scholarly journals Diagnosis and Treatment of AA Amyloidosis with Rheumatoid Arthritis: State of the Art

10.5772/24830 ◽  
2011 ◽  
Author(s):  
Takeshi Kuroda ◽  
Yoko Wada ◽  
Masaaki Nakano
Keyword(s):  
Rheumatoid Arthritis ◽  
State Of The Art ◽  
Diagnosis And Treatment ◽  
Aa Amyloidosis

CLINICAL AND FORENSIC ASPECTS OF PHARMACOBEZOARS

2020 ◽  
Vol 12 ◽  
Author(s):  
Francisco Basílio ◽  
Ricardo Jorge Dinis-Oliveira
Keyword(s):  
State Of The Art ◽  
Signs And Symptoms ◽  
Immediate Release ◽  
Diagnosis And Treatment ◽  
Blood Concentrations ◽  
Forensic Practice ◽  
Wide Range ◽  
Therapeutic Doses ◽  
Complete History ◽  
Lethal Blood

Background: Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations. Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment and other relevant clinical and forensic features of pharmacobezoars. Results: patients of a wide range of ages and in both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but is likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy and surgery through laparotomy of the lower tract are useful for diagnosis and treatment. Conclusion: Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.

scholarly journals AB0221 CURRENT IMPLEMENTATION OF TREAT-TO-TARGET APPROACH IN RHEUMATOID ARTHRITIS TREATMENT: THE PERSPECTIVE OF CHINESE RHEUMATOLOGISTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1136.2-1137
Author(s):  
J. L. Zhao ◽  
X. Liu ◽  
L. Zhan ◽  
H. Tang ◽  
J. Li ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Duration ◽  
Goal Achievement ◽  
Diagnosis And Treatment ◽  
Treat To Target ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Current Implementation ◽  
Advanced Therapy

Background:Treat-to-target (T2T) approach is recommended as a standard management strategy in rheumatoid arthritis (RA) treatment by Chinese guideline for diagnosis and treatment of RA[1]. However, there is little known about its current implementation in China.Objectives:This study aimed to evaluate the implementation and achievement of T2T approach and explore their associated factors in Chinese RA cohort.Methods:A comprehensive cross-sectional survey of rheumatologists and their RA patients was conducted in China. Data were collected during May-Aug 2019 via physician-completed patient record forms. 60 rheumatologists provided data on demographic, clinical characteristics, treatments, and T2T approach implementation for 600 RA patients. Two logistic regressions were used to evaluate factors associated with T2T approach implementation and T2T goal achievement, respectively. Patients with missing data were not included in the models.Results:600 patients were included in this study (48.8±11.7 years, 70.3% female). 39.0% (N=234) of 600 patients were being treated with T2T approach, and 64.9% (N=366) of 564 patients had achieved T2T goal. Patients with longer disease duration (>2 years diagnosis) (odds ratio (OR) [95%CI]=1.61 [1.05, 2.49], vs. diagnosis ≤2 years), higher pain score (OR [95%CI]=1.26 [1.04, 1.51]), or receiving advanced therapy (OR [95%CI]=6.91 [3.64, 13.13]) were more likely to use T2T. Patients with BMI >23.9kg/m2 (OR [95%CI]=2.83 [1.59, 5.04], vs. BMI≤23.9kg/m2), or who worked full-time (OR [95%CI]=2.12 [1.26, 3.57]) were more likely to achieve T2T goal, while patients with more pain (OR [95%CI]=0.77 [0.64, 0.92]) were less likely to achieve T2T goal.Conclusion:Low implementation of T2T approach is observed in Chinese RA treatment. Longer disease duration, more pain, and receiving advanced therapy are associated with higher probability of T2T use, while higher BMI, full-time work and less pain are associated with higher probability of T2T goal achievement. Standard diagnosis and treatment according to guidelines may improve T2T approach implementation.References:[1]Association, C.R., 2018 Chinese guideline for the diagnosis and treatment of rheumatoid arthritis. Zhonghua nei ke za zhi, 2018. 57(4): p. 242.Disclosure of Interests:Jiu-liang Zhao: None declared, Xin Liu Employee of: Eli Lilly and Company, Lujing Zhan Employee of: Eli Lilly and Company, Hongyu Tang Employee of: Eli Lilly and Company (Intern), Jinnan Li Employee of: Eli Lilly and Company, Mengru Liu Employee of: Eli Lilly and Company, Elizabeth Holdsworth Consultant of: Eli Lilly and Company, Employee of: Adelphi Real World, Yan Zhao: None declared

DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS

1993 ◽  
Vol 20 (4) ◽  
pp. 827-837
Author(s):  
Terence W. Starz ◽  
Edward B. Miller
Keyword(s):  
Rheumatoid Arthritis ◽  
Diagnosis And Treatment

scholarly journals Rituximab Therapy in Renal Amyloidosis Secondary to Rheumatoid Arthritis

Biomolecules ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 136 ◽  
Author(s):  
Levent Kilic ◽  
Abdulsamet Erden ◽  
Yusuf Sener ◽  
Berkan Armagan ◽  
Alper Sari ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Improvement ◽  
Inflammatory Diseases ◽  
Case Series ◽  
New Drugs ◽  
Renal Amyloidosis ◽  
Secondary Amyloidosis ◽  
Aa Amyloidosis ◽  
Amyloid A ◽  
Significant Clinical Improvement

Secondary amyloid A (AA) amyloidosis is a late and serious complication of poorly controlled, chronic inflammatory diseases. Rheumatoid arthritis (RA) patients with poorly controlled, longstanding disease and those with extra-articular manifestations are under risk for the development of AA amyloidosis. Although new drugs have proven to be significantly effective in the treatment of secondary AA amyloidosis, no treatment modality has proven to be ideal. To date, only in small case series preliminary clinical improvement have been shown with rituximab therapy for AA amyloidosis secondary to RA that is refractory to TNF-α inhibitors (TNF-i) therapy. In these case series, we assessed the efficacy and safety of rituximab therapy for patients with RA and secondary amyloidosis. Hacettepe University Biologic Registry was developed at 2005. The data of the RA patients who were prescribed a biological drug were recorded regularly. Patients with biopsy proven AA amyloidosis patients were screened. Of 1022 RA patients under biologic therapy, 0.7% patients had clinically apparent histologically confirmed amyloidosis. Four of seven patients who were prescribed rituximab at least one infusion enrolled to those case series. Two of four patients showed significant clinical improvement and one of them also had decrease in proteinuria and the other one had stable renal function and proteinuria. The main goal for the treatment of AA amyloidosis is to control the activity of the underlying disorder. In this study, we showed that rituximab may be an effective treatment in RA patients with amyloidosis who were unresponsive to conventional disease modifying anti-rheumatic drugs (DMARDs) and/or TNFi.

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