Rheumatology care of migrants from sub-Saharan Africa: a literature review and qualitative pilot study of patients’ perspectives

Clinical Rheumatology - Rheumatologists practising in the UK National Health Service (NHS) are likely to treat migrant patients from sub-Saharan Africa. This study aimed to conduct a literature...     

Infliximab in patients with primary Sjögren's syndrome: a pilot study

OBJECTIVE: Tumor necrosis factor alpha (TNFalpha) is a proinflammatory cytokine involved in the pathogenesis of Sj?gren's syndrome (SS), and blockade of TNFalpha may reduce the activity of the disease. The purpose of this study was to evaluate the safety and potential efficacy of infliximab, a chimeric human-mouse anti-TNFalpha monoclonal antibody, in patients with active primary SS. METHODS: This was a single-center, open-label pilot study. Sixteen patients with active primary SS received 3 infusions of infliximab (3 mg/kg) at 0, 2, and 6 weeks. Standard clinical assessment, complete ophthalmologic testing, and functional evaluation of salivary flow were performed at baseline and at weeks 2, 6, 10, and 14. RESULTS: All patients completed the study. There was statistically significant improvement in all clinical and functional parameters, including global assessments (patient's global assessment, patient's assessment of pain and fatigue, physician's global assessment), erythrocyte sedimentation rate, salivary flow rate, the Schirmer I test, tender joint count, fatigue score, and dry eyes and dry mouth. This clinical benefit was observed at week 2 and was maintained throughout the study and the 2-month followup period. The treatment was well tolerated in all patients, and no significant adverse events were seen. No lupus-like syndrome was observed, and no anti-double-stranded DNA antibodies were observed that were attributable to infliximab therapy. CONCLUSION: In patients with active primary SS, a loading-dose regimen of 3 infusions of infliximab provided a fast and significant clinical benefit without major adverse reactions. It was possible to maintain statistically significant improvement for up to 8 weeks after the third infusion.     

Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study

OBJECTIVE: To investigate the association of arthritis with health status indicators among elders living in Bambuí, Brazil. METHODS: A cross-sectional study was conducted among 1606 elders using baseline data from the Bambuí Health and Aging Study, a population based cohort study of older adults. Arthritis was self-reported and defined as a physician diagnosis of arthritis or rheumatism, and/or chronic hand and knee symptoms. Health status indicators, defined a priori as the main independent variables, were self-rated health, psychological distress (based on the General Health Questionnaire), report of sleep complaints, disability in activities of daily living (ADL), "2-week" disability, mobility disability, and 2 composite indexes of mental health problems and physical disability problems. Logistic regression compared health status indicators among elders reporting arthritis (N = 833) and non-arthritis subjects. RESULTS: After controlling for sociodemographics and chronic conditions, all measures were found to be associated with arthritis: sleep complaints (OR 1.81, 95% CI 1.43-1.92), fair (OR 2.17, 95% CI 1.62-2.90) and poor self-rated health (OR 3.48, 95% CI 2.46-4.94), ADL disability (OR 1.73, 95% CI 1.02-2.87), mobility disability (OR 2.65, 95% CI 2.06-3.41), 2-week disability (OR 1.86, 95% CI 1.35-2.57), 2 mental health problems (OR 2.25, 95% CI 1.67-3.04), and one (OR 2.46, 95% CI 1.91-3.16) and 2 physical disability problems (OR 4.19, 95% CI 2.02-8.59). CONCLUSION: Considering the paucity of similar studies addressing the impact of arthritis in developing nations, these findings may be applied to similar communities and support better planning of resource allocations to minimize the effects of arthritis among the elderly.     

Do asthma patients in general practice profit from a structured allergy evaluation and skin testing? A pilot study

BACKGROUND: Although allergy is central to the pathophysiology of asthma, little is known about the benefits of a structured approach to allergen diagnosis and management in primary care asthma patients. OBJECTIVES: We studied effects of a structured allergen evaluation and allergen avoidance advice combined with or without additional allergy skin testing on health status, illness perception, and lung function of asthma patients treated in general practice. METHOD: Fifty-four asthma patients were randomly assigned to three groups: (i) Standard asthma care with information on the stepwise treatment approach, a written action plan, and inhaler technique training; (ii) Additional structured allergen evaluation and avoidance advice; (iii) Additional structured allergen evaluation and avoidance advice based on skin prick test results. Patients were seen for one initial appointment at a primary care asthma clinic and a follow-up examination 3 months later. On both occasions, questionnaire measures of symptoms, illness perception, and the perceived control of asthma were administered. Lung function was measured by spirometry (PEF, FEV1). Perceived allergic asthma triggers, the trigger impact, and the trigger control were assessed in both intervention groups. Results: Following intervention, a decrease in beta-adrenergic inhaler use, an increase in the perceived control of asthma, and a decrease in the bothering from asthma symptoms were observed for all three groups. Intervention groups showed a higher awareness of animal-allergic triggers, and the perceived control of asthma triggers was increased in the group receiving no skin tests. FEV1 showed an improvement in both intervention groups. CONCLUSION: Structured allergy evaluation and avoidance advice can improve lung function and the control of asthma in primary care. Further research is needed on the additional benefits of allergy skin testing.     

Alterations in the mucosa-associated bacterial composition in Crohn’s disease: a pilot study

Introduction

Changes in the intestinal bacterial composition seem to play a major role in the pathogenesis and in the clinical course of inflammatory bowel diseases (IBD), which consist of Crohn’s disease (CD), and ulcerative colitis (UC). Mutations in the NOD2 gene are the most important genetic risk factors for the development of CD. In this study, the association between mucosal biopsies and the mucosa-associated bacterial composition from CD and UC patients regarding their genetic risk factors (mutations in the NOD2 gene), their endoscopic activity, and their medical therapy (TNF-α blocking therapy) was examined.

Material and methods

Seventy biopsies from routine colonoscopies from 33 IBD patients (26 CD and 7 UC) were obtained. Disease activity and clinical characteristics were assessed. Seven different bacterial strains (Bacteroides fragilis, Escherichia coli, Prevotella melaninogenica, Clostridium coccoides, Clostridium difficile, Bifidobacterium bifidum, and Faecalibacterium prausnitzii) were quantified using real-time PCR. NOD2 genotyping from patients with CD was performed.

Results

Five of the 24 patients were positive for at least one mutation in the NOD2 gene. The bacterial composition was different in CD compared to UC, in macroscopic healthy compared to macroscopic inflamed biopsies, in NOD2 mutated compared to NOD2 wildtype patients, and in patients receiving TNF-α blocking therapy compared to patients without this treatment.

Conclusion

This study further characterizes the mucosa-associated bacteria in IBD patients. Different clinical situations lead to an altered mucosa-associated bacterial composition. The analyzed bacteria could be promising targets for cost-effective surveillance or therapies in IBD patients.

     

The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators

Background

Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status).

Methods

A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland.

Results

Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald’s χ²?=?24.767, p?<?0.001 for ATH Global), as well as gender and SAH (Wald’s χ²?=?16.712, p?<?0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50–74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M?=?5.40, SD?=?0.07 and M?=?5.21, SD?=?0.07, for women and men, respectively, p?=?0.046), positive emotion (M?=?5.55, SD?=?0.06 and M?=?5.33, SD =0.06, for women and men, respectively, p?=?0.015) and motivation to be involved in their health issues (M?=?5.71, SD?=?0.07 and M?=?5.39, SD?=?0.07, for women and men, respectively, p?=?0.001). The level of negative emotions related to health was not significantly different between genders (p?=?0.971).

Conclusions

The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50–74).

     

Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa

Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers’ mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents’ HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents’ risk behavior and HIV incidence.     

Adjuvant interferon gamma in patients with drug – resistant pulmonary tuberculosis: a pilot study

Background  

Tuberculosis (TB) is increasing in the world and drug-resistant (DR) disease beckons new treatments.     

Etanercept in the treatment of patients with primary Sjögren's syndrome: a pilot study

OBJECTIVE: This pilot study evaluated the effect of anti-tumor necrosis factor-a antiinflammatory treatment with etanercept (Enbrel(R)) on sicca, systemic, and histological signs in patients with primary Sj?gren's syndrome (SS). METHODS: Fifteen patients with well defined primary SS were treated with 25 mg etanercept subcutaneously twice per week during 12 weeks, with followup visits at Weeks 18 and 24. Evaluation measures included a Multidimensional Fatigue Inventory (MFI) questionnaire, serological monitoring, salivary flow tests, Schirmer test, rose bengal cornea staining, and tear film breakup time. A sublabial minor salivary gland biopsy was performed at baseline and at Week 12 and lymphocytic focus score and percentage IgA-containing plasma cells (IgA%) were assessed. RESULTS: No increase of salivary or lachrymal gland function was observed in any participant. In 4 patients a decrease of fatigue complaints was noted, which was also reflected by decreased scores in the MFI questionnaire. Reduced erythrocyte sedimentation rate was observed in 3 of 4 patients with reduced fatigue. No significant change of lymphocyte focus score or IgA% was observed. A repeated treatment up to 26 weeks showed the same results. CONCLUSION: A 12-week or prolonged treatment of etanercept 25 mg twice weekly did not appear to reduce sicca symptoms and signs in SS. However, etanercept treatment may be beneficial in a small subgroup of SS patients with severe fatigue. Etanercept 25 mg twice weekly did not affect minor salivary gland biopsy results.     

Synovial nitric oxide concentrations are increased and correlated with serum levels in patients with active Behçet’s disease: a pilot study

Behçets disease (BD) is a relapsing immunoinflammatory vasculitis of unknown etiology characterized by endothelial dysfunction. Articular symptoms and signs are present in about 75% of cases and characterized by seronegative arthritis and nonspecific synovitis. We demonstrated that both serum and erythrocyte nitric oxide (NO^·) levels, the most abundant free radical in the body, were elevated in BD and associated with disease activity. This study further investigated NO^· levels in the synovial fluid and serum from patients with active and inactive BD. A total of 23 BD patients with articular involvement (14 men and 9 women) satisfying International Study Group criteria and 15 age- and sex-matched healthy control subjects (9 men and 6 women) undergoing elective arthroscopy were included in this case-control investigation. The synovial fluid and serum were obtained from BD patients and controls. Clinical and laboratory findings including neutrophil count and erythrocyte sedimentation rate (ESR) were used to classify BD patients as active (n=11) or inactive (n=12). Synovial as well as serum NO^· levels were compared between the groups and correlation analysis was performed. Acute phase reactant levels were significantly higher (for each, p<0.01) in BD patients than control subjects in the active period. The mean synovial NO^· level in active Behçets patients (mean±SD 76.61±11.95 mol/l) was significantly higher than in inactive patients (46.16±8.89 mol/l, p<0.001) and healthy control subjects (39.60±8.03 mol/l, p<0.001). The difference between inactive patients and controls was not significant (p>0.05). Active BD patients had significantly higher serum NO^· levels (38.84±9.15 mol/l) than inactive patients (30.91±5.88 mol/l, p=0.018) and control subjects (28.86±5.91 mol/l, p=0.002). In addition, synovial NO^· levels were positively correlated with serum levels (r²=0.621, p<0.001). Increased synovial NO^· levels in active BD patients probably reflect a nonspecific inflammatory process of the synovium and, therefore, arthralgia and arthritis as a common finding of BD.     

Current status of the rheumatologists’ workforce in Latin America: a PANLAR collaborative study

Clinical Rheumatology - Studies conducted by various scientific societies have shown that the demand for specialized rheumatology care is greater than the projected growth of the workforce. Our...     

Possible predictors for relapse from etanercept discontinuation in ankylosing spondylitis patients in remission: a three years’ following-up study

The aim of this study is to assess the recurrence probability and the possible predictors in patients with ankylosing spondylitis from etanercept discontinuation in a 3-year observational cohort (ClinicalTrials.gov: NCT02915354). A cohort of 35 patients who achieved an ASAS 20 response at the end of a randomized controlled trial underwent a 3-year follow-up evaluation. The primary end point was clinical relapse defined as the BASDAI score going back to 80% of its initial level at the beginning of the trial. Prognostic factors of relapse were analyzed using the Cox regression. Median duration of clinical remission was 15.0 months (interquartile range, 3.7–26.3 months). The cumulative probabilities of relapse at 1, 2, and 3 years were 45.7, 57.1, and 60.0%, respectively. The proportion of recurrence was not significantly different between placebo group and etanercept group by Kaplan-Meier analysis (placebo vs. etanercept: 61.11 vs. 58.82%, P = 0.890). Two independent factors associated with increasing risk of relapse were (1) age of patients (25 years or older with risk of 3.07, 95% confidence interval, 1.19–7.97, P = 0.021); (2) onset age (younger than 24 years with risk of 3.12, 95% confidence interval, 1.24–7.83, P = 0.016). No correlation was observed in the present study between the time of relapse and the duration of the treatment with etanercept in AS patients who achieved the ASAS 20 response after receiving the treatment. The older age and younger onset age of patients seems to be important factors associate with an increasing risk of relapse.     

The clinical pattern differentiates ANCA-positive infective endocarditis patients from ANCA-associated vasculitis patients: a 23 years’ retrospective cohort study in China and follow-ups

Clinical Rheumatology - Patients with infective endocarditis (IE) may present rheumatic manifestations concurrent with various autoantibodies and thus mimic antineutrophil cytoplasmic antibody...     

Long-term safety and efficacy of subcutaneous pasireotide in patients with Cushing’s disease: interim results from a long-term real-world evidence study

Pituitary - Clinical trials have demonstrated the favorable efficacy/safety profile of pasireotide in patients with Cushing’s disease (CD). We report interim long-term results of an ongoing...     

Is there a relationship between 24-hour urinary sodium and potassium and mental health in migraine patients?: A cross-sectional study

There is a lack of evidence and consensus in terms of the association between dietary intake of sodium (Na) and potassium (K) with mental health. By using 24-hours urinary samples as the gold standard method, we conducted a study to explore the association between dietary intake of Na and K with parameters of mental health including depression, anxiety, and stress among an Iranian population diagnosed with migraine. In the present study, 262 subjects (20–50 years old), with a confirmed diagnosis of migraine were enrolled. Mental health was investigated by the Depression, Anxiety, and Stress Scales (DASS-21) questionnaire. Dietary intake of Na and K was estimated by means of a 24-hour urine sample. Multinomial logistic regression analysis was implemented and odds ratio (OR) with 95% confidence interval (CI) was stated. After controlling for potential confounders, the 24-hour urinary Na was associated significantly with the risk of depression (OR = 0.55, 95% CI: 0.30, 1.00; P = .053). After adjustment for confounders, those in the highest tertile of the 24-hour urinary Na/K ratio had lower odds for having depression (OR = 0.54, 95% CI: 0.31, 0.93; P = .027), and marginally significantly lower risk of anxiety (OR = 0.58, 95% CI: 0.31, 1.06; P = .079) and stress (OR = 0.56, 95% CI: 0.31, 1.02; P = .061). In conclusion, higher 24-hour urine Na was associated with a significantly lower risk of depression. Moreover, the 24-hour Na/K ratio was significantly associated with lower risk of depression, anxiety, and stress.