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| Romão VC, et al. Immunol Res. 2014 Nov 13. |
| Methotrexate (MTX) is the anchor disease-modifying antirheumatic drug (DMARD) in rheumatoid arthritis (RA) treatment. It is used in monotherapy and/or in combination with other synthetic or biological DMARDs, and is known to have the best cost-effectiveness and efficacy/toxicity ratios. However, toxicity is still a concern, with a significant proportion of patients interrupting long-term treatment due to the occurrence of MTX-related adverse drug reactions (ADRs), which are the main cause of drug withdrawal. In this paper, the authors aimed to review and summarize current data on low-dose MTX-associated toxicity, its prevention and predictors, keeping in mind practical RA clinical care… |
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| Tanaka Y, et al. Drugs 2014 Nov 12. |
| The combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD), and biological DMARDs (bDMARDs) has revolutionized the treatment of RA; and clinical remission and low disease activity (LDA) are now realistic targets, achieved by a large proportion of RA patients. We are now in a position to evaluate if it is possible to maintain remission or LDA while at the same time reducing the burden of treatment on the patient and healthcare system. Data are emerging from large, well-conducted studies designed to answer this question, shedding light on which patient populations and treatment algorithms can survive treatment discontinuation or tapering with low-risk of disease flare. For early RA, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining clinical remission by bDMARDs with MTX… |
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| Biggioggero M, et al. Drug Dev Res. 2014;75(Suppl 1):S38–S41. |
| Postmarketing phase IV tumor necrosis factor (TNF) inhibitor therapies (anti-TNFs) are used routinely as first-line biotherapy for the treatment of RA and spondyloarthritis [SpA: psoriatic arthritis (PsA) and ankylosing spondylitis (AS)] in patients who have failed traditional non-biologic disease-modifying anti-rheumatic drugs (DMARDs). However, about 30% of patients experienced failure of first-line anti-TNF agent because of inefficacy or adverse events. This study analyzed long-term anti-TNF-α drug survival in a clinical practice setting. The overall 10-year retention rate of first-line anti-TNF agent is about 23%, being significantly higher for SpA compared with RA patients. ETN is the most persistent anti-TNF with a drug survival rate significantly higher than IFX and ADA… |
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| Siemons L, et al. BMC Musculoskelet Disord. 2014;15(1):368. |
| The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two commonly used measures of inflammation in RA. As current RA treatment guidelines strongly emphasize early and aggressive treatment aiming at fast remission, optimal measurement of inflammation becomes increasingly important. Dependencies with age, sex, and body mass index have been shown for both inflammatory markers, yet it remains unclear which inflammatory marker is affected least by these effects in patients with early RA… |
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| Pourcho AM, et al. Am J Phys Med Rehabil. 2014;93(11 Suppl 3):S108–S121. |
| Intra-articular platelet-rich plasma (PRP) injection has emerged as a promising treatment for knee osteoarthritis. Studies to date, including multiple randomized controlled trials, have shown that PRP is a safe and effective treatment option for knee osteoarthritis. Intra-articular PRP is similar in efficacy to hyaluronic acid, and seems to be more effective than hyaluronic acid in younger, active patients with low-grade osteoarthritis. Treatment benefits seem to wane after 6–9 months… |
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| Caporali R, et al. Neuroimmunomodulation 2015;22(1-2):104–111. |
| At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side-effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC ‘bridging’ treatment on a disease-modifying anti-rheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, observed even after GC therapy withdrawal… |
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| Gaujoux-Viala C, et al. Ann N Y Acad Sci. 2014;1318:32–40. |
| Glucocorticoids are widely used in the management of RA; however, their effectiveness and safety are still a subject of debate. In particular, when to introduce glucocorticoids, also when and how to taper them, are important questions for clinicians. In this paper, the authors have discussed the place of glucocorticoids in the European League Against Rheumatism (EULAR) recommendations for the management of RA and review the literature that was the basis for these recommendations. The recommendations cover the introduction of glucocorticoids (and for whom they are recommended), doses and duration of treatment, and tapering strategies… |
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| Li YT, et al. Osteoporos Int. 2014 Sep 30. |
| Ten studies with 2888 patients were included. Four trials used alendronate, three trials used zoledronic acid, two trials used risedronate, and one trial used etidronate. Early administration of bisphosphonates (BPs) was considered less than 3 months after surgery. Patients treated with BP therapy had no significant differences in radiological fracture healing times compared with patients in the control group. There were also no significant differences in the rate of delay or non-union of fracture healing. However, the bone mineral density (BMD) of total hips did significantly improve after 12 months of treatment with BPs. And most bone turnover markers of patients in the study group were significantly decreased. The authors concluded that early administration of BPs after surgery did not appear to delay fracture healing time either radiologically or clinically. Furthermore, the anti-resorptive efficacy of BPs given immediately after surgical repair should positively affect the rate of subsequent fractures… |
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| Krause ML, et al. Ther Adv Musculoskelet Dis. 2014;6(5):169–184. |
| This review provides evidence-based recommendations for use of DMARDs and biologic response modifiers to guide rheumatologists in their care of pregnant and lactating women with RA and serves as a guide to counsel male patients with RA on family planning decisions.… |
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| Santiago T, et al. Ann N Y Acad Sci. 2014;1318:41–49. |
| Low- to medium-dose glucocorticoids have been shown to have not only anti-inflammatory but also disease-modifying properties in rheumatoid arthritis. The evidence for the benefit of its early use in combination with DMARDs underlines the need for a close evaluation of their risk–benefit ratio. Over time, numerous myths and fears about glucocorticoid toxicity in rheumatoid arthritis have arisen from observational studies, and many concerns have been unduly extrapolated from observations with higher dose treatment… |
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| Behrens F, et al. Rheumatology (Oxford) 2014 Oct 27. |
| The aim of this study was to review the available evidence on TNF inhibitor monotherapy vs. combination therapy with MTX in PsA. A literature search was conducted up to and including October 2013 for randomized controlled trials (RCTs) and observational studies comparing TNF inhibitor monotherapy vs. combination therapy with MTX in patients with PsA. Eleven published articles and three conference abstracts were retrieved, reporting on six RCTs on four TNF inhibitors. The investigators concluded that available evidence on the efficacy and safety of TNF inhibitor monotherapy vs. add-on MTX therapy shows little or no improvement with combination therapy, although the use of concomitant MTX appears to prolong TNF inhibitor drug survival of mAb TNF inhibitors… |
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