The effect of anti-TNF on renal function in patients with ankylosing spondylitis: a prospective cohort study

Clinical Rheumatology - Biologicals, such as anti-tumor necrosis factor (anti-TNF), reduce cardiovascular disease (CVD) in patients with inflammatory rheumatic diseases. Impaired renal function is...     

Correction to: Coagulation in gout: is there a link with disease activity?

Clinical Rheumatology -     

Determining cardiovascular risk in patients with rheumatoid arthritis: waiting for trial outcomes is not recommended

Cardiovascular risk management is clearly indicated in patients with rheumatoid arthritis (RA) today because this risk is comparable to patients with diabetes. Although formal evidence of cardiovascular endpoint trials with statins and/or antihypertensives is lacking in patients with RA, there are no indications that these drugs will have limited effect. In contrast, there is accumulating evidence as to the efficacy of the use of these drugs in RA that is at least comparable to their effects in the general population. All patients with RA should therefore receive cardiovascular risk-management therapy aimed at powerful suppression of the chronic inflammatory process as well as treatment with statins and/or antihypertensives, if indicated. Obviously, monitoring in the clinical setting is necessary to document if such therapy does indeed reduce cardiovascular disease in patients with RA.     

Small carcinoma of the lip with big consequences

A 79-year-old man, an 81-year-old woman and a 60-year-old woman were referred to our oral and maxillofacial surgery clinic with a large submandibular swelling. All three patients had a history of prior excision of a small carcinoma of the lower lip. Primary treatment had been carried out by a number of different medical specialists. In the first two patients, none of the caregivers had recognized this swelling as a possible lymph node metastasis. Oncological follow-up had not been performed and the patients were unaware of the metastatic potential of their cancers. Although in the third patient follow-up was adequate, there was too much delay between confirmation of the metastasis and planning of the surgery. All three patients died of a small lip carcinoma. Stage I lip carcinomas generally have a good prognosis. However, patients have to be informed about the risk of lymph node metastasis and need to be followed up on a routine basis.     

Dutch orthopedic thromboprophylaxis: a 5-year follow-up survey

Background and purpose Previous surveys in the Netherlands have revealed that guidelines regarding orthopedic thromboprophylaxis were not followed and that a wide variation in protocols exists. This survey was performed to assess the current use of thromboprophylactic modalities and to compare it with the results of a previous survey.Methods All departments of orthopedic surgery in the Netherlands were sent a follow-up survey on venous thromboprophylaxis, and the data obtained were compared to the results of a survey performed 5 years earlier.Results All departments used pharmacological thromboprophylaxis following arthroplasties of the hip and knee. Low-molecular-weight heparin (LMWH) was used most frequently (79%) of the departments, followed by fondaparinux (13%). 5 years earlier, coumarin treatment was the predominant prophylaxis (79%). All departments prescribed pharmacological prophylaxis after femoral and tibial fractures; 78% used LMWH. Prophylaxis was continued for 6 weeks in 85% of cases. LMWH treatment was initiated on the day before surgery in 31% of cases (65% in the previous survey), perioperatively in 55%, and in the evening following surgery in 24%. In general, for daycare surgery and arthroscopies either no prophylaxis was given or a LMWH was given for 1 day. After anterior cruciate ligament reconstruction, 94% of departments prescribed some form of pharmacological prophylaxis.Interpretation The use of pharmacological prophylaxis after arthroplasty of the hip and knee and also after fracture surgery around the hip and knee is common practice in the Netherlands. In 5 years, the widely used coumarin derivates have been largely replaced with LMWH.     

Increased disease activity is associated with a deteriorated lipid profile in patients with ankylosing spondylitis

BACKGROUND: Cardiovascular mortality is increased in patients with ankylosing spondylitis. A possible explanation might be a more prevalent atherogenic lipid profile in patients with ankylosing spondylitis than in the general population. It has been postulated that inflammation deteriorates the lipid profile, thereby increasing cardiovascular risk. OBJECTIVE: To explore the association between disease activity and lipid profile in patients with ankylosing spondylitis. METHODS: Disease activity parameters for ankylosing spondylitis and lipid levels (total cholesterol, high-density lipoprotein cholesterol (HDLc) and triglycerides) were measured in 45 patients with ankylosing spondylitis for 6 months after starting treatment with leflunomide or placebo. Findings in this treatment group were compared with those in 10 patients with ankylosing spondylitis treated with etanercept. A specialised regression model, adjusting for repeated measurements, age and sex, was used to assess the influence of the disease activity variables on the lipid levels. RESULTS: Multilevel regression analyses showed significant associations between disease activity parameters and lipid levels-for instance, an increase of 30 mm at the end of the first hour in erythrocyte sedimentation rate was associated with a decrease of about 6% in total cholesterol level and a decrease of about 11% in HDLc levels. Similar significant associations were found between other disease activity parameters and lipid levels. CONCLUSION: Increase in disease activity was associated with decreases in lipid levels. The decrease in HDLc levels tended to be almost twice as large as the decrease in total cholesterol levels, resulting in a more atherogenic lipid profile. Hence, effective treatment of disease activity in patients with ankylosing spondylitis may lower the cardiovascular risk by improving the lipid profile.     

Development of antiinfliximab antibodies and relationship to clinical response in patients with rheumatoid arthritis

OBJECTIVE: Treatment of patients with infliximab, a chimeric monoclonal IgG1 antibody against tumor necrosis factor, may result in the formation of infliximab-specific IgG antibodies. This study evaluated the clinical significance of these antibodies in patients with rheumatoid arthritis (RA). METHODS: Antiinfliximab antibodies were measured using a newly developed radioimmunoassay in a cohort of 51 consecutive patients with RA treated with infliximab, with a followup of 1 year. In addition, serum infliximab levels were determined by enzyme-linked immunosorbent assay. The results were analyzed in relation to the clinical response to treatment according to the European League Against Rheumatism criteria. RESULTS: Antibodies against infliximab were detected in 22 patients (43%). Patients without detectable antiinfliximab antibodies (n = 29 [57%]) were significantly more often classified as responders (20 of 29 [69%]) compared with patients with detectable antiinfliximab antibodies (8 of 22 [36%]; P = 0.04). Three patients had an infusion-related allergic reaction, all of whom had detectable antiinfliximab antibodies. CONCLUSION: In this study, nearly half of the RA patients treated with infliximab developed antiinfliximab antibodies within the first year of treatment. This seems to be clinically relevant, since development of antiinfliximab antibodies is associated with a reduced response to treatment.     

Fever of unknown origin caused by the adult form of Still's disease

In three patients, two women aged 70 and 19 years and a man aged 33 years with long-lasting fever no diagnosis was made after extensive diagnostic work-up. After exclusion of infectious, malignant and rheumatic diseases, adult-onset Still's disease was diagnosed in all three patients on the basis of clinical and laboratory criteria. Adult-onset Still's disease is an important but less well known cause of fever. Clinically, adult-onset Still's disease is characterized by the triad of fever, skin rash and arthritis/arthralgia. A greatly elevated serum ferritin level proved to be an additional valuable diagnostic clue. Treatment consists of non-steroidal anti-inflammatory drugs, corticosteroids or immunosuppressive agents. The long-term prognosis is usually good, but severe joint destruction may occur. All three patients recovered.     

A multi-parameter response prediction model for rituximab in rheumatoid arthritis

Objectives

To validate the IFN response gene (IRG) set for the prediction of non-response to rituximab in rheumatoid arthritis (RA) and assess the predictive performance upon combination of this gene set with clinical parameters.