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Rheumatoid Arthritis: HELP
Articles from North Carolina
Based on 189 articles published since 2008
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These are the 189 published articles about Arthritis, Rheumatoid that originated from North Carolina during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. Electronic address: goodmans@hss.edu. · Bryan Springer, MD: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · Gordon Guyatt, MD: McMaster University, Hamilton, Ontario, Canada. · Matthew P. Abdel, MD: Mayo Clinic, Rochester, Minnesota. · Vinod Dasa, MD: Louisiana State University, New Orleans. · Michael George, MD: University of Pennsylvania, Philadelphia. · Ora Gewurz-Singer, MD: University of Michigan, Ann Arbor. · Jon T. Giles, MD, MPH: Columbia University, New York, New York. · Beverly Johnson, MD: Albert Einstein College of Medicine, Bronx, New York. · Steve Lee, DO: Kaiser Permanente, Fontana, California. · Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · Michael A. Mont, MD: Cleveland Clinic, Cleveland, Ohio. · Scott Sporer, MD: Midwest Orthopaedics at Rush, Chicago, Illinois. · Louis Stryker, MD: University of Texas Medical Branch, Galveston. · Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia. · Antonia F. Chen, MD, MBA: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · Jeremy Gililland, MD: University of Utah, Salt Lake City. · Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania. · Arlene Hurley-Rosenblatt, ANP: Rockefeller University, New York, New York. · Elena Losina, PhD: Brigham and Women's Hospital, Boston, Massachusetts. · Kaleb Michaud, PhD: National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha. · Ted Mikuls, MD, MSPH: University of Nebraska Medical Center, Omaha. · Alexander Sah, MD: Dearborn-Sah Institute for Joint Restoration, Fremont, California. · Jasvinder A. Singh, MBBS, MPH: University of Alabama at Birmingham. ·J Arthroplasty · Pubmed #28629905.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

2 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · McMaster University, Hamilton, Ontario, Canada. · Mayo Clinic, Rochester, Minnesota. · Louisiana State University, New Orleans. · University of Pennsylvania, Philadelphia. · University of Michigan, Ann Arbor. · Columbia University, New York, New York. · Albert Einstein College of Medicine, Bronx, New York. · Kaiser Permanente, Fontana, California. · Cleveland Clinic, Cleveland, Ohio. · Midwest Orthopaedics at Rush, Chicago, Illinois. · University of Texas Medical Branch, Galveston. · American College of Rheumatology, Atlanta, Georgia. · Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · University of Utah, Salt Lake City. · University of Pittsburgh, Pittsburgh, Pennsylvania. · Rockefeller University, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha. · Dearborn-Sah Institute for Joint Restoration, Fremont, California. · University of Alabama at Birmingham. ·Arthritis Rheumatol · Pubmed #28620948.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

3 Guideline Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. 2017

Carsons, Steven E / Vivino, Frederick B / Parke, Ann / Carteron, Nancy / Sankar, Vidya / Brasington, Richard / Brennan, Michael T / Ehlers, William / Fox, Robert / Scofield, Hal / Hammitt, Katherine M / Birnbaum, Julius / Kassan, Stuart / Mandel, Steven. ·Winthrop-University Hospital Campus, State University of New York, Stony Brook, Mineola. · University of Pennsylvania, Philadelphia. · University of Connecticut Health Center, Farmington. · University of California at San Francisco. · University of Texas San Antonio Dental School, San Antonio. · Washington University, St. Louis, Missouri. · Carolinas Medical Center, Charlotte, North Carolina. · Scripps Memorial Hospital Xi-Med, La Jolla, California. · University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Oklahoma City Department of Veterans Affairs Medical Center, Oklahoma City. · Sjögren's Syndrome Foundation, Bethesda, Maryland. · Johns Hopkins University, Baltimore, Maryland. · University of Colorado, Denver. · Lenox Hill Hospital, New York, and Hofstra Northwell School of Medicine, Hempstead, New York. ·Arthritis Care Res (Hoboken) · Pubmed #27390247.

ABSTRACT: OBJECTIVE: The Sjögren's Syndrome Foundation clinical practice guidelines (CPGs) are designed to improve quality and consistency of care in Sjögren's syndrome by offering recommendations for management. METHODS: Management questions for the systemic manifestations of Sjögren's syndrome were posed by the CPG committee with input from patients and rheumatologists. Clinical questions were assigned to a topic review group that performed systematic reviews and data extraction and drafted guidelines. Quality of evidence and strength of recommendation were rated using the American Society of Clinical Oncology's modification of the Grading of Recommendations Assessment, Development, and Evaluation. Guideline recommendations were reviewed by a consensus expert panel (CEP) composed of 30-40 clinicians from academia and community practices, as well as registered nurses and patients, using a modified Delphi process. A CEP agreement level of 75% was set as a minimum for adoption of a guideline recommendation. RESULTS: Consensus was achieved for 19 recommendations; for 11 additional modules, available data were insufficient to allow a recommendation to be formulated. Of the 19 recommendations, 15 required 1 Delphi round, 2 required 2 rounds, and 2 required 3 rounds. CONCLUSION: Key recommendations include a decision tree for the use of oral disease-modifying antirheumatic drugs for inflammatory musculoskeletal pain, use of self-care measures and advice regarding exercise to reduce fatigue, and the use of rituximab in selected clinical settings for oral and ocular dryness and for certain extraglandular manifestations, including vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, and mononeuritis multiplex. The CPG committee strongly discouraged the use of tumor necrosis factor inhibitors for sicca symptoms and for the majority of clinical contexts in primary Sjögren's syndrome.

4 Guideline 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. 2016

Singh, Jasvinder A / Saag, Kenneth G / Bridges, S Louis / Akl, Elie A / Bannuru, Raveendhara R / Sullivan, Matthew C / Vaysbrot, Elizaveta / McNaughton, Christine / Osani, Mikala / Shmerling, Robert H / Curtis, Jeffrey R / Furst, Daniel E / Parks, Deborah / Kavanaugh, Arthur / O'Dell, James / King, Charles / Leong, Amye / Matteson, Eric L / Schousboe, John T / Drevlow, Barbara / Ginsberg, Seth / Grober, James / St Clair, E William / Tindall, Elizabeth / Miller, Amy S / McAlindon, Timothy. ·University of Alabama at Birmingham. · American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · University of California, Los Angeles. · Washington University School of Medicine, St. Louis, Missouri. · University of California, San Diego. · University of Nebraska Medical Center, Omaha. · North Mississippi Medical Center, Tupelo. · Healthy Motivation, Santa Barbara, California. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota and Park Nicollet Clinic, St. Louis Park. · NorthShore University Health System, Evanston, Illinois. · Global Healthy Living Foundation, New York, New York. · Duke University Medical Center, Durham, North Carolina. · Rheumatology Consultants of Oregon, West Linn. · American College of Rheumatology, Atlanta, Georgia. ·Arthritis Rheumatol · Pubmed #26545940.

ABSTRACT: OBJECTIVE: To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA). METHODS: We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. RESULTS: The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. CONCLUSION: This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

5 Guideline 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. 2016

Singh, Jasvinder A / Saag, Kenneth G / Bridges, S Louis / Akl, Elie A / Bannuru, Raveendhara R / Sullivan, Matthew C / Vaysbrot, Elizaveta / McNaughton, Christine / Osani, Mikala / Shmerling, Robert H / Curtis, Jeffrey R / Furst, Daniel E / Parks, Deborah / Kavanaugh, Arthur / O'Dell, James / King, Charles / Leong, Amye / Matteson, Eric L / Schousboe, John T / Drevlow, Barbara / Ginsberg, Seth / Grober, James / St Clair, E William / Tindall, Elizabeth / Miller, Amy S / McAlindon, Timothy / Anonymous1780848. ·University of Alabama at Birmingham. · American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · University of California, Los Angeles. · Washington University School of Medicine, St. Louis, Missouri. · University of California, San Diego. · University of Nebraska Medical Center, Omaha. · North Mississippi Medical Center, Tupelo. · Healthy Motivation, Santa Barbara, California. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota and Park Nicollet Clinic, St. Louis Park. · NorthShore University Health System, Evanston, Illinois. · Global Healthy Living Foundation, New York, New York. · Duke University Medical Center, Durham, North Carolina. · Rheumatology Consultants of Oregon, West Linn. · American College of Rheumatology, Atlanta, Georgia. ·Arthritis Care Res (Hoboken) · Pubmed #26545825.

ABSTRACT: OBJECTIVE: To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA). METHODS: We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. RESULTS: The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. CONCLUSION: This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

6 Editorial Bone loss, pain and inflammation: three faces of ACPA in RA pathogenesis. 2016

Sokolove, Jeremy / Pisetsky, David. ·VA Palo Alto Health Care System and the Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA. · Department of Medicine, Division of Rheumatology, Durham VA Medical Center and Duke University Medical Center, Durham, North Carolina, USA. ·Ann Rheum Dis · Pubmed #26768407.

ABSTRACT: -- No abstract --

7 Editorial Editorial: Insulin Resistance: Releasing the Brakes on Synovial Inflammation and Osteoarthritis? 2016

Griffin, Timothy M / Huffman, Kim M. ·Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City. · Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina. ·Arthritis Rheumatol · Pubmed #26749517.

ABSTRACT: -- No abstract --

8 Editorial Rheumatoid vasculitis: going, going, but not yet gone. 2015

Pisetsky, David S. ·Medical Research Service, Durham VA Medical Center, Duke University Medical Center, Durham, NC, 27710, USA. david.pisetsky@duke.edu. ·Arthritis Res Ther · Pubmed #25952359.

ABSTRACT: -- No abstract --

9 Editorial Rheumatology in the current era: the challenge of success. 2008

Pisetsky, David S. ·Division of Rheumatology and Immunology at the Duke University Medical Center, Durham, NC, USA. ·Nat Clin Pract Rheumatol · Pubmed #18382480.

ABSTRACT: -- No abstract --

10 Review Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials. 2018

Kelley, George A / Kelley, Kristi S / Callahan, Leigh F. ·Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA. · Department of Biostatistics, School of Public Health, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA. · Departments of Social Medicine and Orthopaedics, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA. ·BMJ Open · Pubmed #29455165.

ABSTRACT: BACKGROUND/PURPOSE: Given conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD). METHODS: Randomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge's standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailed RESULTS: Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=-0.40, 95% CI -0.65 to -0.15, tau CONCLUSIONS: Exercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic. PROSPERO REGISTRATION NUMBER: CRD42016048728.

11 Review Niclosamide: Beyond an antihelminthic drug. 2018

Chen, Wei / Mook, Robert A / Premont, Richard T / Wang, Jiangbo. ·Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: w.chen@duke.edu. · Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States. ·Cell Signal · Pubmed #28389414.

ABSTRACT: Niclosamide is an oral antihelminthic drug used to treat parasitic infections in millions of people worldwide. However recent studies have indicated that niclosamide may have broad clinical applications for the treatment of diseases other than those caused by parasites. These diseases and symptoms may include cancer, bacterial and viral infection, metabolic diseases such as Type II diabetes, NASH and NAFLD, artery constriction, endometriosis, neuropathic pain, rheumatoid arthritis, sclerodermatous graft-versus-host disease, and systemic sclerosis. Among the underlying mechanisms associated with the drug actions of niclosamide are uncoupling of oxidative phosphorylation, and modulation of Wnt/β-catenin, mTORC1, STAT3, NF-κB and Notch signaling pathways. Here we provide a brief overview of the biological activities of niclosamide, its potential clinical applications, and its challenges for use as a new therapy for systemic diseases.

12 Review 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · McMaster University, Hamilton, Ontario, Canada. · Mayo Clinic, Rochester, Minnesota. · Louisiana State University, New Orleans. · University of Pennsylvania, Philadelphia. · University of Michigan, Ann Arbor. · Columbia University, New York, New York. · Albert Einstein College of Medicine, Bronx, New York. · Kaiser Permanente, Fontana, California. · Cleveland Clinic, Cleveland, Ohio. · Midwest Orthopaedics at Rush, Chicago, Illinois. · University of Texas Medical Branch, Galveston. · American College of Rheumatology, Atlanta, Georgia. · Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · University of Utah, Salt Lake City. · University of Pittsburgh, Pittsburgh, Pennsylvania. · Rockefeller University, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha. · Dearborn-Sah Institute for Joint Restoration, Fremont, California. · University of Alabama at Birmingham. ·Arthritis Care Res (Hoboken) · Pubmed #28620917.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

13 Review Efficacy and Safety of GuiZhi-ShaoYao-ZhiMu Decoction for Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. 2017

Daily, James W / Zhang, Ting / Cao, Shihua / Park, Sunmin. ·1 Department of R&D Daily Manufacturing, Inc. , Rockwell, NC. · 2 Department of Food and Nutrition, Institute of Basic Science, Obesity/Diabetes Research Center, Hoseo University , Asan, South Korea . ·J Altern Complement Med · Pubmed #28609129.

ABSTRACT: OBJECTIVES: GuiZhi-ShaoYao-ZhiMu decoction (GSZD), a traditional Chinese herbal medication for the management of rheumatoid arthritis (RA), has a long history of use and modern scientific research support for efficacy, but the studies have not been systematically evaluated. Therefore, this study systematically reviewed the efficacy of GSZD using the available human clinical trials and conducted a meta-analysis. METHODS: The available databases were searched using proper languages of English, Korean, and Chinese. The key erms used for searching were "GSZD," "Cassia Twig," "Guizhi," "Paeonia lactiflora," "Shaoyao," "Anemarrhena Rhizome," "Zhimu," "rheumatoid arthritis," "randomized," "controlled trial," and "clinical trial." Randomized clinical trials (RCTs) using GSZD were included in the review and meta-analysis. According to heterogeneity, odds ratio and confidence intervals in the pooled RCTs were assessed by a fixed or random model in meta-analysis. Risk of bias was evaluated for all included studies. RESULTS: Thirteen RCTs met the inclusion criteria and were included in the meta-analysis. All studies evaluated the efficacy of GSZD for treating RA, but the herbal formulations varied since some studies added herbs to the basic GSZD formulation. However, all formulations contained the essential herbs: Guizhi, Shaoyao, and Zhimu. Each RCT included an experimental group (GSZD with or without Western-style medicine) and a control group (either standard Western-style medicines or placebo). When compared to placebo, the GSZD treatment was found to be three to six times more effective than standard Western drugs for some symptoms. Furthermore, only two studies reported any adverse events associated with the GSZD group, whereas several reported serious adverse events in the control groups. CONCLUSIONS: The Traditional Chinese Medicine, GSZD, may have equal or superior effectiveness and safety for treating RA compared to Western RA drugs. It should be considered a viable alternative to Western medicine. However, more long-term research is needed in larger patient groups to better establish its safety and efficacy.

14 Review Biologic Therapies for Autoimmune and Connective Tissue Diseases. 2017

Wolfe, Rachel M / Ang, Dennis C. ·Section on Rheumatology and Immunology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. · Section on Rheumatology and Immunology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. Electronic address: dang@wakehealth.edu. ·Immunol Allergy Clin North Am · Pubmed #28366477.

ABSTRACT: Biologic therapy continues to revolutionize the treatment of autoimmune disease, especially in rheumatology as the pathophysiology of both inflammation and autoimmune disease becomes better understood. These therapies are designed to dampen the response of the inflammatory cascades. Although the first biologic therapies were approved many years ago, expanding indications and new agents continue to challenge the traditional treatment strategies for rheumatic diseases. This article reviews the data supporting the current use of biologic therapies, including off-label indications, in a subset of rheumatic diseases including rheumatoid arthritis, lupus, inflammatory myositis, ankylosing spondylitis, psoriatic arthritis, vasculitis, and gout.

15 Review Basement membranes and autoimmune diseases. 2017

Foster, Mary H. ·Department of Medicine, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA. Electronic address: mary.h.foster@dm.duke.edu. ·Matrix Biol · Pubmed #27496347.

ABSTRACT: Basement membrane components are targets of autoimmune attack in diverse diseases that destroy kidneys, lungs, skin, mucous membranes, joints, and other organs in man. Epitopes on collagen and laminin, in particular, are targeted by autoantibodies and T cells in anti-glomerular basement membrane glomerulonephritis, Goodpasture's disease, rheumatoid arthritis, post-lung transplant bronchiolitis obliterans syndrome, and multiple autoimmune dermatoses. This review examines major diseases linked to basement membrane autoreactivity, with a focus on investigations in patients and animal models that advance our understanding of disease pathogenesis. Autoimmunity to glomerular basement membrane type IV is discussed in depth as a prototypic organ-specific autoimmune disease yielding novel insights into the complexity of anti-basement membrane immunity and the roles of genetic and environmental susceptibility.

16 Review Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. 2016

Daily, James W / Yang, Mini / Park, Sunmin. ·1 Department of R&D Daily Manufacturing, Inc. , Rockwell, North Carolina, USA. · 2 Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University , Asan, South Korea . ·J Med Food · Pubmed #27533649.

ABSTRACT: Although turmeric and its curcumin-enriched extracts have been used for treating arthritis, no systematic review and meta-analysis of randomized clinical trials (RCTs) have been conducted to evaluate the strength of the research. We systemically evaluated all RCTs of turmeric extracts and curcumin for treating arthritis symptoms to elucidate the efficacy of curcuma for alleviating the symptoms of arthritis. Literature searches were conducted using 12 electronic databases, including PubMed, Embase, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were "turmeric," "curcuma," "curcumin," "arthritis," and "osteoarthritis." A pain visual analogue score (PVAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used for the major outcomes of arthritis. Initial searches yielded 29 articles, of which 8 met specific selection criteria. Three among the included RCTs reported reduction of PVAS (mean difference: -2.04 [-2.85, -1.24]) with turmeric/curcumin in comparison with placebo (P < .00001), whereas meta-analysis of four studies showed a decrease of WOMAC with turmeric/curcumin treatment (mean difference: -15.36 [-26.9, -3.77]; P = .009). Furthermore, there was no significant mean difference in PVAS between turmeric/curcumin and pain medicine in meta-analysis of five studies. Eight RCTs included in the review exhibited low to moderate risk of bias. There was no publication bias in the meta-analysis. In conclusion, these RCTs provide scientific evidence that supports the efficacy of turmeric extract (about 1000 mg/day of curcumin) in the treatment of arthritis. However, the total number of RCTs included in the analysis, the total sample size, and the methodological quality of the primary studies were not sufficient to draw definitive conclusions. Thus, more rigorous and larger studies are needed to confirm the therapeutic efficacy of turmeric for arthritis.

17 Review New Treatment Guidelines for Sjögren's Disease. 2016

Vivino, Frederick B / Carsons, Steven E / Foulks, Gary / Daniels, Troy E / Parke, Ann / Brennan, Michael T / Forstot, S Lance / Scofield, R Hal / Hammitt, Katherine M. ·Division of Rheumatology, Penn Presbyterian Medical Center, Penn Sjögren's Center, Penn Medicine University City, University of Pennsylvania, 3737 Market Street, Philadelphia, PA 19104, USA. Electronic address: frederick.vivino@uphs.upenn.edu. · Division of Rheumatology, Allergy and Immunology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 410, Mineola, NY 11501, USA; Stony Brook University School of Medicine, Stony Brook, 120 Mineola Boulevard, Mineola, NY 11501, USA. · Department of Ophthalmology and Vision Science, University of Louisville School of Medicine, 301 East Muhammad Ali Boulevard, Louisville, KY 40202, USA. · Department of Orofacial Sciences, UCSF Schools of Dentistry and Medicine, 521 Parnassus Avenue, Clinic Sci, San Francisco, CA 94143, USA. · Division of Rheumatology, St. Francis Hospital & Medical Center, 114 Woodland Street, Hartford, CT 06105, USA. · Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA. · Corneal Consultants of Colorado, 8381 Southpark Lane, Littleton, CO 80120, USA. · Department of Veterans Affairs, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, 1000 North Lincoln Boulevard, #2900, Oklahoma City, OK 73104, USA. · Sjögren's Syndrome Foundation, 6707 Democracy Boulevard, Suite 325, Bethesda, MD 20817, USA. ·Rheum Dis Clin North Am · Pubmed #27431353.

ABSTRACT: Sjögren's disease is associated with a high burden of illness, diminished quality of life, and increased health care costs. The Sjögren's Syndrome Foundation developed the first US clinical practice guidelines for management of the oral, ocular, and rheumatologic or systemic manifestations. Guideline recommendations were reviewed by a consensus expert panel using a modified Delphi process. This initiative should improve the quality and consistency of care for Sjögren's disease in the United States, guide insurance reimbursement, and define areas for future study. Guidelines will be periodically reviewed and revised as new information becomes available.

18 Review Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. 2016

Schett, Georg / Emery, Paul / Tanaka, Yoshiya / Burmester, Gerd / Pisetsky, David S / Naredo, Esperanza / Fautrel, Bruno / van Vollenhoven, Ronald. ·Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany. · Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK. · Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany. · The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. · Duke University Medical Center, Medical Research Service, Durham, North Carolina, USA. · Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. · Rheumatology Department, UPMC-GRC 08, Pierre Louis Institute for Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France. · ARC: Amsterdam Rheumatology and Immunology Center. ·Ann Rheum Dis · Pubmed #27261493.

ABSTRACT: Improvements in the control of inflammation in rheumatoid arthritis (RA) by conventional synthetic and biologic disease-modifying antirheumatic drugs (DMARDs) have led to a substantial change in the clinical outcomes of patients during the last 30 years. Current treatment can lead to sustained remission in some patients raising questions about the optimal management strategies in this subgroup of patients. Today, tapering of DMARDs and even their discontinuation appears as an interesting concept for achieving a more tailored and dynamic treatment approach of RA, especially in patients, who achieved full disease control by DMARD treatment. In this review article, current developments of DMARD tapering are discussed. The article provides an overview of existing studies on this topic and addresses new strategies to reach drug-free remission. Furthermore, concepts for defining patients eligible for DMARD tapering are described and potential future strategies in using biomarkers in predicting the risk for disease relapse after initiation of DMARD tapering are addressed. These findings are finally considered in light of the vision to achieve cure as an ultimate goal in patients with RA achieving full control of inflammation.

19 Review The role of specialty pharmacy drugs in the management of inflammatory diseases. 2016

Mullican, Kelly A / Francart, Suzanne J. ·Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC. · Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC suzanne.francart@unchealth.unc.edu. ·Am J Health Syst Pharm · Pubmed #27126833.

ABSTRACT: PURPOSE: Specialty drugs used in patients with inflammatory disease states are reviewed, with a focus on the pharmacist's roles in facilitating medication procurement and in the clinical management of affected patients. SUMMARY: Pharmacists in the ambulatory care and community settings are strategically placed to be actively involved in specialty drug procurement and clinical management of patients with inflammatory diseases such as rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, inflammatory bowel disease, and ankylosing spondylitis. Specialty medications used in the treatment of these diseases include anti-tumor necrosis factor (TNF) disease-modifying antirheumatic drugs (DMARDs), non-TNF DMARDs, and interleukin inhibitors. Pharmacist involvement in drug procurement in this area includes navigating insurance barriers and helping patients address high out-of-pocket costs; clinical management activities can include ensuring appropriate baseline screening and vaccine administration, providing drug-specific patient education, and performing routine follow-up and assessment. Patient education is the single biggest area where pharmacists can have a direct impact on overall clinical management of patients receiving specialty drugs for the treatment of inflammatory diseases. These patients need to be educated about dosing, administration, storage and disposal, common and rare adverse effects, adverse-effect management strategies, expectations of drug effect, and considerations for unique circumstances such as illness and planned surgery. CONCLUSION: Specialty drugs represent one of the fastest-growing sectors of pharmacy spending, with inflammatory disease therapies at the forefront. As pharmacists are accessible healthcare practitioners, their responsibilities should include financial and clinical management of patients with inflammatory diseases who are receiving specialty drugs.

20 Review Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review. 2016

Desai, Rishi J / Thaler, Kylie J / Mahlknecht, Peter / Gartlehner, Gerald / McDonagh, Marian S / Mesgarpour, Bita / Mazinanian, Alireza / Glechner, Anna / Gopalakrishnan, Chandrasekar / Hansen, Richard A. ·Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Danube University, Krems, Austria. · Danube University, Krems, Austria, and RTI International, Research Triangle Park, North Carolina. · Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon. · Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. · Harrison School of Pharmacy, Auburn University, Auburn, Alabama. ·Arthritis Care Res (Hoboken) · Pubmed #26663412.

ABSTRACT: OBJECTIVE: To systematically compare the risk of adverse events (AEs) for 13 targeted immunomodulators (TIMs) indicated for ankylosing spondylitis (AS), inflammatory bowel diseases, juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis (PsA), or rheumatoid arthritis (RA). METHODS: We searched electronic databases through July 2015 to retrieve randomized controlled trials (RCTs) and observational studies comparing AEs between 2 or more TIMs head-to-head. We reported on the following outcomes: number of AEs, discontinuation due to AEs, serious AEs, mortality, serious infections, tuberculosis, herpes zoster, and malignancies. We qualitatively synthesized the literature and conducted random-effects meta-analyses if 3 or more studies provided data for an outcome. RESULTS: Ten head-to-head RCTs and 51 observational studies were included in this systematic review. A majority of the studies (70%) were conducted in RA patients. Risk of treatment discontinuation due to AEs was higher with infliximab than with adalimumab or etanercept in RA, PsA, and AS. A higher risk for serious infections was noted with infliximab than with abatacept, adalimumab, or etanercept in RA. Risk for treatment discontinuation due to AEs, serious infections, and tuberculosis was lower with etanercept than with adalimumab in RA. Limited evidence suggested no comparative differences in risk for mortality, malignancies, and herpes zoster for adalimumab, etanercept, and infliximab in RA. CONCLUSION: Important differences were noted in the safety profile of TIMs in RA, generally favoring abatacept, adalimumab, and etanercept over infliximab. Head-to-head comparative evidence for other TIMs and non-RA populations was insufficient to draw conclusions for most of the safety outcomes.

21 Review Remission in Rheumatoid Arthritis: Working Toward Incorporation of the Patient Perspective at OMERACT 12. 2016

van Tuyl, Lilian H / Sadlonova, Martina / Davis, Bev / Flurey, Caroline / Goel, Niti / Hewlett, Sarah E / Hill, Catherine L / Hoogland, Wijnanda / Kirwan, John R / van Schaardenburg, Dirkjan / Scholte-Voshaar, Marieke / Smolen, Josef S / Stamm, Tanja / Wells, George A / Boers, Maarten. ·From the Department of Rheumatology, and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; University of Bristol, and the University of the West of England, Academic Rheumatology Unit, Bristol Royal Infirmary; Bristol, UK; Quintiles Inc., Morrisville; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Queen Elizabeth Hospital Department of Rheumatology, Woodville, South Australia; University of Adelaide, The Health Observatory Woodville, South Australia, Australia; Reade/Jan van Breemen Research Institute, Amsterdam, the Netherlands; Department of Epidemiology and Community Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.L.H. van Tuyl, Postdoctoral Researcher, PhD, Department of Rheumatology, VU University Medical Center; M. Sadlonova, Occupational Therapist, MSc, Division of Rheumatology, Department of Medicine, Medical University of Vienna; B. Davis, Patient Research Partner, University of Bristol, Academic Rheumatology Unit, Bristol Royal Infirmary; C. Flurey, Research Fellow, PhD, University of the West of England, Academic Rheumatology Unit, Bristol Royal Infirmary; N. Goel, MD, Senior Medical Director and Adjunct Assistant Professor of Medicine, Quintiles Inc., and Division of Rheumatology, Department of Medicine, Duke University School of Medicine; S.E. Hewlett, Professor of Rheumatology Nursing, PhD, University of the West of England, Academic Rheumatology Unit, Bristol Royal Infirmary; Queen Elizabeth Hospital, Department of Rheumatology, Woodville; C.L. Hill, MD, Rheumatologist, Queen Elizabeth Hospital Department of Rheumatology, Woodville, University of Adelaide, Health Observatory Woodville; W. Hoogland, MD, Patient Research Partner, Department of Rheumatology, VU University Medical Center; J.R. Kirwan, Professor o ·J Rheumatol · Pubmed #25684772.

ABSTRACT: OBJECTIVE: The treatment of rheumatoid arthritis (RA) should target patient-relevant outcomes, making patient perspective on remission essential. In 2010, patients, physicians, health professionals, and researchers at the Outcome Measures in Rheumatology (OMERACT) conference developed an ambitious research agenda to study the concept of remission. Qualitative research has since helped us understand the concept of remission from the patient perspective. METHODS: During OMERACT 12, the OMERACT working group on patient perspective on remission in RA elaborated on data generated to date and discussed the methodological challenges ahead. Challenges included (1) selection of domains, (2) choice of a patient remission definition or a single domain to add to the current remission definition, and (3) the importance of pain in defining remission from a patient perspective. RESULTS: Focus in the coming years will be on increasing our understanding by identifying the most important domains from the patient perspective regarding remission and investigating how these domains can be measured. Investigation into the Rheumatoid Arthritis Impact of Disease questionnaire, disease flare, as well as the concordance of domains from our ongoing remission survey is appropriate. More data and further discussions are needed to decide on the next steps. CONCLUSION: Progress summarized over 4 years highlights the main methodological challenges discussed within the working group on patient perspective on remission in RA during OMERACT 12.

22 Review Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis. 2014

Kavanaugh, Arthur / Wells, Alvin F. ·Department of Medicine, University of California, San Diego, La Jolla, CA and Department of Rheumatology, Duke University Medical Center, Durham, NC, USA. akavanaugh@ucsd.edu. · Department of Medicine, University of California, San Diego, La Jolla, CA and Department of Rheumatology, Duke University Medical Center, Durham, NC, USA. ·Rheumatology (Oxford) · Pubmed #24729402.

ABSTRACT: Glucocorticosteroids (GCs) have been employed extensively for the treatment of rheumatoid arthritis (RA) and other autoimmune and systemic inflammatory disorders. Their use is supported by extensive literature and their utility is reflected in their incorporation into current treatment guidelines for RA and other conditions. Nevertheless, there is still some concern regarding the long-term use of GCs because of their potential for clinically important adverse events, particularly with an extended duration of treatment and the use of high doses. This article systematically reviews the efficacy for radiological and clinical outcomes for low-dose GCs (defined as ≤10 mg/day prednisone equivalent) in the treatment of RA. Results reviewed indicated that low-dose GCs, usually administered in combination with synthetic DMARDs, most often MTX, significantly improve structural outcomes and decrease symptom severity in patients with RA. Safety data indicate that GC-associated adverse events are dose related, but still occur in patients receiving low doses of these agents. Concerns about side effects associated with GCs have prompted the development of new strategies aimed at improving safety without compromising efficacy. These include altering the structure of existing GCs and the development of delayed-release GC formulations so that drug delivery is timed to match greatest symptom severity. Optimal use of low-dose GCs has the potential to improve long-term outcomes for patients with RA.

23 Review Fertility and infertility in rheumatoid arthritis. 2014

Provost, Meredith / Eaton, Jennifer L / Clowse, Megan E B. ·aDivision of Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology bDivision of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. ·Curr Opin Rheumatol · Pubmed #24663108.

ABSTRACT: PURPOSE OF REVIEW: Despite decades of evidence suggesting that women with rheumatoid arthritis (RA) have fewer children than their healthy peers, this information is not widely known among clinicians. The causes of decreased fertility in this population have been largely unexplored, but likely revolve around altered inflammation, increased age when conception is attempted, limited sexual function, and possibly medications limiting ovarian function. RECENT FINDINGS: Several large Scandinavian cohorts and a cohort study in the United States demonstrate that women with RA have smaller families and are slower to conceive compared with other women. Personal choice to limit family size plays some role, as does infertility. Sexual function in women with RA is hampered by pain and fatigue, perhaps decreasing the opportunity for conception. Finally, data about the role of NSAIDs in preventing ovulation suggest that continued use of these medications may hinder conception. SUMMARY: Infertility in women with RA is an under-recognized, but remarkably common phenomenon. Although research continues into the underlying causes, physicians can discuss this topic and refer women to reproductive endocrinology when needed, thereby helping patients to build the families that they desire.

24 Review Autoimmunity in the pathogenesis and treatment of keratoconjunctivitis sicca. 2014

Liu, Katy C / Huynh, Kyle / Grubbs, Joseph / Davis, Richard M. ·Department of Ophthalmology, University of North Carolina at Chapel Hill School of Medicine, CB# 7040, 5151 Bioinformatics Building, Chapel Hill, NC, 27599, USA, katy_liu@med.unc.edu. ·Curr Allergy Asthma Rep · Pubmed #24395332.

ABSTRACT: Dry eye is a chronic corneal disease that impacts the quality of life of many older adults. Keratoconjunctivitis sicca (KCS), a form of aqueous-deficient dry eye, is frequently associated with Sjögren's syndrome and mechanisms of autoimmunity. For KCS and other forms of dry eye, current treatments are limited, with many medications providing only symptomatic relief rather than targeting the pathophysiology of disease. Here, we review proposed mechanisms in the pathogenesis of autoimmune-based KCS: genetic susceptibility and disruptions in antigen recognition, immune response, and immune regulation. By understanding the mechanisms of immune dysfunction through basic science and translational research, potential drug targets can be identified. Finally, we discuss current dry eye therapies as well as promising new treatment options and drug therapy targets.

25 Review Oral complications of Sjögren's syndrome. 2014

Napeñas, Joel J / Rouleau, Tanya S. ·Division of Oral Medicine and Radiology, Schulich School of Medicine and Dentistry, Western University, Dental Sciences Building, London, Ontario N6A 5C1, Canada; Department of Oral Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA. Electronic address: joel.napenas@schulich.uwo.ca. ·Oral Maxillofac Surg Clin North Am · Pubmed #24287193.

ABSTRACT: Numerous oral manifestations associated with salivary gland dysfunction, and particularly Sjögren's syndrome, have been reported in the literature. This article discusses the evidence on a wide range of oral manifestations associated with Sjögren's syndrome.

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