scholarly journals Аssessment of osteoporosis and occurrence of vertebral fractures in postmenopausal patients with rheumatoid arthritis treated with small doses of glucocorticoids

2020 ◽  
Vol 12 (3) ◽  
pp. 1-8
Author(s):  
Maja Bojadzioska ◽  
Petar Dejanov ◽  
Irena Kafedziska ◽  
Mimoza Nikolovska-Kotevska ◽  
Andzelika Karadzova-Stojanoska ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Vertebral Fractures ◽  
Negative Impact ◽  
Vertebral Fracture Assessment ◽  
Treatment Of Osteoporosis ◽  
Increased Risk ◽  
Small Doses ◽  
Fracture Assessment

Osteoporosis (OP) is a serious extracorporeal manifestation that occurs in patients with rheumatoid arthritis (RA). One of the risk factors is long-term use of glucocorticoids (GC). Osteoporosis together with the increased risk of vertebral (VF) and non-vertebral fractures (non-VF) in particular has a negative impact on quality of life in patients with rheumatoid arthritis. The aim of the study was to detect the occurrence of OP and VF in postmenopausal patients with RA and their association with long-term use of small doses of glucocorticoids. Material and methods: A total of 46 patients were analyzed. All respondents underwent imaging for osteoporosis evaluation with a DXA scanner (Lunar iDXA, GE) and VF  with incorporated Vertebral Fracture Assessment (VFA). Results: The values of bone mineral densities (BMD) were significantly smaller in the group that received glucocorticoids. According to VFA, 37,0% of patients were registered to have a fracture of middle degree, a mild fracture was registered in 19.6% of patients, and severe fractures were registered in 3 patients (6.5%). Conclusion: In postmenopausal patients with RA receiving GC therapy, a more common occurrence of osteoporosis and vertebral fractures was reported compared with the remaining group of RA patients. All patients with RA in menopause need to be screened for timely detection and treatment of osteoporosis and prevention of its complications.

scholarly journals Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment

Rheumatology ◽  
2010 ◽  
Vol 49 (7) ◽  
pp. 1303-1310 ◽  
Author(s):  
A. El Maghraoui ◽  
A. Rezqi ◽  
A. Mounach ◽  
L. Achemlal ◽  
A. Bezza ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Vertebral Fracture ◽  
Vertebral Fractures ◽  
Vertebral Fracture Assessment ◽  
Fracture Assessment

scholarly journals Psychosocial Aspects and Quality of Life in Cancer Patients undergoing Surgery

2021 ◽  
Vol 12 (4) ◽  
pp. 78-84
Author(s):  
M. Bakos ◽  
T. Jankovic ◽  
M. Vidiscak ◽  
S. Durdik
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Negative Impact ◽  
European Organization ◽  
Term Survival ◽  
Physical Relationship ◽  
End Of Treatment ◽  
Eortc Qlq

Introduction:Quality of life in cancer patients and probably also long term survival is negatively affected with fear of the recurrence of cancer and consequences of aggressive therapy. This is the reason for anxiety, depressions, and frustration which are accompanied by cognitive, emotional and behavioral disorders in their physical, relationship, sexual and social func- tioning. The aim of our study is to analyze the dynamics of evolution of the psychosocial loads and qualitative changes its symptomatology in cancer patients who survival 1-4 years after surgery. Material and methods:For assessment of psychosocial mor- bidity ́s in measure in surgery patients standardized question- naires of European Organization for Research and Treatment of Cancer- questionnaire EORTC QLQ-C30.3 (Quality of Life- C.30.3) and its module EORTC QLQ- BR23 were used. Results:The degree of psychosocial mortality in survival pa- tients one year after MRM in our group clearly demonstrated that these patients suffered because of consequences of psy- chosocial loads. It results from fear of recurrence of cancer and next functional, emotional, cognitive and social disorders with- out regard for surgery range. The degree of psychosocial loads in patients after MRM is still more than 4 years after end of treatment. Results show, that after the end of treatment there are many changes in their lives - anxiety and depressions can lead to psychical lability because of higher doubts, nervous- ness, irritability, helplessness and loneliness in their sufferers. Conclusion:Out-patient psychosocial interventions and pre- ventions because of negative impact of ongoing and changing psychosocial loads becomes necessary. It means that there is negative impact on quality of life; of long term cancer remis- sion and survival of patients after surgery.

Ageing, multimorbidity, and daily functioning

2017 ◽  
pp. 111-116
Author(s):  
Barbara Gryglewska ◽  
Karolina Piotrowicz ◽  
Tomasz Grodzicki
Keyword(s):  
Risk Factor ◽  
Chronic Disease ◽  
Functional Performance ◽  
Negative Impact ◽  
High Prevalence ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
Clinical Measures

Multimorbidity is defined as any combination of a chronic disease with at least one other acute or chronic disease or biopsychosocial or somatic risk factor. Old age is a leading risk factor for multimorbidity. It has a negative impact on short- and long-term prognosis, patients’ cognitive and functional performance, self-care, independence, and quality of life. It substantially influences patients’ clinical management and increases healthcare-related costs. There is a great variety of clinical measures to assess multimorbidity; some are presented in this chapter. Despite its high prevalence in older adults, clinical guidelines for physicians managing patients with multimorbidity are underdeveloped and insufficient.

scholarly journals DNA Methylation as a Future Therapeutic and Diagnostic Target in Rheumatoid Arthritis

Cells ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. 953 ◽  
Author(s):  
Marzena Ciechomska ◽  
Leszek Roszkowski ◽  
Wlodzimierz Maslinski
Keyword(s):  
Rheumatoid Arthritis ◽  
Dna Methylation ◽  
Joint Destruction ◽  
Synovial Fibroblasts ◽  
Genetic Mutation ◽  
Unknown Etiology ◽  
Non Invasive ◽  
Fibroblast Like Synoviocytes

Rheumatoid arthritis (RA) is a long-term autoimmune disease of unknown etiology that leads to progressive joint destruction and ultimately to disability. RA affects as much as 1% of the population worldwide. To date, RA is not a curable disease, and the mechanisms responsible for RA development have not yet been well understood. The development of more effective treatments and improvements in the early diagnosis of RA is direly needed to increase patients’ functional capacity and their quality of life. As opposed to genetic mutation, epigenetic changes, such as DNA methylation, are reversible, making them good therapeutic candidates, modulating the immune response or aggressive synovial fibroblasts (FLS—fibroblast-like synoviocytes) activity when it is necessary. It has been suggested that DNA methylation might contribute to RA development, however, with insufficient and conflicting results. Besides, recent studies have shown that circulating cell-free methylated DNA (ccfDNA) in blood offers a very convenient, non-invasive, and repeatable “liquid biopsy”, thus providing a reliable template for assessing molecular markers of various diseases, including RA. Thus, epigenetic therapies controlling autoimmunity and systemic inflammation may find wider implications for the diagnosis and management of RA. In this review, we highlight current challenges associated with the treatment of RA and other autoimmune diseases and discuss how targeting DNA methylation may improve diagnostic, prognostic, and therapeutic approaches.

scholarly journals Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Marco Daperno ◽  
Alessandro Armuzzi ◽  
Silvio Danese ◽  
Walter Fries ◽  
Giuseppina Liguori ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Unmet Needs ◽  
Clinical Symptoms ◽  
Negative Impact ◽  
Delphi Process ◽  
Delphi Consensus ◽  
Medical Needs

Background. The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient’s quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods. With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results. Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions. The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician’s perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.

scholarly journals O26 Non-serious infections in patients with RA: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Katie Bechman ◽  
Kapil Halai ◽  
Sam Norton ◽  
Andrew P Cope ◽  
Kimme L Hyrich ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
British Society ◽  
Tnf Inhibitor ◽  
Drug Survival ◽  
Increased Risk ◽  
Serious Infections ◽  
The Impact ◽  
Biologics Register

Abstract Background Patients with rheumatoid arthritis (RA) are at an increased risk of infection. Most attention has been given to serious infections, but these are the tip of the iceberg. Non-serious infections (NSI) are far more frequent, and although not life-threatening, have potential to impact treatment outcomes (drug survival) and quality of life. Our objective was to describe frequency of NSI and compare incidence of NSI by biologic drug within the British Society for Rheumatology Biologics Register (BSRBR-RA). Methods The BSRBR-RA is a prospective observational cohort study. NSI was identified as not requiring hospitalisation, intravenous therapy or leading to disability or death. Infections were captured from clinician questionnaires and patient diaries. Individuals were considered ‘at risk’ from the date of commencing biologic treatment for 3 years. Drug exposure was defined by agent; TNF inhibitor, IL-6 inhibitor, anti-CD20 or csDMARD only. To account for a high frequency of events, a multiple-failure Cox model was used. Multivariable adjustment included age, gender, DAS28-ESR, HAQ-DI, disease duration, smoking, steroid usage, year recruited to BSRBR-RA, line of biologic therapy and cumulative infection number. Results There were 17,304 NSI in 10,099 patients, with an event rate of 27.0 per year (95% CI 26.6 to 27.4). Increasing age, female gender, comorbidity burden, corticosteroid therapy, DAS28 and HAQ-DI were associated with an increased risk of NSI. The rate of NSI was numerically lowest with csDMARDs. Compared to TNFi, IL-6 inhibitor had a higher risk of NSI, whilst the csDMARD cohort had a lower risk. Between the TNFi agents, adalimumab had a higher risk than etanercept (Table 1). Conclusion These results confirm that NSI is a frequent occurrence for patients, which historically has received little attention in research literature. The data suggest biologics increase the risk of NSI, especially IL-6 inhibition. Whilst unmeasured confounding must be considered, the magnitude of effects are large and it seems likely that a causal link between targeted immunosuppression and NSI risk exists. Further research is needed to understand the impact of NSI on clinical outcomes including drug survival and quality of life. Disclosures K. Bechman: None. K. Halai: None. S. Norton: None. A.P. Cope: None. K.L. Hyrich: Honoraria; AbbVie paid to the institution and grant income from Pfizer and Bristol-Myers Squibb for activities outside of this work. J.B. Galloway: Honoraria; for speaking or attending conferences from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Pfizer and Union Chimique Belge.

scholarly journals Scarring, Disfigurement, and Quality of Life in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2012 ◽  
Vol 30 (20) ◽  
pp. 2466-2474 ◽  
Author(s):  
Karen E. Kinahan ◽  
Lisa K. Sharp ◽  
Kristy Seidel ◽  
Wendy Leisenring ◽  
Aarati Didwania ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Childhood Cancer ◽  
Emotional Distress ◽  
Hair Loss ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer ◽  
Head Neck

Purpose Childhood cancer survivors are at increased risk for adverse outcomes and chronic medical conditions. Treatment-related scarring, disfigurement, and persistent hair loss, in addition to their long-term impact on psychological distress or health-related quality of life (HRQOL), have received little attention. Patients and Methods Self-reported scarring/disfigurement and persistent hair loss were examined in 14,358 survivors and 4,023 siblings from the Childhood Cancer Survivor Study. Multivariable models were used to examine associations with demographic and cancer treatment. The impact of disfigurement and hair loss on HRQOL (ie, Medical Outcomes Short Form–36) and emotional distress (ie, Brief Symptom Inventory–18) was examined. Results Survivors reported a significantly higher rate of scarring/disfigurement compared with siblings for head/neck (25.1% v 8.4%), arms/legs (18.2% v 10.2%), and chest/abdomen (38.1% v 9.1%), as well as hair loss (14.0% v 6.3%). In age-, sex-, and race-adjusted models, cranial radiation exposure ≥ 36 Gy increased risk for head/neck disfigurement (relative risk [RR], 2.42; 95% CI, 2.22 to 2.65) and hair loss (RR, 4.24; 95% CI, 3.63 to 4.95). Adjusting for cranial radiation, age, sex, race, education, and marital status, survivor hair loss increased risk of anxiety (RR, 1.60; 95% CI, 1.23 to 2.07), whereas head/neck disfigurement increased risk of depression (RR, 1.19; 95% CI, 1.01 to 1.41). Limitations due to emotional symptoms were associated with head/neck disfigurement (RR, 1.24; 95% CI, 1.10 to 1.41), arm/leg disfigurement (RR, 1.19; 95% CI, 1.05 to 1.35), and hair loss (RR, 1.26; 95% CI, 1.09 to 1.47). Conclusion Survivors of childhood cancer are at increased risk for disfigurement and persistent hair loss, which is associated with future emotional distress and reduced quality of life. Future studies are needed to better identify and manage functional outcomes in these patients.

Long-term quality of VKA treatment and clinical outcome after extreme overanticoagulation in 14,777 AF and VTE patients

2015 ◽  
Vol 113 (04) ◽  
pp. 881-890 ◽  
Author(s):  
Nic J. G. M. Veeger ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Hilde A. M. Kooistra ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Clinical Outcome ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
P Value ◽  
Risk Of Bleeding ◽  
Increased Risk

SummaryVitamin K antagonists (VKA) are widely used in atrial fibrillation and venous thromboembolism (VTE). Their efficacy and safety depend on individual time in the therapeutic range (iTTR). Due to the variable dose-response relationship within patients, also patients with initially stable VKA treatment may develop extreme overanticoagulation (EO). EO is associated with an immediate bleeding risk, but it is unknown whether VKA treatment will subsequently restabilise. We evaluated long-term quality of VKA treatment and clinical outcome after EO. EO was defined as international normalized ratio (INR) ≥ 8.0 and/or unscheduled vitamin K supplementation. We included a consecutive cohort of initially stable atrial fibrillation and venous thromboembolism patients. In EO patients, the 90 days pre- and post-period were compared. In addition, patients with EO were compared with patients without EO using a matched 1:2 cohort. Of 14,777 initially stable patients, 800 patients developed EO. The pre-period was characterised by frequent overanticoagulation, and half of EO patients had an inadequate iTTR (< 65 %). After EO, underanticoagulation became more prevalent. Although the mean time between INR-measurements decreased from 18.6 to 13.2 days, after EO inadequate iTTR became more frequent (62 %), p-value < 0.001. A 2.3 times (95 % confidence interval [CI] 2.0–2.5) higher risk for iTTR< 65 % after EO, was accompanied by increased risk of bleeding (hazard ratio [HR] 2.1;CI 1.4–3.2), VKA-related death 17.0 (HR 17.0;CI 2.1–138) and thrombosis (HR 5.7;CI 1.5–22.2), compared to the 1600 controls. In conclusion, patients continuing VKA after EO have long-lasting inferior quality of VKA treatment despite intensified INR-monitoring, and an increased risk of bleeding, thrombosis and VKA-related death.Note: There have been no previous presentations, reports or publications of the complete data that appear in the article. Parts of the data in this article have been presented as a poster at the American Society of Hematology (ASH) congress 2013, New Orleans, United States.

Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

2014 ◽  
Vol 83 (12) ◽  
pp. 2177-2180 ◽  
Author(s):  
H.C. van der Jagt-Willems ◽  
B.C. van Munster ◽  
M. Leeflang ◽  
E. Beuerle ◽  
C.R. Tulner ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Fractures ◽  
Vertebral Fracture Assessment ◽  
Intraobserver Agreement ◽  
X Ray ◽  
Chest X Ray ◽  
Fracture Assessment ◽  
Lateral Chest
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