scholarly journals The Efficacy and Safety of Rituximab in a Patient with Rheumatoid Spondylitis

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Şenol Kobak ◽  
Ahmet Karaarslan ◽  
Fahrettin Oksel
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
Connective Tissue ◽  
Partial Response ◽  
Connective Tissue Disease ◽  
Complete Response ◽  
Response To Treatment ◽  
Tnf Alpha ◽  
Efficacy And Safety ◽  
Proven Efficacy

Rheumatoid arthritis (RA) is considered as a connective tissue disease while ankylosing spondylitis (AS) is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS.

Predictive Factors Affecting the Success of Nephrectomy for the Treatment of Nephrogenic Hypertension: Multicenter Study

2021 ◽  
pp. 1-6
Author(s):  
Ediz Vuruskan ◽  
Hakan Ercil ◽  
Umut Unal ◽  
Ergun Alma ◽  
Hakan Anil ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Partial Response ◽  
Medical Treatment ◽  
Predictive Factors ◽  
Treatment Success ◽  
Complete Response ◽  
Response To Treatment ◽  
Factors Affecting ◽  
Success Of Treatment ◽  
Functioning Kidney

<b><i>Introduction:</i></b> The aim of our study is to evaluate the predictive factors affecting the success of treatment with nephrectomy in patients with poorly functioning kidney and nephrogenic hypertension. <b><i>Methods:</i></b> Data for patients who underwent nephrectomy with a diagnosis of nephrogenic hypertension in 3 centers between May 2010 and January 2020 were analyzed. In the postoperative period, if the blood pressure (BP) was below 140/90 mm Hg without medical treatment, it was accepted as complete response; if the arterial BP was below 140/90 mm Hg with medical treatment or less medication, it was accepted as partial response; and if BP did not decrease to normal values, it was accepted as unresponsive. Demographic characteristics, duration of hypertension, preoperative and postoperative BP values, and presence of metabolic syndrome were statistically evaluated. <b><i>Results:</i></b> Our study consisted of 91 patients with a mean preoperative hypertension duration of 23.3 ± 12.1 months. Among patients, 42 (46.2%) had complete response, 18 (19.8%) had partial response, and 31 (34.0%) had no response. Preoperative systolic and diastolic BP values were not effective on treatment success (<i>p</i> = 0.071, <i>p</i> = 0.973, respectively), but the increase in age and hypertension duration (<i>p</i> = 0.030 and <i>p</i> &#x3c; 0.001, respectively) and the presence of metabolic syndrome (<i>p</i> = 0.002) significantly decreased the complete response rates. <b><i>Conclusions:</i></b> Preoperative hypertension duration, advanced age, and presence of metabolic syndrome are predictive factors affecting the response to treatment in patients who undergo nephrectomy due to nephrogenic hypertension.

scholarly journals Replacing a phosphodiesterase-5 inhibitor with riociguat in patients with connective tissue disease-associated pulmonary arterial hypertension: a case series

2017 ◽  
Vol 7 (3) ◽  
pp. 741-746 ◽  
Author(s):  
Amresh Raina ◽  
Raymond L. Benza ◽  
Harrison W. Farber
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Connective Tissue ◽  
Arterial Hypertension ◽  
Clinical Response ◽  
Connective Tissue Disease ◽  
Case Series ◽  
Response To Treatment ◽  
Tolerability Profile ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Pulmonary Arterial

Patients with pulmonary arterial hypertension associated with connective tissue disease (PAH-PAH-CTD) such as systemic sclerosis (SSc) have a poorer response to treatment and increased mortality compared with patients with idiopathic PAH. Current treatment options for PAH-CTD include prostanoids, phosphodiesterase type-5 inhibitors (PDE-5i), endothelin receptor antagonists, and the soluble guanylate cyclase stimulator riociguat. In this case series, we describe three patients with PAH-CTD related to limited scleroderma who were switched from a PDE-5i to riociguat due to insufficient clinical response. The switch to riociguat was associated with an improvement in respiratory and hemodynamic parameters and a favorable tolerability profile. These cases demonstrate that switching to riociguat is a therapeutic option in patients with PAH-CTD who have not achieved a satisfactory clinical response to a PDE-5i.

AB1274 STIFF SPINE AND A WEAK HEART: A CASE OF LONG STANDING ANKYLOSING SPONDYLITIS DEVELOPING PULMONARY ARTERIAL HYPERTENSION SECONDARY TO MIXED CONNECTIVE TISSUE DISEASE, CONFERRING POOR PROGNOSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1928-1929
Author(s):  
C. Dharmapalaiah ◽  
B. Ms ◽  
P. Sn
Keyword(s):  
Ankylosing Spondylitis ◽  
Pericardial Effusion ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Mixed Connective Tissue Disease ◽  
Case Reports ◽  
Peripheral Arthritis ◽  
Small Joint ◽  
Pulmonary Arterial ◽  
Salt And Pepper

Background:Spondyloarthritides (SpA) and Connective Tissue Diseases (CTD) are considered distinct entities with diverse clinical features and genetic characteristics. There are very few case reports1of SpA coexisting with CTDs like Lupus, Scleroderma and Morphoea. Drugs used in treating SpA like Sulphasalazine and anti TNF drugs can also induce CTD.Objectives:We report a case of a patient with eleven years history of Ankylosing Spondylitis (AS), presenting with Mixed Connective Tissue Disease (MCTD) and Pulmonary Arterial Hypertension (PAH) constituting a therapeutic challenge.Methods:A 36 year old gentleman was diagnosed with AS at the age of 25 years, fulfilling the ASAS criteria (chronic inflammatory back pain, sacroiliitis on radiograph, HLAB27 positive). He was treated with NSAIDs, Sulphasalazine (SSZ) and physical therapy since 2008. There was gradual progression of his arthritis with high BASDAI along with recurrent anterior uveitis. He was treated with 5 doses of IV Infliximab 3mg/kg, between 2017 and early 2018. In May 2018, following further Infliximab he developed a serum sickness like reaction which was thought to be HACA response to Infliximab. He responded to IV hydrocortisone and antihistamines and Infliximab was discontinued.In February 2019 he developed severe flare up of peripheral arthritis. He was treated with Injection Adalimumab 40mg every 2 weeks along with Latent TB prophylaxis with Isoniazid and Rifampicin. He received 4 doses to no effect and was discontinued.In April 2019 Methotrexate (MTX) was added for peripheral arthritis. He discontinued both MTX and SSZ in July 2019 due to inefficacy. Peripheral arthritis responded well to Leflunomide that was started in September 2019.There was an unexpected turn of events in October 2019, when he was admitted with severe dyspnoea and cough with new onset raynauds, skin tightening over forearms and nape of neck with salt and pepper appearance of skin at these sites (Images). He was hypoxic requiring oxygen support. Echocardiogram showed moderate pericardial effusion and pulmonary hypertension (PASP 60mmHg), dilated right heart and pulmonary artery. Pulmonary embolism was excluded on a CT pulmonary angiogramFigure 1.Image 1, 2 – “salt and pepper” appearance of skin over the wrist and nape of neck, small joint arthritisFigure 2.Image 1, 2 – “salt and pepper” appearance of skin over the wrist and nape of neck, small joint arthritisResults:Investigations revealed 3+ ANA speckled pattern, anti RNP/ Sm 3+, Rheumatoid Factor negative. CRP 45.7u/l, Hemogram, renal and liver function tests were normal.Cardiac MRI showed minimal pericardial effusion with mildly dilated right ventricle, non-dilated left ventricle with LVEF (~44%).Right heart catheterization confirmed PAH with Mean PAP 58mmHg, LVEDP 8mmHg, PCWP 15mmHgA diagnosis of Mixed Connective Tissue Disease (MCTD) was made, associated with PAH and pericardial effusion.He was started on Ambrisentan and Tadalafil for PAH. Hydroxychloroquine and Mycophenolate Mofetil were also added in view of the PAH being associated with CTD. The additional pericardial effusion confers a poor prognosis.Conclusion:Association of Spondyloarthritides and Connective Tissue Disease is rare. There are very few case reports of their chance association, especially MCTD2. Our patient had been exposed to Sulphasalazine, Infliximab, Adalimumab and Isoniazid, all with a potential to induce an auto immune CTD. MCTD features have persisted despite drug withdrawal. This case may suggest routinely checking for ANA in SpA patients prior to initiating anti TNF drugs.References:[1]Brandt J, Maier T, Rudwaleit M et al. Co-occurrence of spondyloarthropathy and connective tissue disease: Development of Sjögren’s syndrome and mixed connective tissue disease (MCTD) in a patient with ankylosing spondylitis. Clinical and experimental rheumatology. 2002;20:80-4.[2]Lee JK, Jung SS, Kim TH, Jun JB, Yoo DH, Kim SY. Coexistence of ankylosing spondylitis and mixed connective tissue disease in a single patient. Clin Exp Rheumatol. 1999;17:263.Disclosure of Interests:None declared

Possible immunologic predictors of the PD-1/PD-L1 checkpoint inhibitors' efficiency in lung cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21035-e21035
Author(s):  
Elena Yu. Zlatnik ◽  
Oleg I. Kit ◽  
Elena S. Bondarenko ◽  
Aleksandr B. Sagakyants ◽  
Maria A. Teplyakova ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Partial Response ◽  
Checkpoint Inhibitors ◽  
Complete Response ◽  
Response To Treatment ◽  
Cell Mediated Immunity ◽  
Initial Amount ◽  
Lung Cancer Patients ◽  
Effect Of Therapy ◽  
Check Point Inhibitors

e21035 Background: Immunotherapy with PD-1/PD-L1 check-point inhibitors (CPI) is a new trend in oncology. Their effect significantly depends on the patients` immune status. The aim of the study was to search the immunologic parameters of lung cancer (LC) patients receiving immunotherapy as factors that could predict their effect. Methods: 20 patients (12 male and 8 female) with LC had adenocarcinoma – 15 (75%), squamous cell carcinoma – 5 (25%). PD-1/PD-L1 CPI were used: 9 patients received atezolizumab (43%), 9 (43%) – pembrolizumab and 3 (14%) – nivolumab. The effect of therapy was evaluated according to imRECIST v.1.1. Factors of cell-mediated immunity were assessed by flow cytometry before treatment including immunotherapy. CD8+CD279+, CD4+CD279+, TLR2, TLR4, TLR3, TLR8 were studied. Results: Complete response was observed in 2 (9%) patients, partial response in 5 (24%), stabilization in 4 (19%) and progression in 8 (38%). In one patient the treatment was cancelled due to the development of immune-mediated complication (Guillain-Barre syndrome). The factors studied varied depending on different effect. In cases of LC stabilization/progression the initial amount of CD8+CD279+ cells were twice lower than in cases with complete/partial response. In the first group CD8+CD279+ cells` level before the treatment was 0,1-3,4%, while in the other group 4,1-9% (7,0±1,16%). In patients with stabilization/progression CD4+CD279+ cells` level before the immunotherapy was 0,1-3,3 and in patients with response to treatment 1,4-7,8% (3,4±0,8%) of total CD4+ lymphocytes. Besides, the LC patients with different effect of treatment had different initial amount of CD4+ Tem cells: stable response to CPI developed in patients with their higher levels (40,8±3,9%) vs 15,3±3,9% in cases of tumor progression (p < 0.05). Initial high expression of TLR2 and TLR4 as well as low expression of TLR3 and TLR8 on monocytes in patients with response to immunotherapy suggests the contribution of innate immunity to its effect. Conclusions: Complete or partial response should be expected in cases of initially high per cent of T lymphocytes (CD4+, CD8+) CD4+ Tem cells and TLR2+, TLR4+ as well as low amount of TLR3+ and TLR8+ monocytes. These factors should be studied in future as predictive factors for effectiveness of CPI.

Bone, joint and connective tissue disorders

2021 ◽  
pp. 245-252
Author(s):  
David Howell
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Systemic Sclerosis ◽  
Ankylosing Spondylitis ◽  
Connective Tissue ◽  
Musculoskeletal Disorders ◽  
Lupus Erythematosus ◽  
Anaesthetic Management ◽  
Systemic Lupus ◽  
Anaesthetic Practice

This chapter describes the anaesthetic management of the patient with those musculoskeletal disorders which are relevant to anaesthetic practice. Topics covered include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus (SLE); systemic sclerosis; scoliosis and achondroplasia. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described.

Connective tissue disease

2019 ◽  
pp. 281-326
Author(s):  
Gavin Spickett
Keyword(s):  
Rheumatoid Arthritis ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Mixed Connective Tissue Disease ◽  
Raynaud’S Phenomenon ◽  
Connective Tissue Diseases ◽  
Raynaud's Phenomenon ◽  
Overlap Syndromes

This chapter covers the presentation, immunogenetics, immunopathology, diagnosis, treatment, and testing for a range of connective tissue diseases. It covers a range of rheumatic disorders, from rheumatoid arthritis to Raynaud’s phenomenon, and also covers the undifferentiated diseases, overlap syndromes, and mixed connective tissue disease.

Sign in / Sign up

Export Citation Format

Share Document