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91.
Wakefield RJ D'Agostino MA Naredo E Buch MH Iagnocco A Terslev L Ostergaard M Backhaus M Grassi W Dougados M Burmester GR Saleem B de Miguel E Estrach C Ikeda K Gutierrez M Thompson R Balint P Emery P 《Annals of the rheumatic diseases》2012,71(6):799-803
For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network--the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA. 相似文献
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Gossec L Smolen JS Gaujoux-Viala C Ash Z Marzo-Ortega H van der Heijde D FitzGerald O Aletaha D Balint P Boumpas D Braun J Breedveld FC Burmester G Cañete JD de Wit M Dagfinrud H de Vlam K Dougados M Helliwell P Kavanaugh A Kvien TK Landewé R Luger T Maccarone M McGonagle D McHugh N McInnes IB Ritchlin C Sieper J Tak PP Valesini G Vencovsky J Winthrop KL Zink A Emery P;European League Against Rheumatism 《Annals of the rheumatic diseases》2012,71(1):4-12
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Spencer FA Kroll A Lessard D Emery C Glushchenko AV Pacifico L Reed G Gore JM Goldberg RJ 《Journal of thrombosis and thrombolysis》2012,33(3):211-217
The prevalence of isolated calf deep vein thrombosis (DVT) in the community setting is relatively unexplored. Confusion remains
with regards to its management and contemporary natural history. The purpose of this investigation was to describe the number
of cases of calf DVT in the community, use of early management strategies, and rates of venous thromboembolism (VTE) recurrence
and major bleeding. The medical records of residents of the Worcester (MA) metropolitan area with ICD-9 codes consistent with
potential VTE during 4 study years (1999/2001/2003/2005) were validated by trained nurses. Patient demographic/clinical characteristics,
treatment practices, and outcomes were evaluated. Isolated calf DVT was diagnosed in 166 (11.1%) of 1,495 patients with lower
extremity DVT. Patients with calf DVT were less likely to be discharged on anticoagulants or with an IVC filter than patients
with proximal DVT (84.1 vs. 92.3%). The rates of VTE recurrence and pulmonary embolism did not differ significantly between
patients with calf DVT and proximal DVT at 6 months (11.0 vs. 8.7%, 2.6 vs. 1.8%, respectively). Patients with calf DVT had
higher adjusted risk of early (14-day) VTE recurrence/extension (OR 2.34, 95% CI 1.01–5.44). Patients with calf DVT had lower
rates of major bleeding at 6 months compared to patients with proximal DVT (5.2 vs. 9.3%, P = 0.04). Rates of recurrent VTE and major bleeding following calf DVT in the community are much higher than in randomized
clinical trials of patients with proximal or calf DVT. Further study of management strategies for isolated calf DVT is needed. 相似文献
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Strand V Burmester GR Ogale S Devenport J John A Emery P 《Rheumatology (Oxford, England)》2012,51(10):1860-1869
Objective. To investigate the effect of tocilizumab on patient-reported outcomes (PROs) in RA patients with inadequate responses to TNF inhibitors (TNFis). Methods. In a Phase III randomized controlled trial, 489 patients received 4 or 8 mg/kg tocilizumab or placebo every 4 weeks plus MTX for 24 weeks. Mean changes from baseline over time and proportions of patients reporting improvements greater than or equal to minimum clinically important differences (MCIDs) in PROs were analyzed. Results. At week 24, 8?mg/kg resulted in significantly greater improvements vs placebo in pain, global assessment of disease activity (P?=?0.001), Health Assessment Questionnaire-Disability Index (HAQ-DI; P?0.0001), Functional Assessment of Chronic Illness Therapy-Fatigue (P?=?0.0150) and Medical Outcomes Survey Short Form 36 (SF-36 v2) Physical Component Summary (PCS; P?=?0.0003) scores, all greater than MCID; 4?mg/kg resulted in greater improvements in pain (P?=?0.0100), HAQ-DI (P?=?0.0030) and SF-36 PCS (P?=?0.0020) scores. Tocilizumab-associated improvements were evident as early as week 2. At week 24, more tocilizumab-treated than control patients reported improvements greater than or equal to MCID in SF-36 domain scores and related PROs (50.9-84.9% vs 35.0-51.7%) and achieved ACR50 responses and/or Disease Activity Score 28 (DAS28) remission with PRO improvements greater than or equal to MCID (36.2-51.2% vs 10-20.7% and 10.7-37.5% vs 0.0-3.4%, respectively). Conclusion. Tocilizumab treatment in patients with inadequate responses to TNFis resulted in rapid and sustained improvements in multiple PROs that were statistically significant and clinically meaningful, consistent with previous efficacy reports. Trial Registration. ClinicalTrials.gov, http://clinicaltrials.gov/, NCT00106522. 相似文献
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