.003 OR=2.36, 95% CI: 1.332- 4.181), history of heart disease (p = 0.036 OR=3.01, 95% IC: 1.073-8.468) and history of neoplasia (p = 0.026 OR= 5.07, 95% CI: 1.219- 21.110). In multiple regression models, high blood pressure was associated to the initiation of biologic agents (p= 0.026, OR= 2.07, 95% CI: 1.090-3.932).Conclusion:the probability of initiating therapy with biologic agents in patients with RA is affected by different co-morbidities in our context specifically hypertension.References:[1]Machado-Alba JE, et al. Time to and factors associated with initiation of biological therapy in patients with rheumatoid arthritis in Colombia. Rev Colomb Reumatol. 2018[2]Priyanka Gaitonde et al. Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey. Seminars in Arthritis and Rheumatism. 2017Disclosure of Interests:None declared

Biopsy-proven isolated sarcoid meningitis

1993 ◽  
Vol 78 (6) ◽  
pp. 994-996 ◽  
Author(s):  
Stephan A. Mayer ◽  
Gregory K. Yim ◽  
Stephen T. Onesti ◽  
Timothy Lynch ◽  
Phyllis L. Faust ◽  
...  
Keyword(s):  
Granulomatous Inflammation ◽  
Brain Biopsy ◽  
Oral Steroid ◽  
Chronic Meningitis ◽  
Content Type ◽  
Systemic Involvement ◽  
History Of ◽  
Oral Steroid Therapy ◽  
Lymphocytic Meningitis ◽  
Rule Out

✓ Neurosarcoidosis without systemic involvement is rare and difficult to diagnose. The case of a 27-year-old man with a 6-week history of headache, mental status changes, and polyradiculopathy attributable to hypoglycorrheic lymphocytic meningitis is presented. Extensive testing for occult systemic sarcoidosis was negative. The presence of noncaseating granulomatous inflammation was established by open brain biopsy, and the patient improved clinically with oral steroid therapy. In individuals with undiagnosed chronic meningitis, brain biopsy may be necessary to rule out isolated neurosarcoidosis.

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