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[PMID]:28460083
[Au] Autor:Rendas-Baum R; Kosinski M; Singh A; Mebus CA; Wilkinson BE; Wallenstein GV
[Ad] Endereço:QualityMetric Incorporated Lincoln, RI.
[Ti] Título:Estimated medical expenditure and risk of job loss among rheumatoid arthritis patients undergoing tofacitinib treatment: post hoc analyses of two randomized clinical trials.
[So] Source:Rheumatology (Oxford);56(8):1386-1394, 2017 Aug 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: RA causes high disability levels and reduces health-related quality of life, triggering increased costs and risk of unemployment. Tofacitinib is an oral Janus kinase inhibitor for the treatment of RA. These post hoc analyses of phase 3 data aimed to assess monthly medical expenditure (MME) and risk of job loss for tofacitinib treatment vs placebo. Methods: Data analysed were from two randomized phase 3 studies of RA patients (n = 1115) with inadequate response to MTX or TNF inhibitors (TNFi) receiving tofacitinib 5 or 10 mg twice daily, adalimumab (one study only) or placebo, in combination with MTX. Short Form 36 version 2 Health Survey physical and mental component summary scores were translated into predicted MME via an algorithm and concurrent inability to work and job loss risks at 6, 12 and 24 months, using Medical Outcomes Study data. Results: MME reduction by month 3 was $100 greater for tofacitinib- than placebo-treated TNFi inadequate responders (P < 0.001); >20 and 6% reductions from baseline, respectively. By month 3 of tofacitinib treatment, the odds of inability to work decreased ⩾16%, and risk of future job loss decreased ∼20% (P < 0.001 vs placebo). MME reduction by month 3 was $70 greater for tofacitinib- than placebo-treated MTX inadequate responders (P < 0.001); ⩾23 and 13% reductions from baseline, respectively. By month 3 of tofacitinib treatment, the odds of inability to work decreased ⩾31% and risk of future job loss decreased ⩾25% (P < 0.001 vs placebo). Conclusion: Tofacitinib treatment had a positive impact on estimated medical expenditure and risk of job loss for RA patients with inadequate response to MTX or TNFi.
[Mh] Termos MeSH primário: Antirreumáticos/economia
Artrite Reumatoide/economia
Efeitos Psicossociais da Doença
Gastos em Saúde
Piperidinas/economia
Pirimidinas/economia
Pirróis/economia
Retorno ao Trabalho/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adalimumab/administração & dosagem
Adalimumab/economia
Adulto
Antirreumáticos/administração & dosagem
Artrite Reumatoide/tratamento farmacológico
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Masculino
Metotrexato/administração & dosagem
Metotrexato/economia
Meia-Idade
Piperidinas/administração & dosagem
Pirimidinas/administração & dosagem
Pirróis/administração & dosagem
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antirheumatic Agents); 0 (Piperidines); 0 (Pyrimidines); 0 (Pyrroles); 87LA6FU830 (tofacitinib); FYS6T7F842 (Adalimumab); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex087


  2 / 19698 MEDLINE  
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[PMID]:28460018
[Au] Autor:Nieuwenhuis WP; van Steenbergen HW; Mangnus L; Newsum EC; Bloem JL; Huizinga TWJ; le Cessie S; Reijnierse M; van der Helm-van Mil AHM
[Ad] Endereço:Department of Rheumatology.
[Ti] Título:Evaluation of the diagnostic accuracy of hand and foot MRI for early Rheumatoid Arthritis.
[So] Source:Rheumatology (Oxford);56(8):1367-1377, 2017 Aug 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: To assess the diagnostic value of MRI for early RA. In some RA patients, a classifiable diagnosis cannot be made at first presentation; these patients present with unclassified arthritis (UA). The use of MRI for early diagnosis of RA is recommended, yet the evidence for its reliability is limited. Methods: MRI of hand and foot was performed in 589 early arthritis patients included in the Leiden Early Arthritis Clinic (229 presented with RA, 159 with other arthritides and 201 with UA). Symptom-free controls provided a reference for defining an abnormal MRI. In preliminary investigations, MRI of patients who presented with RA was compared with MRI of symptom-free controls and of patients with other arthritides. Thereafter, the value of MRI in early RA diagnosis was determined in UA patients using the 1-year follow-up on fulfilling the 1987 RA criteria and start of disease-modifying drugs as outcomes. Results: Preliminary investigations were promising. Of the UA patients, 14% developed RA and 37% started disease-modifying treatment. MRI-detected tenosynovitis was associated with RA development independent of other types of MRI-detected inflammation [odds ratio (OR) = 7.5, 95% CI: 2.4, 23] and also independent of age and other inflammatory measures (swollen joints, CRP) (OR = 4.2, 95% CI: 1.4, 12.9). Within UA patients, the negative predictive value of abnormal tenosynovitis was 95% (95% CI: 89%, 98%) and the positive predictive value 25% (95% CI: 17%, 35%). The performance was best in the subgroup of UA patients presenting with oligoarthritis (18% developed RA): the positive predictive value was 36% (95% CI: 23%, 52%), the negative predictive value was 98% (95% CI: 88%, 100%), the sensitivity was 93% (95% CI: 70%, 99%) and the specificity was 63% (95% CI: 51%, 74%). Conclusion: MRI contributes to the identification of UA patients who will develop RA, mostly in UA patients presenting with oligoarthritis.
[Mh] Termos MeSH primário: Artrite Reumatoide/diagnóstico por imagem
/diagnóstico por imagem
Mãos/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Antirreumáticos/uso terapêutico
Artrite/diagnóstico por imagem
Artrite Reumatoide/tratamento farmacológico
Estudos de Casos e Controles
Progressão da Doença
Diagnóstico Precoce
Feminino
Seres Humanos
Masculino
Meia-Idade
Razão de Chances
Valor Preditivo dos Testes
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
Tenossinovite/diagnóstico por imagem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antirheumatic Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex167


  3 / 19698 MEDLINE  
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[PMID]:28461531
[Au] Autor:Ogdie A; de Wit M; Callis Duffin K; Campbell W; Chau J; Coates LC; Eder L; Elmamoun M; FitzGerald O; Gladman DD; Goel N; James J; Kalyoncu U; Latella J; Lindsay C; Mease PJ; O'Sullivan D; Steinkoenig I; Strand V; Tillett W; Orbai AM
[Ad] Endereço:From Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Utah, Salt Lake City, Utah; QuintilesIMS, Denver, Colorado; Duke University School of Medicine, Durham, North Carolina; Rheumatology Research, Swedish Medical Center; Un
[Ti] Título:Defining Outcome Measures for Psoriatic Arthritis: A Report from the GRAPPA-OMERACT Working Group.
[So] Source:J Rheumatol;44(5):697-700, 2017 May.
[Is] ISSN:0315-162X
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) Core Set working group recently published the updated 2016 psoriatic arthritis (PsA) core domain set, a set of disease features that should be measured in all clinical trials. At the GRAPPA annual meeting in July 2016, the PsA working group presented the updated PsA core domain set endorsed by 90% of participants at OMERACT in May 2016 and drafted a roadmap for the development of the PsA core outcome measurement set. In this manuscript, we review the development process of the PsA core domain set and the ongoing and proposed work streams for development of a PsA core measurement set.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Artrite Psoriásica/tratamento farmacológico
Avaliação de Resultados (Cuidados de Saúde)
Reumatologia
[Mh] Termos MeSH secundário: Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antirheumatic Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.3899/jrheum.170150


  4 / 19698 MEDLINE  
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[PMID]:28464909
[Au] Autor:Gmuca S; Xiao R; Brandon TG; Pagnini I; Wright TB; Beukelman T; Morgan EM; Weiss PF
[Ad] Endereço:Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
[Ti] Título:Multicenter inception cohort of enthesitis-related arthritis: variation in disease characteristics and treatment approaches.
[So] Source:Arthritis Res Ther;19(1):84, 2017 May 02.
[Is] ISSN:1478-6362
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Enthesitis-related arthritis (ERA) is a specific subtype of juvenile idiopathic arthritis (JIA) defined according to the International League of Associations for Rheumatology (ILAR) criteria. We aimed to characterize the clinical features and treatment regimens in an inception cohort of children with ERA. METHODS: We performed a retrospective, cross-sectional, multicenter cohort study including subjects diagnosed with ERA between 1989 and 2012. Patients all fulfilled the ILAR criteria for ERA within 3 months of initial presentation to the rheumatology clinic. Differences in the prevalence of clinical criteria across study sites and by human leukocyte antigen (HLA)-B27 status were assessed using the Wilcoxon rank-sum or chi-square test, as appropriate. RESULTS: Two hundred thirty-four children met the inclusion criteria. Their median age at diagnosis was 11.6 years, and 59% were HLA-B27-positive. Sixty-nine percent had enthesitis and arthritis at the time of diagnosis. Seventy-eight percent had a pauciarticular onset. The prevalence of all ILAR criteria at diagnosis, except arthritis and acute anterior uveitis, differed significantly across sites (all p < 0.01). Medication use varied significantly across sites for children with peripheral arthritis (p < 0.001), but not for sacroiliitis or enthesitis only. Nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs were the most commonly prescribed treatments, with anti-TNF agents primarily being initiation for sacroiliitis. HLA-B27 positivity was associated with male sex, higher active joint count, sacroiliitis, and higher disease activity at disease onset. CONCLUSIONS: The majority of children had a pauciarticular onset, and several statistically significant clinical differences based on HLA-B27 status were identified. The observed heterogeneity in clinical presentation across sites reflects either true differences in patient populations or differences in how the ILAR criteria are being applied.
[Mh] Termos MeSH primário: Anti-Inflamatórios não Esteroides/uso terapêutico
Antirreumáticos/uso terapêutico
Artrite Juvenil/diagnóstico
Artrite Juvenil/tratamento farmacológico
Internacionalidade
[Mh] Termos MeSH secundário: Adolescente
Artrite Juvenil/sangue
Criança
Estudos de Coortes
Estudos Transversais
Feminino
Antígeno HLA-B27/sangue
Seres Humanos
Masculino
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Antirheumatic Agents); 0 (HLA-B27 Antigen)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s13075-017-1297-x


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[PMID]:29185961
[Au] Autor:Galli M; Antinori S; Atzeni F; Meroni L; Riva A; Scirè C; Adorni F; Quartuccio L; Sebastiani M; Airò P; Bazzichi L; Cristini F; Del Bono V; Manfredi A; Viapiana O; De Rosa F; Favalli E; Petrelli E; Salvarani C; Govoni M; Corcione S; Scrivo R; Sarmati L; Lazzarin A; Grassi W; Mastroianni C; Gaeta GB; Ferraccioli G; Cutolo M; De Vita S; Lapadula G; Matucci-Cerinic M; Armignacco O; Sarzi-Puttini P
[Ad] Endereço:Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy. massimo.galli@unimi.it.
[Ti] Título:Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis.
[So] Source:Clin Exp Rheumatol;35(6):1018-1028, 2017 Nov-Dec.
[Is] ISSN:0392-856X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group).
[Mh] Termos MeSH primário: Artrite Reumatoide/complicações
Pneumopatias Fúngicas/tratamento farmacológico
[Mh] Termos MeSH secundário: Antirreumáticos/efeitos adversos
Coccidioidomicose/tratamento farmacológico
Criptococose/tratamento farmacológico
Histoplasmose/tratamento farmacológico
Seres Humanos
Pneumonia por Pneumocystis/tratamento farmacológico
Aspergilose Pulmonar/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antirheumatic Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171130
[St] Status:MEDLINE


  6 / 19698 MEDLINE  
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[PMID]:29185959
[Au] Autor:Marchesoni A; Olivieri I; Salvarani C; Pipitone N; D'Angelo S; Mathieu A; Cauli A; Punzi L; Ramonda R; Scarpa R; Maccarone M; Lubrano E
[Ad] Endereço:Day Hospital of Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy. antonio.marchesoni@asst-pini-cto.it.
[Ti] Título:Recommendations for the use of biologics and other novel drugs in the treatment of psoriatic arthritis: 2017 update from the Italian Society of Rheumatology.
[So] Source:Clin Exp Rheumatol;35(6):991-1010, 2017 Nov-Dec.
[Is] ISSN:0392-856X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To update the 2011 Italian Society of Rheumatology (SIR) recommendations for the use of biologics and other novel agents in the treatment of psoriatic arthritis (PsA). METHODS: To create this new set of recommendations, the SIR "Spondyloartritis and Psoriatic Arthritis study group - A. Spadaro" went through the following steps: literature search, identification of the items of interests for each of the four previously identified clinical domains of PsA and the different treatment phases, achievement of the consensus on all topics, and generation of the recommendations. RESULTS: An update on the available evidence on all of the biologics and new small molecules tested in PsA is reported, comprising the data for each of the individual articular manifestation. Indications for therapy inclusion criteria, choice of the drug, disease assessment, response definition, therapy failure management, and disease remission management for PsA peripheral joint arthritis, enthesitis, dactylitis, and spondylitis are provided. Suggestions for the treatment of patients with PsA and concomitant extra-articular manifestations are also given. CONCLUSIONS: These evidence-based recommendations may be used for guidance in the complex and fast-evolving field of the treatment of PsA.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Artrite Psoriásica/tratamento farmacológico
Produtos Biológicos/uso terapêutico
[Mh] Termos MeSH secundário: Abatacepte/uso terapêutico
Anticorpos Monoclonais Humanizados/uso terapêutico
Prática Clínica Baseada em Evidências
Seres Humanos
Interleucina-17/antagonistas & inibidores
Guias de Prática Clínica como Assunto
Fator de Necrose Tumoral alfa/antagonistas & inibidores
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Antirheumatic Agents); 0 (Biological Products); 0 (Interleukin-17); 0 (Tumor Necrosis Factor-alpha); 0 (clazakizumab); 7D0YB67S97 (Abatacept)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171130
[St] Status:MEDLINE


  7 / 19698 MEDLINE  
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[PMID]:29466165
[Au] Autor:Mease P; Gladman D
[Ad] Endereço:Swedish Medical Center, Seattle, WA pmease@philipmease.com
[Ti] Título:Tofacitinib for Psoriatic Arthritis.
[So] Source:N Engl J Med;378(8):775-776, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Artrite Psoriásica
Pirimidinas
[Mh] Termos MeSH secundário: Antirreumáticos
Artrite Reumatoide
Seres Humanos
Piperidinas
Inibidores de Proteínas Quinases
Pirróis
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Antirheumatic Agents); 0 (Piperidines); 0 (Protein Kinase Inhibitors); 0 (Pyrimidines); 0 (Pyrroles); 87LA6FU830 (tofacitinib)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1715189


  8 / 19698 MEDLINE  
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[PMID]:29390386
[Au] Autor:Nusshag C; Morath C; Zeier M; Weigand MA; Merle U; Brenner T
[Ad] Endereço:Department of Nephrology.
[Ti] Título:Hemophagocytic lymphohistiocytosis in an adult kidney transplant recipient successfully treated by plasmapheresis: A case report and review of the literature.
[So] Source:Medicine (Baltimore);96(50):e9283, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease entity primarily described in children, but not less relevant in adults. It is characterized by a misdirected activation of the immune system, resulting in an uncontrolled cytokine release from macrophages and cytotoxic T-cells (CTLs). Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies or autoimmune diseases. However, the awareness and therapeutic knowledge for HLH in adulthood is limited. Most therapy protocols are almost exclusively validated in pediatric cohorts and for primary HLH. Their transferability to adult individuals with mostly secondary HLH is doubtful. Especially the high liver and bone marrow toxicity of applied etoposide-based protocols is discussed controversially and connected to overwhelming infections and death. PATIENT CONCERN: A 51-year old, male, kidney transplant recipient was admitted to our center suffering from diarrhea, fever, nausea, hyponatremia, kidney graft failure, disorientation, progressive hemodynamic instability, and multiorgan failure. DIAGNOSES: Clinical and laboratory findings resembled those of a septic shock. Ferritin and soluble interleukin-2 receptor (sCD25) levels were disproportionally elevated. Only a mild hepatosplenomegaly was diagnosed in a CT scan. A T2-weighted, fluid-attenuated inversion recovery MRI showed marked, bilateral and periventricular white matter hyperintensities. The cerebrospinal fluid (CSF) analysis showed a moderately elevated protein content and cell count. There was no evidence of any bacterial, viral, or parasitic infection. The diagnosis of HLH was made. INTERVENTIONS & OUTCOMES: The patient was successfully treated by a combined approach consisting of plasma exchange (PE), corticosteroids, anakinra, and cyclosporine (CsA). LESSONS: HLH is an important differential diagnosis in critically ill patients. Its unspecific clinical picture complicates an early diagnosis and may be misclassified as sepsis. A combination of plasma exchange (PE), corticosteroids, anakinra, and cyclosporine (CsA) may be a promising and less toxic approach for HLH therapy in adults.
[Mh] Termos MeSH primário: Transplante de Rim
Linfo-Histiocitose Hemofagocítica/terapia
Plasmaferese
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Antirreumáticos/uso terapêutico
Terapia Combinada
Ciclosporina/uso terapêutico
Diagnóstico Diferencial
Diagnóstico por Imagem
Seres Humanos
Imunossupressores/uso terapêutico
Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico
Linfo-Histiocitose Hemofagocítica/etiologia
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Antirheumatic Agents); 0 (Immunosuppressive Agents); 0 (Interleukin 1 Receptor Antagonist Protein); 83HN0GTJ6D (Cyclosporine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009283


  9 / 19698 MEDLINE  
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[PMID]:29390339
[Au] Autor:Chen Y; Shen Y; Ma HF; Cai JF; Hua YQ; Zou J; Guan JL
[Ad] Endereço:Rheumatology and Immunology Department.
[Ti] Título:Infliximab associated with life-threatening lung infection in a patient with Behcet disease with intestinal and hematopoietic system involvement: A case report.
[So] Source:Medicine (Baltimore);96(50):e9202, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Tumor necrosis factor (TNF-α) participates in the pathophysiology of Behcet's disease (BD) and myelodysplastic syndrome (MDS). Infliximab is recommaned for the most severe type of BD, however, there is little evidence for its effectiveness in BD associated MDS. PATIENT CONCERNS: A 46-year-old female, initially diagnosed with intestinal BD and leukopenia was later diagnosed as MDS. Treatement with infliximab and other immunoregulators lead to life-threatening pneumonia. DIAGNOSIS: Intestinal BD associated with MDS involving trisomy 8. INTERVENTIONS: The patient initially treated with methylprednisolone, thalidomide, cyclosporine A, and infliximab, which lead to severe lung infection. Therefore, the patient was transferred to Intensive Care Unit for life supportive, anti-infection and immune improving therapy. OUTCOMES: The patient survived from the lung infection. With combination of methylprednisolone, thalidomide and cyclosporine A, the patient recovered from her intestinal ulceration and MDS manifestations. LESSONS: Infliximab treatment may not benefit a patient with BD associated with MDS but place the patient at risk of infection.
[Mh] Termos MeSH primário: Antirreumáticos/efeitos adversos
Antirreumáticos/uso terapêutico
Síndrome de Behçet/complicações
Síndrome de Behçet/tratamento farmacológico
Infliximab/efeitos adversos
Infliximab/uso terapêutico
Síndromes Mielodisplásicas/tratamento farmacológico
Síndromes Mielodisplásicas/etiologia
Pneumonia/induzido quimicamente
[Mh] Termos MeSH secundário: Ciclosporina/uso terapêutico
Feminino
Glucocorticoides/uso terapêutico
Seres Humanos
Imunossupressores/uso terapêutico
Metilprednisolona/uso terapêutico
Meia-Idade
Talidomida/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antirheumatic Agents); 0 (Glucocorticoids); 0 (Immunosuppressive Agents); 4Z8R6ORS6L (Thalidomide); 83HN0GTJ6D (Cyclosporine); B72HH48FLU (Infliximab); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009202


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[PMID]:29390329
[Au] Autor:Zhou Z; Jiang W; Wang M; Liu Y; Zhang W; Huang M; Liang D
[Ti] Título:Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting: A case report.
[So] Source:Medicine (Baltimore);96(50):e9187, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. PATIENT CONCERNS: Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. DIAGNOSES: Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. INTERVENTIONS: The patient was placed on a trial of hydroxychloroquine (200 mg once daily). OUTCOMES: The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. LESSONS: These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Hidroxicloroquina/uso terapêutico
Hipergamaglobulinemia/diagnóstico
Hipergamaglobulinemia/tratamento farmacológico
Púrpura/diagnóstico
Púrpura/tratamento farmacológico
Síndrome de Sjogren/diagnóstico
Síndrome de Sjogren/tratamento farmacológico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Extremidade Inferior
Meia-Idade
Postura
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antirheumatic Agents); 4QWG6N8QKH (Hydroxychloroquine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009187



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